Is urodynamics necessary to identify occult stress urinary incontinence?

PURPOSE: To investigate Occult Stress Urinary Incontinence (OSUI) using physical exam (PE) and urodynamics (UDS) in women with advanced pelvic organ prolapse (POP), and compare the two methods. METHODS: This study comprised 105 women with POP stage-III and -IV, according to POP quantification (POP-Q) system, evaluated prospectively between January and December 2015. A standard history, an incontinence questionnaire and PE were completed before the investigation of the OSUI that was performed in the supine and standing positions, reducing the prolapse using gauze and Cheron dressing forceps. The stress test was performed with and without the prolapse reduction. RESULTS: The mean patient age was 65.7 years, mean parity 5.1 and mean body mass index 27.4. From a total of 105 patients, 70 (66.7%) presented with POP-Q stage III and 35 (33.3%) stage IV. Sixty-three (60%) women were identified as having OSUI, 27 (25.7%) as continent, and 15 (14.3%) having stress urinary incontinence. From the 63 OSUI subjects, 48 (76.2%) were identified in both evaluations, eight were identified only during PE, and seven only during UDS. The sensitivity to detect OSUI during PE and UDS was 88.9 and 87.3%, respectively (P = .783). The kappa value to measure the agreement between both tests was .648 (95% CI .441-.854). CONCLUSION: UDS and PE are equivalent and concordant to demonstrate OSUI, thus it is not necessary to perform UDS to exclusively identify OSUI. UDS utility in OSUI patients, to evaluate urethral and detrusor function, deserves further investigation.

Modified pubovaginal sling technique in the surgical management of female stress urinary incontinence / Técnica modificada do sling pubovaginal no tratamento cirúrgico da incontinência urinária de esforço feminina

Objective: To assess the application of aponeurotic sling by a modified technique with direct visualization of needles in patients with stress urinary incontinence. Methods: we applied the Kings Health Questionnaire (KHQ) for quality of life, gynecological examination, urinalysis I and urine culture approximately seven days prior to the urodynamic study (UDS) and the one-hour PAD test in patients undergoing making aponeurotic sling with its passing through the retropubic route with direct visualization of the needle, PAD test and King's Helth Questionnaire before and after surgery. Results: The mean age was 50.6 years, BMI of 28 and Leak Pressure (LP) 58,5cm H2O; 89% were Caucasian. Forty-six of them were monitored for three and six months, 43 for 12 months. The objective cure rate at 12 months postoperatively was approximately 93.5%. In evaluating quality of life, we observed a significant improvement in 12 months postoperatively compared with the preoperative period. There was no no urethral/bladder injury. As adverse results, we had one persistent urinary retention (2.3%), who was submitted to urethrolysis, currently without incontinence. Conclusion: The proposed procedure is safe as for the risk of bladder or urethral injuries, promoting significant improvement in quality of life and objective cure.

Objetivo: avaliar a aplicação de faixa aponeurótica por técnica modificada com visibilização direta das agulhas em pacientes com incontinência urinária de esforço. Métodos: foi aplicado o questionário Kings Health Questionaire (KHQ) de qualidade de vida, exame ginecológico, exame de urina I e urocultura aproximadamente sete dias antes da realização do estudo urodinâmico (EUD) e PAD test de uma hora submetidas à confecção de faixa aponeurótica com passagem de faixa pela via retropúbica, com agulha sob visibilização direta, PAD test e King´s Helth Questionaire, no pré e pós operatórios. Resultados: a média de idade foi 50,6 anos, 89% da cor branca, IMC de 28 e PPE de 58,5cm de H2O. Quarenta e seis delas tiveram acompanhamento de três e seis meses, 43 de 12 meses. A taxa de cura objetiva, em 12 meses de pós-operatório foi aproximadamente 93,5%. Ao avaliarmos a qualidade de vida das pacientes, observamos a melhora significante em 12 meses de pós-operatório, quando comparada ao pré-operatório. Não foi observada nenhuma lesão uretral/vesical. Como resultados adversos tivemos uma retenção urinária persistente (2,3%), sendo submetida à uretrolíse, estando atualmente sem perda. Conclusão: a operação proposta é segura quanto ao risco de lesões vesicais ou uretrais, promovendo melhora acentuada na qualidade de vida e cura objetiva.

