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Homer T, Shen J, Vale L, McColl E, Tincello DG, Hilton P. Invasive urodynamic testing prior to surgical treatment for stress urinary incontinence in women: cost-effectiveness and value of information analyses in the context of a mixed methods feasibility study. Pilot Feasibility Stud 2018; 4:67. [PMID: 29588862 PMCID: PMC5865344 DOI: 10.1186/s40814-018-0255-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 02/19/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND INVESTIGATE-I (INVasive Evaluation before Surgical Treatment of Incontinence Gives Added Therapeutic Effect?) was a mixed methods study to assess the feasibility of a future randomised controlled trial of invasive urodynamic testing (IUT) prior to surgery for stress urinary incontinence (SUI) in women. Here we report one of the study's five components, with the specific objectives of (i) exploring the cost-effectiveness of IUT compared with clinical assessment plus non-invasive tests (henceforth described as 'IUT' and 'no IUT' respectively) in women with SUI or stress-predominant mixed urinary incontinence (MUI) prior to surgery, and (ii) determining the expected net gain (ENG) from additional research. METHODS Study participants were women with SUI or stress-predominant MUI who had failed to respond to conservative treatments recruited from seven UK urogynaecology and female urology units. They were randomised to receive either 'IUT' or 'no IUT' before undergoing further treatment. Data from 218 women were used in the economic analysis. Cost utility, net benefit and value of information (VoI) analyses were performed within a randomised controlled pilot trial. Costs and quality-adjusted life years (QALYs) were estimated over 6 months to determine the incremental cost per QALY of 'IUT' compared to 'no IUT'. Net monetary benefit informed the VoI analysis. The VoI estimated the ENG and optimal sample size for a future definitive trial. RESULTS At 6 months, the mean difference in total average cost was £138 (p = 0.071) in favour of 'IUT'; there was no difference in QALYs estimated from the SF-12 (difference 0.004; p = 0.425) and EQ-5D-3L (difference - 0.004; p = 0.725); therefore, the probability of IUT being cost-effective remains uncertain. The estimated ENG was positive for further research to address this uncertainty with an optimal sample size of 404 women. CONCLUSIONS This is the largest economic evaluation of IUT. On average, up to 6 months after treatment, 'IUT' may be cost-saving compared to 'no IUT' because of the reduction in surgery following invasive investigation. However, uncertainty remains over the probability of 'IUT' being considered cost-effective, especially in the longer term. The VoI analysis indicated that further research would be of value. TRIAL REGISTRATION ISRCTN. ISRCTN71327395. Registered 7 June 2010.
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Affiliation(s)
- Tara Homer
- Health Economics Group, Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX UK
| | - Jing Shen
- Health Economics Group, Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX UK
| | - Luke Vale
- Health Economics Group, Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX UK
| | - Elaine McColl
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | | | - Paul Hilton
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
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Cetinel B, Demirkesen O, Onal B, Erdal S, Gezer M. Is It Possible to Predict Urodynamic Stress Urinary Incontinence in Women with Minimal Diagnostic Evaluation? Urol Int 2014; 93:444-8. [DOI: 10.1159/000362823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Accepted: 04/09/2014] [Indexed: 11/19/2022]
Abstract
<b><i>Objectives:</i></b> To determine whether it is possible to predict urodynamic stress urinary incontinence (uSUI) in women with minimal diagnostic evaluation. <b><i>Materials and Methods:</i></b> Medical records of 2,643 female incontinent patients were reviewed and 301 women were eligible for this study. The positive predictive values (PPV), sensitivity, specificity and negative predictive values (NPV) for uSUI and uSUI with or without detrusor overactivity (DO), and DO patients of pure SUI symptom (group 1), combination of pure SUI symptom and positive provocative stress test (+PST; group 2) and combination of pure SUI symptom, +PST and absence of overactive bladder symptoms (group 3) were calculated for each group. <b><i>Results:</i></b> Mean age was 51.03 years (22-88). PPV, sensitivity and specificity values for uSUI with or without DO of group 3 were 100, 7.4, and 100%, while these values for pure uSUI were 93.3, 9.3, and 99.3%, respectively. Interestingly, none of the patients in groups 2 and 3 had DO. <b><i>Conclusions:</i></b> Our results show that it was possible to predict uSUI with high accuracy using minimal diagnostic evaluation in a group of female patients with pure stress incontinence symptoms +PST while it was also possible to eliminate DO accurately in this group of patients.
