Aims
The working group initiated by the ICS Standardisation Steering Committee has updated the International Continence Society Standard “Good Urodynamic Practice” published in 2002.
Methods
On the ...basis of the manuscript: “ICS standard to develop evidence‐based standards,” a new ICS Standard was developed in the period from December 2013 to December 2015. In July, a draft was posted on the ICS website for membership comments and discussed at the ICS 2015 annual meeting. The input of ICS membership was included in the final draft before ICS approval and subsequent peer review (for this journal).
Results
This evidence‐based ICS‐GUP2016 has newly or more precisely defined more than 30 terms and provides standards for the practice, quality control, interpretation, and reporting of urodynamics; cystometry and pressure‐flow analysis. Furthermore, the working group has included recommendations for pre‐testing information and for patient information and preparation. On the basis of earlier ICS standardisations and updating according to available evidence, the practice of uroflowmetry, cystometry, and pressure‐flow studies are further detailed.
Conclusion
ICS‐GUP2016 updates and adds on to ICS‐GUP2002 to improve urodynamic testing and reporting both for individual care and scientific purposes.
Stress urinary incontinence (SUI) is common after radical prostatectomy and likely to persist despite conservative treatment. The sling is an emerging operation for persistent SUI, but randomised ...controlled trial (RCT) comparison with the established artificial urinary sphincter (AUS) is lacking.
To compare the outcomes of surgery in men with bothersome urodynamic SUI after prostate surgery.
A noninferiority RCT was conducted among men with bothersome urodynamic SUI from 27 UK centres. Blinding was not possible due the surgeries.
Participants were randomly assigned (1:1) to the male transobturator sling (n = 190) or the AUS (n = 190) group.
The primary outcome was patient-reported SUI 12 mo after randomisation, collected from postal questionnaire using a composite outcome from two items in validated International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form questionnaire (ICIQ-UI SF). Noninferiority margin was 15%, thought to be of acceptable lower effectiveness, in return for reduced adverse events (AEs) and easier operation, for the sling. Secondary outcomes were operative and postoperative details, patient-reported measures, and AEs, up to 12 mo after surgery.
A total of 380 participants were included. At 12 mo after randomisation, incontinence rates were 134/154 (87.0%) for male sling versus 133/158 (84.2%) for AUS (difference 3.6% 95% confidence interval {CI} –11.6 to 4.6, pNI = 0.003), showing noninferiority. Incontinence symptoms (ICIQ-UI SF) reduced from scores of 16.1 and 16.4 at baseline to 8.7 and 7.5 for male sling and AUS, respectively (mean difference 1.4 95% CI 0.2–2.6, p = 0.02). Serious AEs (SAEs) were few: n = 6 and n = 13 for male sling and AUS (one man had three SAEs), respectively. Quality of life scores improved, and satisfaction was high in both groups. All other secondary outcomes that show statistically significant differences favour the AUS.
Using a strict definition, urinary incontinence rates remained high, with no evidence of difference between male sling and AUS. Symptoms and quality of life improved significantly in both groups, and men were generally satisfied with both procedures. Overall, secondary and post hoc analyses were in favour of AUS.
Urinary incontinence after prostatectomy has considerable effect on men’s quality of life. MASTER shows that if surgery is needed, both surgical options result in fewer symptoms and high satisfaction, despite most men not being completely dry. However, most other results indicate that men having an artificial urinary sphincter have better outcomes than those who have a sling.
The results of this large, high-quality trial allow surgeons to discuss and recommend the use of both the artificial sphincter and the sling procedure for postprostatectomy incontinence, as the results with respect to urine leakage were similar. However, men will wish to know that the majority will have some persistent urinary incontinence, although satisfaction with surgery was high: in the artificial urinary sphincter (AUS) group 91% and 85% were, respectively, completely and fairly satisfied, and 85% would recommend an AUS to a friend; and in the sling group, 72% were completely or fairly satisfied and 72% would recommend a sling to a friend. Similarly, most of the other secondary outcomes favoured the AUS over the sling procedure.
Basic understanding of urodynamics Hall, Rebecca; Ward, Karen
Obstetrics, gynaecology and reproductive medicine,
June 2022, 2022-06-00, Letnik:
32, Številka:
6
Journal Article
Recenzirano
Urodynamic investigations are an important tool aiding the clinical management of patients with lower urinary tract symptoms, such as overactive bladder, urinary incontinence, and voiding ...dysfunction. Urodynamic investigations can be non-invasive or invasive. Non-invasive tests include uroflowmetry and ultrasound measurement of post-void residual urine volumes. Invasive tests involve urethral catheterization to measure bladder pressure, and placement of a catheter either in the vagina or the rectum to measure abdominal pressure. The detrusor pressure is obtained by subtracting abdominal pressure from bladder pressure. Invasive urodynamics carry a low risk of urinary tract infection. The International Continence Society has published standards on good urodynamic practice and the terminology of lower urinary tract function. Urodynamic investigations should be performed by a trained clinician who can understand urodynamics on a physical and technical level, as well as the physiology and pathophysiology of the lower urinary tract.
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