Bacteriuria and urinary tract infection after female urodynamic studies: risk factors and microbiological analysis.

BACKGROUND: This study was conducted to determine risk factors for infectious complications after urodynamic study (UDS) in women, which can assist clinicians in identifying high-risk subjects who would benefit from antibiotic prophylaxis before UDS. METHODS: In this prospective cohort study, we studied 232 women who underwent UDS at Santa Casa de São Paulo School of Medical Sciences between June 2013 and June 2014. Women ranging in age from 26 to 84 years who had urinary incontinence, pelvic organ prolapse, or voiding dysfunction were required to collect urine samples at 7 days before, on the day of, and 3-5 days after UDS. Urine cultures with >100,000 CFU/mL were considered positive. Risk factors associated with bacteriuria and urinary tract infection (UTI) after UDS were evaluated using multivariate analysis with multiple logistic regression. RESULTS: Two hundred thirty-two out of 257 women were subjected to further analysis. The incidence of bacteriuria, transient bacteriuria, and UTI after UDS was 11.6%, 7.3%, and 4.3%, respectively. On multivariate analysis, hypothyroidism (P = .04), body mass index (BMI) >30 (P = .025), and advanced pelvic organ prolapse (P = .021) were associated with a significantly increased risk of bacteriuria; however, only BMI >30 (P = .02) was associated with an increased risk for UTI. CONCLUSIONS: The rate of infectious complications after UDS was low, and advanced pelvic organ prolapse and hypothyroidism increased the risk for bacteriuria. However, only BMI >30 was associated with bacteriuria and UTI after UDS.

Modified pubovaginal sling technique in the surgical management of female stress urinary incontinence.

OBJECTIVE: To assess the application of aponeurotic sling by a modified technique with direct visualization of needles in patients with stress urinary incontinence. METHODS: we applied the Kings Health Questionnaire (KHQ) for quality of life, gynecological examination, urinalysis I and urine culture approximately seven days prior to the urodynamic study (UDS) and the one-hour PAD test in patients undergoing making aponeurotic sling with its passing through the retropubic route with direct visualization of the needle, PAD test and King's Health Questionnaire before and after surgery. RESULTS: The mean age was 50.6 years, BMI of 28 and Leak Pressure (LP) 58,5 cm H2O; 89% were Caucasian. Forty-six of them were monitored for three and six months, 43 for 12 months. The objective cure rate at 12 months postoperatively was approximately 93.5%. In evaluating quality of life, we observed a significant improvement in 12 months postoperatively compared with the preoperative period. There was no no urethral/bladder injury. As adverse results, we had one persistent urinary retention (2.3%), who was submitted to urethrolysis, currently without incontinence. CONCLUSION: The proposed procedure is safe as for the risk of bladder or urethral injuries, promoting significant improvement in quality of life and objective cure.

Estudo urodinâmico da pressão de perda ao esforço, nas posições ortostática e sentada, em mulheres com incontinência urinária / Urodynamic evaluation of leak point pressure under stress, in orthostatic and seating position, in women with urinary incontinency