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Adelowo A, Dessie S, Rosenblatt PL. The role of preoperative urodynamics in urogynecologic procedures. J Minim Invasive Gynecol 2013; 21:217-22. [PMID: 24144925 DOI: 10.1016/j.jmig.2013.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 10/01/2013] [Accepted: 10/07/2013] [Indexed: 11/15/2022]
Abstract
Urodynamic studies refer to any tests that provide objective information about lower urinary tract function with the goal of evaluating bladder and urethral function. Pre-operative urodynamic testing is commonly performed prior to urogynecologic procedures for urinary incontinence and pelvic organ prolapse. Although the utility of preoperative urodynamics testing before urogynecologic procedures have been challenged in the literature, the preoperative utilization of urodynamic testing in women with complex voiding dysfunction or associated conditions such as prolapse or urethral diverticulum is still considered important for surgical planning and pre-operative counseling.
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Affiliation(s)
- Amos Adelowo
- Division of Urogynecology, Department of Obstetrics and Gynecology, Mount Auburn Hospital, Harvard Medical School, Cambridge, Massachusetts
| | - Sybil Dessie
- Division of Urogynecology, Department of Obstetrics and Gynecology, Mount Auburn Hospital, Harvard Medical School, Cambridge, Massachusetts
| | - Peter L Rosenblatt
- Division of Urogynecology, Department of Obstetrics and Gynecology, Mount Auburn Hospital, Harvard Medical School, Cambridge, Massachusetts.
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De novo stress urinary incontinence after vaginal repair for pelvic organ prolapse: one-year follow-up. Eur J Obstet Gynecol Reprod Biol 2013; 168:227-30. [DOI: 10.1016/j.ejogrb.2012.12.029] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2012] [Revised: 12/07/2012] [Accepted: 12/28/2012] [Indexed: 11/19/2022]
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How often does detrusor overactivity cause urinary leakage during a stress test in women with mixed urinary incontinence? Int Urogynecol J 2013; 24:1537-41. [DOI: 10.1007/s00192-013-2049-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Accepted: 01/10/2013] [Indexed: 10/27/2022]
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Reproducibility of a cough and jump stress test for the evaluation of urinary incontinence. Int Urogynecol J 2012; 23:1449-53. [DOI: 10.1007/s00192-012-1733-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Accepted: 03/04/2012] [Indexed: 10/28/2022]
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Renganathan A, Duckett J, Nayak K. Female urinary incontinence – urodynamics: Yes or no? J OBSTET GYNAECOL 2010; 29:473-9. [DOI: 10.1080/01443610903003142] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Dompeyre P, Pizzoferrato AC. Examen urodynamique et incontinence urinaire féminine non neurologique. ACTA ACUST UNITED AC 2009; 38:S166-73. [DOI: 10.1016/s0368-2315(09)73576-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Digesu GA, Hendricken C, Fernando R, Khullar V. Do women with pure stress urinary incontinence need urodynamics? Urology 2009; 74:278-81. [PMID: 19515404 DOI: 10.1016/j.urology.2009.01.089] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2008] [Revised: 01/14/2009] [Accepted: 01/15/2009] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To evaluate the value of performing urodynamic investigations in the assessment of women with a history of pure stress urinary incontinence (SUI). METHODS Consecutive women with lower urinary tract symptoms were studied retrospectively. Urinary symptoms were determined from the frequency-volume chart and symptom section of the King's Health Questionnaire. Only women with pure SUI symptoms were included. RESULTS A total of 3428 women aged 24-81 years were studied. Only 308 women (8.9%) could be classified as having pure SUI from the questionnaire. Of these, 241 of women (78.2%) had urodynamic stress incontinence, 23 women (7.5%) had detrusor overactivity, 9 women (2.9%) had mixed urodynamic diagnosis, and 35 women (11.4%) had inconclusive urodynamics. Postvoid residual volumes greater than 100 mL were noted in 24 (7.8%) women. CONCLUSIONS Our results show that urodynamic investigations provide useful information in the assessment of women with a history of pure SUI, because as many as 20% of them might not need surgery as the first line of treatment.
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Affiliation(s)
- G Alessandro Digesu
- Department of Urogynaecology, St Mary's Hospital, Imperial College, London, UK.
