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Urodynamic Voiding Parameters: Do Differences Exist between Stress Incontinence and Intrinsic Sphincter Deficiency?
Abstracts / Journal of Minimally Invasive Gynecology 18 (2011) S47–S70 178
Open Communications 8dUrogynecology (12:35 PM d 12:40 PM)
Urodynamic Voiding Parameters: Do Differences Exist between Stress Incontinence and Intrinsic Sphincter Deficiency? Gross CK, Smith AL, Karp DR, Aguilar V, Davila WG. Urogynecology and Reconstructive Pelvic Surgery, Cleveland Clinic Florida, Weston, Florida Study Objective: To determine if patients with intrinsic sphincter deficiency (ISD) have different voiding patterns when compared to those with stress urinary incontinence (SUI). Design: This was a retrospective cohort study. Setting: It was performed between January 2008 and December 2010 at a single institution. Patients: 325 patients were identified with urodynamic stress incontinence, 203 had ISD and 122 SUI. A diagnosis of ISD was made by maximal urethral closure pressure % 20 cm H20 and/or Valsalva leak point pressure of % 60 cm H20. Intervention: Urodynamic testing was performed in a standardized fashion using air charged catheters. Valsalva leak point pressure, maximal urethral closure pressures, and pressure flow study were completed. Measurements and Main Results: Patients with ISD were significantly older than those with SUI (70.5 12 vs. 57.0 12 years, p\0.01). The ISD group had significantly more detrusor instability [70 (35%) vs. 22 (18%), p\ 0.01)]. There were no significant differences between the groups in first sensation, bladder capacity, Valsalva voiding patterns, flow time, and post-void residual. During pressure flow studies, patients with ISD had significantly lower peak and mean flow rates (Table 1). The ISD group had significantly lower detrusor voiding pressures (P det @ qmax) (13.3 11 vs. 18.2 11 cm H20, p \0.01) (Table 1).
S55
taken at the following times: immediately before prep, immediately after pre, ½ hour, 1 hour, and 1 ½ hour into the surgery. The rate and type of bacterial colonization was assessed. Measurements and Main Results: 39 (93%) of the cultures were positive immediately before the prep, and 11 (26%) were positive immediately after the prep. Overall colonization progressed rapidly with 67% positive in 30 minutes, 81% positive in 60 minutes, and 91% positive in 90 minutes into surgery. There was no difference in rate of re-colonization based on patient’s age, BMI, WIC status, presence or absence of uterus, use or not use of mesh. Conclusion: Our study confirms two major points. First, it is hard to eradicate all bacteria from the vaginal milieu despite an extensive vaginal prep. Second, the rate of re-colonization is rapid, with over 90% of patients recolonized 90 minutes into surgery. Given the high rate of bacterial re-colonization and the low rate of mesh extrusion, it is safe to say that infection does not play a role in mesh exposure. Most complications associated with mesh use are therefore iatrogenic in nature.
Table 1 Urodynamic and Voiding Parameters
Overactive detrusor Voided volume (mL) PVR (mL) Qmax (mL/s) Qave (mL/s) p detrusor (Qmax) (cm H20)
ISD n=203
SUI n=122
70 (35)
22 (18)
0.002
312.1 141
348.3 141
0.03
51.9 15.3 6.3 13.3
61 9 3 11
35.9 16.8 7.4 18.2
39 8 4 11
p-value
0.008 0.02 0.01 \0.0001
Expressed as mean sd and n (%) where appropriate. Conclusion: Patients with ISD generate weaker urinary flow rates and detrusor pressures during urodynamic voiding studies. 179
Open Communications 8dUrogynecology (12:41 PM d 12:46 PM)
Recolonization during Reconstructive Vaginal Surgery Hessami SH, Hassan K, Radjabi AR, McKinney T. Department of Obstetrics and Gynecology, Division of Urogynecology and Reconstructive Pelvic Surgery, St. Joseph’s Regional Medical Center, Mount Sinai - School of Medicine, Paterson, New Jersey Study Objective: Vaginal procedures are considered clean-contaminated cases. With the new synthetic mesh technology, more such devices are regularly implanted. As the use of such devices has increased, so have reports on mesh extrusion and erosion, resulting in the new FDA warnings. Infection of the mesh has often been cited as an inciting factor by surgeons. In this study we looked at the rate of vaginal re-colonization after standard Povidone Iodine preparation. Design: A total of 42 consecutive patients underwent vaginal reconstructive surgery for prolapse, lasting longer than one hour. Vaginal cultures were taken from a point about 3 cm from the urethral meatus on the anterior vaginal wall, at the level of urethrovesical junction. Vaginal cultures were
180
Open Communications 8dUrogynecology (12:47 PM d 12:52 PM)
Ultrasonographic Scan Evaluation of Synthetic Mesh Used for Vaginal Cystocele Repair Comparing Four Arms Trans Obturator Techniques to Bilateral Anterior Sacrospinous Ligament and Arcus Tendineus Suspension, at 1 Year Follow-Up Letouzey V, Mousty E, Huberlant S, Pouget O, Mares P, de Tayrac R. Gynecology and Obstetrics, Caremeau University Hospital, Nimes, Gard, France, Metropolitan