OBJETIVOS: comparar os resultados obtidos durante o estudo urodinâmico realizado em duas diferentes posições em relação às pressões de perda urinária sob esforço e discutir sua relevância clínica. MÉTODOS: sessenta e quatro pacientes com queixa de incontinência urinária de esforço (IUE) com idades variando entre 25 e 80 anos, atendidas no ambulatório de uroginecologia e cirurgia vaginal, no período de junho 2003 a setembro 2005 foram incluídas neste estudo. As pacientes foram inicialmente submetidas ao estudo urodinâmico de acordo com a técnica preconizada pela International Continency Society (ICS) na posição ortostática e logo depois foram avaliadas na posição sentada. RESULTADOS: diferença significante foi obtida após a avaliação das pressões de perda obtidas nas diferentes posições (99,8 ± 33,3 versus 102,9 ± 32,4; respectivamente, posição sentada e em pé, p < 0,05). Testes de regressão linear com análise de freqüência foram realizados com a finalidade de verificar a porcentagem de pacientes que ficaram dentro dos limites de confiança em relação às PP nas posições sentada e em pé. Uma taxa de 90,6 por cento de compatibilidade foi obtida nesses resultados. Quando três unidades foram somadas aos valores das pressões obtidas no estudo urodinâmico realizado na posição sentada, percebeu-se que 92,2 por cento ficaram inseridas neste intervalo. CONCLUSÕES: estes achados sugerem que o estudo urodinâmico pode ser realizado na posição sentada sem comprometimento diagnóstico e terapêutico proporcionando maior conforto e comodidade às pacientes.

PURPOSE: compare the outcomes verified during urodynamic investigation realized in two different positions related to urinary leak point pressure under stress and to discuss its clinical relevance. METHODS: sixty-four patients with stress urinary incontinency (SUI) aged 25-80 years old, attended, during June 2003 to September 2005 were included in this study. Patients were initially submitted to urodynamic investigation in accordance with International Continence Society (ICS) techniques in orthostatic position and just after were evaluated in seating position. RESULTS: statistical significance was obtained after evaluation of Vasalva leak point pressure (VLPP) obtained in two positions (99,8 ± 33,3 versus 102,9 ± 32,4; respectivamente, posição sentada e em pé, p<0,05). Linear regression test based on frequency analyses was applied with the purpose to verify the patient percentage allocated in confidence interval in terms of Valsalva leak point pressure in seating or orthostatic positions. A rate of 90.6 percent of compatibility was gotten in these results. When three unities were added to VLPP values after urodynamic investigation in seating position, it was noted that 92.2 percent of patients was included in this interval. CONCLUSIONS: these findings suggest that the urodynamic investigation can be realized in seating position without diagnostic a therapeutic impairment allowing higher comfort to the patients.

Freqüência de neoplasia intra-epitelial cervical em portadoras do vírus da imunodeficiência humana / Frequency of cervical intraepithelial neoplasia in human immunodeficiency virus-infected women

Objetivo: verificar a freqüência de neoplasia intra-epitelial cervical (NIC) em mulheres infectadas pelo vírus da imunodeficiência humana (HIV). Métodos: foram estudadas 99 mulheres HIV -soropositivas; o diagnóstico da infecção pelo HIV foi realizado por meio de dois testes ELISA, complementados por teste Western blot ou de imunofluorescência indireta. Como grupo controle foram analisadas 104 mulheres que não apresentavam positividade no teste ELISA. Em ambos os grupos o rastreamento de NIC foi realizado por meio da associação de colpocitologia oncológica e colposcopia. Nos casos em que a colposcopia revelou existência de zonas de transformação anormal, o diagnóstico de NIC foi realizado mediante biopsia dirigida, complementada ou não por conização. Resultados: em 15 das 99 pacientes do grupo de estudo (15,2 por cento) foi encontrada neoplasia intra-epitelial cervical, sendo dez casos de NIC I, um de NIC II e quatro de NIC III. Entre as 104 mulheres do grupo controle, quatro (3,8 por cento) eram portadoras de neoplasia intra-epitelial cervical, encontrando-se um caso de NIC I e três de NIC III. Conclusão: a análise comparativa dos resultados evidenciou que freqüência de neoplasia intra-epitelial cervical foi significantemente mais elevada entre as pacientes infectadas pelo HIV