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Lemos A, de Souza AI, Ferreira ALCG, Figueiroa JN, Cabral-Filho JE. Do perineal exercises during pregnancy prevent the development of urinary incontinence? A systematic review. Int J Urol 2008; 15:875-80. [DOI: 10.1111/j.1442-2042.2008.02145.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ghoniem G, Stanford E, Kenton K, Achtari C, Goldberg R, Mascarenhas T, Parekh M, Tamussino K, Tosson S, Lose G, Petri E. Evaluation and outcome measures in the treatment of female urinary stress incontinence: International Urogynecological Association (IUGA) guidelines for research and clinical practice. Int Urogynecol J 2008; 19:5-33. [PMID: 18026681 PMCID: PMC2096636 DOI: 10.1007/s00192-007-0495-5] [Citation(s) in RCA: 127] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2007] [Accepted: 10/14/2007] [Indexed: 02/06/2023]
Affiliation(s)
- G Ghoniem
- Cleveland Clinic Florida, Weston, FL, USA.
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Anger JT, Rodríguez LV, Wang Q, Pashos CL, Litwin MS. The Role of Preoperative Testing on Outcomes After Sling Surgery for Stress Urinary Incontinence. J Urol 2007; 178:1364-8; discussion 1368-9. [PMID: 17706717 DOI: 10.1016/j.juro.2007.05.139] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2007] [Indexed: 10/22/2022]
Abstract
PURPOSE In this study we analyzed Medicare claims data to measure the effect of preoperative urodynamics and cystoscopy on outcomes after sling surgery. MATERIALS AND METHODS We analyzed 1999 to 2001 Medicare claims data on a 5% national random sample of beneficiaries. Women who underwent sling procedures between July 1, 1999 and December 31, 2000 were identified on the basis of the presence of CPT-4 code 57288 (sling operation for stress incontinence). Subjects were tracked for 6 months before surgery to identify type of preoperative studies performed (urodynamics and cystoscopy) and for 12 months after surgery to assess short-term complications. RESULTS Of 1,356 subjects 24.8% underwent preoperative cystoscopy and 27.4% underwent preoperative urodynamic testing. In postoperative year 1, 32.4% of subjects underwent cystoscopy and 30.5% underwent urodynamics. Patients who underwent preoperative urodynamics were more likely to be newly diagnosed with urge incontinence after surgery (21.9% vs 12.7%, p <0.0001). Those who underwent preoperative cystoscopy were significantly more likely to be diagnosed with (9.4% vs 6.1%, p <0.043) or treated for (10.6% vs 7.2%, p <0.047) outlet obstruction postoperatively than those who did not. Multivariate analysis revealed that subjects who underwent preoperative urodynamics were significantly less likely to undergo postoperative urodynamics than those who did not (OR 0.34, 95% CI 0.24-0.48). CONCLUSIONS Our findings of worse outcomes among women who underwent preoperative testing may be due in part to case selection. Our finding that women who underwent preoperative urodynamics were only a third as likely to undergo postoperative urodynamics as those who did not supports the use of urodynamics in the preoperative setting. However, the true effect of urodynamics on sling outcomes remains controversial.
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Affiliation(s)
- Jennifer T Anger
- Department of Urology, David Geffen School of Medicine and School of Public Health, University of California, Los Angeles, CA 90404, USA.
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Neumann PB, Grimmer KA, Grant RE, Gill VA. Physiotherapy for female stress urinary incontinence: a multicentre observational study. Aust N Z J Obstet Gynaecol 2005; 45:226-32. [PMID: 15904449 DOI: 10.1111/j.1479-828x.2005.00393.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND No previous data are available on the effectiveness of physiotherapy management of urinary stress incontinence with relevance to the Australian health system. AIMS To evaluate Australian ambulatory physiotherapy management of stress urinary incontinence. METHODS Observational multicentre clinical study of physiotherapy management of female stress urinary incontinence between February 1999 and October 2000, with 1-year follow-up. Outcome measures were a stress test and a 7-day diary of incontinent episodes (pretreatment and at every visit) and a condition-specific quality of life (QoL) questionnaire (pre- and post-treatment). Subjects were followed-up 1 year after treatment by questionnaire with a 7-day diary, QoL questionnaire, and assessment of subjective outcome, subjective cure, satisfaction and need for surgery. RESULTS Of the 274 consenting subjects, 208 completed an episode of physiotherapy care consisting of a median (IQ range) of five (four to six) visits. At the end of the episode, 84% were cured and 9% improved on stress testing, whilst 53% were cured and 25% improved according to the 7-day diary. Mean volume of urine loss on stress testing reduced from 2.4 (2.5) mL to 0.1(0.4) mL after treatment. There was a significant improvement in all QoL domains. Median (interquartile range) incontinent episodes per week were reduced from five (three to 11) to zero (zero to two) (P < 0.05) after treatment and to one (zero to four) at 1 year (P < 0.05). At 1 year, approximately 80% of respondents had positive outcomes on all outcome measures. CONCLUSIONS Physiotherapy management in Australian clinical settings is an effective treatment option for women with stress urinary incontinence.
