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Evidence Tables Evidence tables Urodynamics Does urodynamic testing affect outcome? Study Study type No. of Patient Intervention Comparison Length of Outcome measures Effect size Additional comments and EL patients characteristics follow-up Ramsay RCT 60 (48 F with frequency, Urodynamic Multicomponent 3 months tx Leakage –73% vs –73%, Funding: none declared. 1995123 EL = 1– completed urgency, nocturia, investigation conservative tx** episodes/week P = NS [EL = 1–] No baseline characteristics and urge and stress UI then tx (n = 33 (mean change) presented, analysis on completers only, analysed) Exclusions: previous tailored to randomised, 28 Frequency/day –34% vs –40%, with no explanation for withdrawals. tx for UI haematuria, diagnosis* analysed) (mean change) P = NS (n = 27 *bladder training for DO or recurrent dysuria or hypersensitive bladder (aiming for 5 h randomised, Nocturia/night (mean –59% vs –60%, voiding difficulty, UTI voiding interval); PFMT for SUI (tailored 20 analysed) change) P = NS Short pad test –72% vs –72%, to individual, 3–10 repetitions 3×/day); (mean change, g) P = NS CISC for voiding difficulty. Subjective –3.5 vs –3.6 **bladder training (as inpatients), assessment (VAS, (units not stated), PFMT, dietary and fluid intake advice. mean change) P = NS Self-reported cure or 60% vs 71%, improvement (no P = NS further tx required) 28 Evidence tables Study Study type No. of Patient Intervention Comparison Length of Outcome measures Effect size Additional comments and EL patients characteristics follow-up Thompson Cohort* 131 (109 F ≤ 50 years who Full pre-op Minimal pre-op Mean Subjective outcome Cure 70% vs 72% Funding: Woman’s Hospital of Texas 2000124 EL = 2– followed up) underwent UD (n = 95; assessment# ~25 months for stress UI Improved 18% vs Research and Education Foundation. retropubic surgery 77 followed (n = 36; 32 follow-up (n = 109) 19% *retrospective chart review. for stress UI; surgery up) followed up) Failed 12% vs 9% **Thomson also compared these performed by a 10 had 3 had surgery P = NS for all findings with results for women urogynaecologist** surgery (Burch), tx comparisons operated on by urologists who do not Exclusions: prior (Burch), tx others had not use any formal urodynamic studies; retropubic others had stated Subjective outcome True success data not reproduced here as not urethropexy, low not stated with ‘true’ success 69% vs 78% directly relevant to guideline question. MUCP and/or low (no urge UI or other (UD Partial success #uroflowmetry, subtracted CMG, cough leak-point diagnosis voiding problems) 19% vs 13% (n = 109) MUCP, CLPP, cystourethroscopy. pressure SUI 45%, Failed 12% vs 9% 27% MUI, P = NS for all 27% UUI) comparisons Black 1997125 Cohort* 442 (68% of F mean age Pre-op No pre-op 1 year Mean symptom 5.7 vs 6.0 Funding: MRC Health Services Associated EL = 2+ 650 treated 52 years who had urodynamic urodynamics severity score at (difference 0.3, Research and Public Health Board. reference who wished surgery for stress UI pressure (n = 103) 1 year [95% CI –1.2 to *137 gynaecologists/urologists from Hutchings to participate between Jan 93 and studies 1.8]) North Thames region invited to 1998126 and returned June 94 (n = 164) (baseline 12.2 vs participate in the study; 47% agreed, (competence Q on time) Exclusions: unable 14.6, P = NS) 9% declined and 44% did not respond. section) 359 (81%) to read or Cure 24% vs 26%, 49 of the 64 who agreed to participate Impact of responded to understand English P = NS were selected (38 gynae, 11 other 1 year Procedure: 3.8% urologists), as it was deemed a symptoms follow-up missing info, 50% representative sample in terms of case and Q**, colposuspension, load, specialty, setting (DGH or comorbidity surgeons 12% needle teaching; rural, suburban, or urban also completed suspension, 29% population). Surgeons provided pre-op described in data on 63% anterior data. the report – Urodynamic colporrhaphy, 4.5% Pts completed pre-op questionnaire re data not data other sociodemographic factors, symptoms, reproduced available for history, mental health, expectations here. 267 from surgery. **more non-respondents had severe symptoms (33% vs 23%). Respondents more likely to have colpo (57% vs 46%) and less likely to have a needle suspension (7% vs 26%), P < 0.01. 29 Evidence tables Do preoperative urodynamic findings predict post-surgical outcomes? Study Study type Aim No. of Patient characteristics Outcomes Results Additional comments and EL patients Francis Case Identify UD changes 50 F mean age 50 years (32–71) with Objective failure rate 26% (n = 13) Funding: none declared. 