How do Urodynamic Studies (UDS) Provide More Information about Women With Urinary Incontinence?
Imagine with me, it is a typical day at your clinic when you follow up with your patients, and every 2 or 3 patients is a female patient in her 3rd or 4th decade complaining of urinary leakage. You proceed to history taking and clinical examination, and at the clinical diagnosis step, you discover that the patient has a stress urinary incontinence. You ask yourself questions like, “should I send her for Urodynamic study?”, “is it cost-effective?”, “is it adding more information to the clinical diagnosis?”, “will it affect the results of the surgery?”, when in fact, it’s the right step! According to research, the prevalence of urinary incontinence in women is up to 50%. Stress Urinary Incontinence (SUI) represents 50% of these cases, urge incontinence (UI) accounts for almost 10%, while mixed incontinence represents nearly 40%.
50%
Female with Urinary Incontinence.
50%
Females with Pure SUI.
40%
Female with Urinary Incontinence.
10%
Females with Pure SUI.
Complicated SUI Vs. Uncomplicated SUI
Complicated Stress Urinary Incontinence (SUI) is defined as the urinary incontinence associated with conditions like:
- Pain
- Hematuria
- Neurological conditions
- Recurrent urinary tract infections
- Suspected voiding dysfunction
- Significant pelvic organ prolapses
- Previous incontinence surgery
- Pelvic irradiation or surgery
- Suspected fistula
Most women struggle with non-typical or complicated SUI. It is recommended to perform a urodynamic evaluation in these patients before proceeding to invasive or irreversible treatments to decide on the best treatment plan.
Moreover, complicated SUI is more common among women; however, it’s a total myth that Urodynamic Studies should only be done for women with complicated SUI. For women with Uncomplicated SUI, Urodynamics can be beneficial, especially in cases that didn’t show any improvement with conservative treatment. In cases that need surgery or invasive procedures, Urodynamic Studies provide better information for better success rates.
Why Doctors Consider UDS in SUI Patients If they Are Planning an Invasive Procedure
UDS helps in preventing surgical intervention in women without SUI. Specific urodynamics data could guide the choice of the operation. They may also identify patients at risk of failure and whether they’re at risk of developing postoperative symptoms. But before considering UDS, doctors should define what questions they’re asking and how the answers will help with the treatment plan. Furthermore, in women with sphincter problems, doctors need to warn their patients about the possibility of poorer outcomes before their operation.
The Bladder Is an Unreliable Witness!
According to a paper published in the European Journal of Obstetrics & Gynecology and Reproductive Biology, “the bladder is an unreliable witness.” Many researchers believe that urodynamic studies have a significant role before any anti-incontinence surgery. The urodynamic investigation is the most objective element when diagnosing women with urinary incontinence. In addition, the test data can facilitate the tailored counseling of patients by offering a wealth of information to the surgeon and the patient.
Dr Mai Maged
Author
Sarah Marzouk
Editor