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Affiliation(s)
- Patricia B Neumann
- Centre for Allied Health Evidence, University of South Australia, Adelaide, Australia.
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Yalcin I, Versi E, Benson JT, Schäfer W, Bump RC. VALIDATION OF A CLINICAL ALGORITHM TO DIAGNOSE STRESS URINARY INCONTINENCE FOR LARGE STUDIES. J Urol 2004; 171:2321-5. [PMID: 15126813 DOI: 10.1097/01.ju.0000124909.31527.a9] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE We assessed the accuracy with which a clinical diagnostic algorithm for stress urinary incontinence (SUI) based on symptoms and signs without including urodynamics predicted the observation of urodynamic SUI and the condition of SUI. Such an algorithm would have applicability to ensure that the majority of women entering large SUI clinical trials would have urodynamic SUI and/or the condition of SUI without performing urodynamic testing in all subjects. MATERIALS AND METHODS A total of 1455 women with urinary incontinence at least 3 months in duration were enrolled in 3 randomized clinical trials (1 phase 2 and 2 phase 3 trials) of duloxetine vs placebo for the treatment of SUI in Europe and North America. Subjects were identified as having SUI based on a clinical algorithm that required a predominant symptom of SUI with a weekly incontinence episode frequency of 4 or greater (phase 2 study), or 7 or greater (phase 3 studies), absent predominant urge symptoms, normal diurnal and nocturnal frequency, a bladder capacity of 400 ml or greater, and a positive cough stress (sign of SUI) and stress pad test. Multichannel urodynamic studies were performed in a subset of 184 women at 23 study sites. Of these urodynamic tracings 173 (94%) were of adequate quality to make an assessment of the filling phase and assign a diagnosis of urodynamic SUI, detrusor overactivity or a normal filling phase. Two-sided 95% exact CIs for the proportions were calculated. RESULTS The clinical algorithm had a positive predictive value of 90.2% for urodynamic SUI with or without detrusor overactivity and 76.9% for urodynamic SUI only (pure urodynamic SUI). The positive predictive value for the condition of pure SUI was 85.0%, while for the condition of SUI in pure and mixed forms the positive predictive value was 98.3%. Patient age, previous continence surgery or the severity of incontinence did not influence algorithm accuracy. CONCLUSIONS The algorithm is suitably feasible and sufficiently predictive to be used in large clinical trials designed to evaluate conservative treatment for women with SUI. It ensures that the overwhelming majority of the study population would have urodynamic SUI and the condition of SUI.
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Affiliation(s)
- Ilker Yalcin
- Lilly Research Laboratories and Methodist Hospital, Indiana University School of Medicine, Indianapolis, Indiana, USA.
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Choe JM. Pubovaginal sling surgery without using abdominal leak point pressure: an outcomes analysis. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2004; 539:467-80. [PMID: 15088923 DOI: 10.1007/978-1-4419-8889-8_32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Affiliation(s)
- Jong M Choe
- Urodynamics and Continence Center, Division of Urology, University of Cincinnati Medical Center, OH 45267, USA
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Affiliation(s)
- Charles W Nager
- Department of Reproductive Medicine (Ob/Gyn), Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Surgery, UCSD Medical Center, San Diego, California, USA.
