Presentation Authors: Christina Escobar*, Benoit Peyronnet, Rachael Sussman, Ricardo Palmerola, Nirit Rosenblum, Benjamin Brucker, Victor Nitti, Dominique Malacarne Pape, New York , NY
Introduction: Urodynamics (UDS) have a limited role when patients clearly have symptoms of obstruction soon after anti-incontinence procedures. However, in patients with primarily storage symptoms after anti-incontinence procedures UDS may be useful. Five contemporary UDS criteria have been proposed to define bladder outlet obstruction (BOO) in females based on pressure-flow (PF) studies (Zimmern criterion, Blaivas-Groutz nomogram, BOO index (BOOi), Solomon nomogram) or on video-fluoroscopy (Nitti video-urodynamic (VUD) criteria). The ability of these criteria to predict outcomes of women with primarily storage symptoms has not been studied. The aim of this study was to evaluate the clinical relevance of the five contemporary female BOO UDS criteria that asses for obstruction to predict surgical outcome in patients presenting with storage symptoms who underwent sling revision.
Methods: A retrospective chart review was performed of all female patients who underwent sling revisions between 2010 and 2018. Women with primarily storage symptoms, history of an anti-incontinence procedure, revision of an anti-incontinence procedure and complete UDS data were included. The primary outcome was patients&[prime] reported improvement in post-operative storage symptoms defined as cured or improved vs. unchanged or worsened. ROC curves were generated to compare predictive values of the five aforementioned UDS criteria.
Results: Thirty-three patients were eligible for inclusion. Postoperatively, 15.1% of patients had complete resolution of symptoms (cured), 48.5% were improved, 27.3% were unchanged and 9.1% were worsened. 63.6% of patients met the primary endpoint (storage symptoms cured/improved). Of the patients that presented with storage symptoms and were clinically thought to be obstructed from a sling procedure, 48.4% met Nitti VUD criteria, 45.4% met Zimmern criteria, 66.7 % met Blaivas criteria and 24.2% met BOOI criteria for obstruction. For Solomon criteria, 39.4 % were classified as &[Prime]obstruction almost certain&[Prime]. The ROC curves of all 5 criteria are presented in figure 1. The VUD criteria had the best predictive value with a specificity of 67% and a sensitivity of 57.9%, however did not reach statistical significance (p=0.16).
Conclusions: When analyzing 5 contemporary criteria for BOO in females there was no significant evidence to support their predictive value for favorable outcomes in patients with clinical obstruction and primarily storage symptoms. Future work is needed to establish better objective predictors of favorable outcome.