Open Communications 8dUrogynecology (12:35 PM d 12:40 PM)
Urodynamic Voiding Parameters: Do Differences Exist between Stress Incontinence and Intrinsic Sphincter Deficiency? Gross CK, Smith AL, Karp DR, Aguilar V, Davila WG. Urogynecology and Reconstructive Pelvic Surgery, Cleveland Clinic Florida, Weston, Florida Study Objective: To determine if patients with intrinsic sphincter deficiency (ISD) have different voiding patterns when compared to those with stress urinary incontinence (SUI). Design: This was a retrospective cohort study. Setting: It was performed between January 2008 and December 2010 at a single institution. Patients: 325 patients were identified with urodynamic stress incontinence, 203 had ISD and 122 SUI. A diagnosis of ISD was made by maximal urethral closure pressure % 20 cm H20 and/or Valsalva leak point pressure of % 60 cm H20. Intervention: Urodynamic testing was performed in a standardized fashion using air charged catheters. Valsalva leak point pressure, maximal urethral closure pressures, and pressure flow study were completed. Measurements and Main Results: Patients with ISD were significantly older than those with SUI (70.5 12 vs. 57.0 12 years, p\0.01). The ISD group had significantly more detrusor instability [70 (35%) vs. 22 (18%), p\ 0.01)]. There were no significant differences between the groups in first sensation, bladder capacity, Valsalva voiding patterns, flow time, and post-void residual. During pressure flow studies, patients with ISD had significantly lower peak and mean flow rates (Table 1). The ISD group had significantly lower detrusor voiding pressures (P det @ qmax) (13.3 11 vs. 18.2 11 cm H20, p \0.01) (Table 1).
S55
taken at the following times: immediately before prep, immediately after pre, ½ hour, 1 hour, and 1 ½ hour into the surgery. The rate and type of bacterial colonization was assessed. Measurements and Main Results: 39 (93%) of the cultures were positive immediately before the prep, and 11 (26%) were positive immediately after the prep. Overall colonization progressed rapidly with 67% positive in 30 minutes, 81% positive in 60 minutes, and 91% positive in 90 minutes into surgery. There was no difference in rate of re-colonization based on patient’s age, BMI, WIC status, presence or absence of uterus, use or not use of mesh. Conclusion: Our study confirms two major points. First, it is hard to eradicate all bacteria from the vaginal milieu despite an extensive vaginal prep. Second, the rate of re-colonization is rapid, with over 90% of patients recolonized 90 minutes into surgery. Given the high rate of bacterial re-colonization and the low rate of mesh extrusion, it is safe to say that infection does not play a role in mesh exposure. Most complications associated with mesh use are therefore iatrogenic in nature.
Table 1 Urodynamic and Voiding Parameters
Overactive detrusor Voided volume (mL) PVR (mL) Qmax (mL/s) Qave (mL/s) p detrusor (Qmax) (cm H20)
ISD n=203
SUI n=122
70 (35)
22 (18)
0.002
312.1 141
348.3 141
0.03
51.9 15.3 6.3 13.3
61 9 3 11
35.9 16.8 7.4 18.2
39 8 4 11
p-value
0.008 0.02 0.01 \0.0001
Expressed as mean sd and n (%) where appropriate. Conclusion: Patients with ISD generate weaker urinary flow rates and detrusor pressures during urodynamic voiding studies. 179
Open Communications 8dUrogynecology (12:41 PM d 12:46 PM)
Recolonization during Reconstructive Vaginal Surgery Hessami SH, Hassan K, Radjabi AR, McKinney T. Department of Obstetrics and Gynecology, Division of Urogynecology and Reconstructive Pelvic Surgery, St. Joseph’s Regional Medical Center, Mount Sinai - School of Medicine, Paterson, New Jersey Study Objective: Vaginal procedures are considered clean-contaminated cases. With the new synthetic mesh technology, more such devices are regularly implanted. As the use of such devices has increased, so have reports on mesh extrusion and erosion, resulting in the new FDA warnings. Infection of the mesh has often been cited as an inciting factor by surgeons. In this study we looked at the rate of vaginal re-colonization after standard Povidone Iodine preparation. Design: A total of 42 consecutive patients underwent vaginal reconstructive surgery for prolapse, lasting longer than one hour. Vaginal cultures were taken from a point about 3 cm from the urethral meatus on the anterior vaginal wall, at the level of urethrovesical junction. Vaginal cultures were
180
Open Communications 8dUrogynecology (12:47 PM d 12:52 PM)
Ultrasonographic Scan Evaluation of Synthetic Mesh Used for Vaginal Cystocele Repair Comparing Four Arms Trans Obturator Techniques to Bilateral Anterior Sacrospinous Ligament and Arcus Tendineus Suspension, at 1 Year Follow-Up Letouzey V, Mousty E, Huberlant S, Pouget O, Mares P, de Tayrac R. Gynecology and Obstetrics, Caremeau University Hospital, Nimes, Gard, France, Metropolitan