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Defreitas G, Zimmern P. The Role of Urodynamics in Women with Stress Urinary Incontinence. ACTA ACUST UNITED AC 2003. [DOI: 10.1016/s1570-9124(03)00036-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Abstract
PURPOSE OF REVIEW Ongoing controversy exists as to the extent of the necessary evaluation of the female presenting with lower urinary tract symptoms. Most would agree that a detailed history, a physical examination and a urine analysis are essential components of the initial evaluation of lower urinary tract symptoms in the female. Beyond these assessments, however, there are no universally accepted guidelines or recommendations. In selected patients, a urodynamic, endoscopic and/or radiographic evaluation may be indicated. When further investigation of lower urinary tract symptoms is being considered, individual test characteristics, including sensitivity, specificity, reproducibility and accuracy, must be balanced against such factors as cost, morbidity, discomfort, availability and invasiveness. This review discusses some of the recent reports, controversies and developments in the evaluation of lower urinary tract symptoms in the female, and briefly reviews the most recent relevant International Continence Society subcommittee publications. RECENT FINDINGS The proceedings of the International Consultation on Incontinence, as well as recent publications by a number of its subcommittees, have provided some guidance for the structured evaluation of lower urinary tract symptoms in the female, especially with regard to the investigation of urinary incontinence. The role of urodynamics and radiographic imaging continues to be refined. Magnetic resonance imaging is, at present, still primarily a research tool in the evaluation of lower urinary tract disorders in the female; however, a clinical role for this technology is evolving. SUMMARY The goal of a diagnostic evaluation is the accurate characterization of lower urinary tract symptoms for the purposes of treatment. Ideally, a brief, low-cost, non-invasive evaluation would provide a high degree of diagnostic accuracy. However, existing technology is limited in this regard. Until future refinements permit a completely non-invasive, cost-effective and accurate analysis of female lower urinary tract symptoms, existing technology must be appropriately utilized. Well-conducted, evidence-based, prospective studies are needed.
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Affiliation(s)
- Eric S Rovner
- University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA.
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Deruelle P, Houfflin-Debarge V, Nayama M, Vinatier D, Crépin G, Cosson M. [Comparative analysis of rate scales of urinary incontinence in women]. GYNECOLOGIE, OBSTETRIQUE & FERTILITE 2003; 31:516-20. [PMID: 12865189 DOI: 10.1016/s1297-9589(03)00126-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Rate scales are used to analyse urinary incontinence. There are many scales making it difficult to compare the different studies of urinary incontinence. The purpose of this study was to evaluate and compare the rate scales pertaining specifically to urinary incontinence. PATIENTS AND METHOD A review of the literature was performed for publications specifically addressing rate scales of urinary incontinence. Each scale was evaluated using the following four criteria: principal characteristics (reference source, number of items addressed, scoring method, language), objectives (type of incontinence, severity and quality of life measures), psychometric properties (scientific validity, reliability and responsiveness) and linguistic validation. RESULTS Thirteen scales were identified. These were divided into two groups: (1) those based on "classifications" and (2) those based on specific questionnaires. Scales based on classifications were not precise and are never scientifically validated. Scales based on questionnaires were more elaborate and more detailed; nevertheless, the study of their psychometric properties was often incomplete. DISCUSSION AND CONCLUSION Classification-based rate scales are inadequate to analyse urinary incontinence. Questionnaire-based rate scales are superior, but at minimum, they should address the previously stated objective and psychometric criteria. The choice of questionnaire should depend on whether it is to be used in clinical practice or for research protocol.
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Affiliation(s)
- P Deruelle
- Clinique de gynécologie et d'obstétrique, hôpital Jeanne de Flandre, CHRU de Lille, 1, rue Eugène-Aviné, 59037 Lille cedex, France.
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Weber AM, Walters MD. Cost-effectiveness of urodynamic testing before surgery for women with pelvic organ prolapse and stress urinary incontinence. Am J Obstet Gynecol 2000; 183:1338-46; discussion 1346-7. [PMID: 11120494 DOI: 10.1067/mob.2000.111251] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This study was undertaken to compare cost-effectiveness between 2 preoperative testing strategies for women with pelvic organ prolapse and stress urinary incontinence symptoms. STUDY DESIGN We developed decision-analytic models that evaluated the cost-effectiveness of basic office evaluation before surgery in women with prolapse and stress urinary incontinence symptoms and contrasted it with that of urodynamic testing. Costs were obtained from the Federal Register; effectiveness of treatment for urinary incontinence was based on the published literature. RESULTS The strategies of basic office evaluation and urodynamic testing had the same cure rate of urinary incontinence (96%) after initial and secondary treatment. Under baseline assumptions incremental cost-effectiveness (cost for single extra cure of urinary incontinence) of urodynamic testing was $328,601. According to sensitivity analyses, basic office evaluation was more cost-effective than urodynamic testing when the prevalence of pure detrusor instability was <8% or when the cost of urodynamic testing was >$103. CONCLUSION Urodynamic testing before surgery in women with prolapse and stress urinary incontinence symptoms is not cost-effective relative to basic office evaluation.
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Affiliation(s)
- A M Weber
- Department of Gynecology and Obstetrics, Cleveland Clinic Foundation, OH 44195, USA
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