1987127 series in a grp undergoing genuine stress UI UD method: MC pre-op and at 3 months post- EL = 3 modified Burch 56% had prior continence surgery, op. Static and stress UCPP studied in supine colposuspension (MMK in 12, anterior colporrhaphy empty and sitting empty positions with bladder in 20, Burch in 5, Stamey in 1) Urethral closure Mean pre-op 18 vs filled with 150 ml saline Studies also conducted 74% had prior hysterectomy pressure in 33 cmH2O, P < 0.005 in sitting full position at max. cystometric objectively failed vs (10 of 13 with failed capacity. successful surgery surgery had pre-op Not stated whether UD performed to ICS closure standards. pressure < 20 cmH2O) Kujansuu Case Investigate UD 79 F with previous failed continence Objective failure rate 41% (n = 32) Funding: none declared. 1983128 series before and after surgery, investigated clinically and Urethral relaxation at 0.584 (SD 0.197) vs UD method: MC, with UPP measurement in the EL = 3 continence surgery, by simultaneous urethrocystometry stress* (mean pre-op 0.710 (SD 0.216), standing position. Not stated whether ICS and correlate findings before and 15 months (SD 4) after values in failed vs P < 0.01 standards for UD followed. with operative continence surgery (11 vaginal successful grp) success Kelly, 7 Lyodura sling, 18 MMK, 43 *ratio of highest intraurethral pressure between coughs in the stress UPP to the maximal UCP in Burch) the UPP at rest. 97% had stress UI, 3% mixed UI No other UD measurements found to ‘correlate’ with surgical success (MUCP, location of max. closure pressure, urethral length). Digesu Case Determine whether 209 F mean age 60 years (34–90) with Objective cure 82% at 1 year post-op Funding: none declared. 2004129 series acceleration of flow UD stress UI, seen at a tertiary UD Pre-op MUCP, ODP, MUCP: 37.5 (15) vs UD method: VCU, pressure flow studies. EL = 3 rate (AFR), pressure clinic, owing to undergo modified CDP, AFR in failed 40.5 (18), P = NS Acceleration of flow rate (AFR = max. flow rate flow variables, and Burch colposuspension. 17% had vsvs Successful grps ÷ time to reach max. flow), opening detrusor UPP measurements prior continence surgery ODP: 12.1 (8.8) vs 21.3 (mean, SD)* (12), P = 0.02 pressure (ODP), and urethral pressure at have a role in Exclusions: DO and/or POP closure (CDP), UPP calculated pre-op. Terms evaluating women beyond vaginal introitus; irritative CDP: 21.2 (10) vs 25.2 and definitions for UD conform to ICS standards. with urodynamic (16), P = 0.04 urinary symptoms Complete pressure flow studies obtained from stress UI, to predict AFR: 4.0 (2.5) vs 4.2 96% F before surgery surgical outcomes (3.2), P = NS VCU repeated 1 year after surgery and de novo DO De novo DO 18% at 1 year post-op 30 Evidence tables Study Study type Aim No. of Patient characteristics Outcomes Results Additional comments and EL patients Pre-op MUCP, ODP, MUCP: 45.6 (19) vs 39 *MUCP, ODP, CDP in cmH2O; AFR units ml/s2. CDP, AFR in de (17.2), P = NS novo DO vs ‘normal’ ODP: 27.5 (16) vs 22.4 bladder function grps (12), P = 0.04 (mean, SD) CDP: 36.8 (17) vs 26.5 (16), P = 0.03 AFR: 5.6 (4.6) vs 3.9 (2.7), P = 0.009 Rodriguez Case Examine role of 174 F mean age 62 years (32–88) with Objective* cure rates 95% (no leak on UD) Funding: none declared. 2004130 series VLPP in predicting stress UI according to VLPP 92% VLPP > 80 UD method: videoUD, according to ICS risk of failure, (cmH2O) EL = 3 Mean no. of previous surgeries 93% VLPP 30–80 recommendations. VLPP determined at bladder success rates and 0.6–0.7 across VLPP grps volume of 200 ml. surgical outcomes in 92% VLPP < 30 33% had concomitant prolapse Mean follow-up 14.7 months (12–30). pts who underwent repair the distal urethral *self-reported, where failure defined as < 50% polypropylene sling improvement. procedure McLennan Case Determine time to 61 (UD F mean age 60 years (40–84) with Time to normal Max. flow (≥ 20 ml/s) Funding: none declared. 1988140 series resumption of normal studies in UD stress UI, who had fascia lata voiding as a function 79% vs 43%, P = 0.03 Retrospective review. voiding after a fascia 49) suburethral sling for ISD or of UD voiding indices EL = 3 [Logistic regression UD method: MC UD, and Cystourethroscopy. lata suburethral sling, recurrent UI. 77% had sling alone, (results for early vs analysis: max. flow and whether clinical, 23% had additional procedures late voiders*) Cough and static UCPP measured at max. rate < 20 ml/s capacity, and MUCP calculated electronically. operative, or UD 67% had prior continence surgery, associated with delayed Not stated whether ICS criteria followed. variables predict this mean 1.7 (range 1–7); 21% had voiding (OR 4.6, 95% CI time failed prior continence surgery 1.06 to 20.01), P = 0.04. Voiding trial began day 2 post-op; suprapubic catheter removed when PVR < 100 ml with 46% had low VLPP (≤ 65 cm), 3% Mean max.
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