The document discusses the role of urodynamics in the preoperative management of women with pelvic organ prolapse with or without stress urinary incontinence. It notes that while urodynamics can detect occult stress incontinence and overactive bladder in some patients, the clinical significance and impact on surgical decision-making is unclear. Additionally, symptoms of overactive bladder often resolve after prolapse repair alone. Therefore, the benefits of routine urodynamics before prolapse surgery are uncertain, as the test results rarely change management plans or surgical procedures.

1. CONTRO

5. It’s better to
be tormented by
doubts, rather than
run the risk of living
with the wrong
conviction

6. PROLASSO GENITALE
Urodinamica

7. Prolasso genitale
Urodinamica

8. CONCOMITANTE SUI
SINTOMI IRRITATIVI
VOIDING DYSFUNCTION
Quando farla prima della
chirurgia del prolasso?
Urodinamica

9. Quando farla prima della
chirurgia del prolasso?
Urodinamica
CONCOMITANTE SUI
SINTOMI IRRITATIVI
VOIDING DYSFUNCTION

10. Urodinamica
CONCOMITANTE SUI
Diagnosi Terapia

11. Urodinamica
CONCOMITANTE SUI
Manifesta Occulta

12. Urodinamica
CONCOMITANTE SUI

13. Urodinamica: USI
2000
342 euro

14. Urodinamica: USI
OPUS trial 2012

15. Urodinamica: USI

16. OPUS trial 2012
Urodinamica: USI
The authors estimated that
in asymptomatic female
population, at 12 months,
6.3 prophylactic slings
would have to be inserted
to prevent one woman
from becoming stress
incontinent after prolapse
repair.

17. Urodinamica: USI

18. Urodinamica: USI
CONCLUSIONS

19. Urodinamica: USI
OPUS trial 2012
The authors who are in favour of urodynamics
in women with POP, often claim that this
evaluation, in women without symptoms of
SUI, enables the demonstration of occult stress
incontinence (OSI) and possibly its treatment.
However, this has not been well-demonstrated
and, moreover, the best way to unmask the
OSI during urodynamics, is not
standardised and universally
accepted.

20. Urodinamica
2007
OSI is diagnosed in about 50% of the patients
with genital prolapse not reporting
stress incontinence before surgery

21. Urodinamica
2007

22. Urodinamica: USI

23. Urodinamica: USI

24. Urodinamica: USI

25. Urodinamica: USI

26. Urodinamica: USI
It seems evident that even if urodynamics could
diagnose OSI, using validated and standardised
methods (which is not true at the time), there would
be no scientific evidence that it is always appropriate
and convenient to associate the two surgical
procedures. Therefore, the urodynamics
diagnosis would still not be able to
change with absolute certainty the
surgical choice

27. Quando farla prima della
chirurgia del prolasso?
Urodinamica
CONCOMITANTE SUI
SINTOMI IRRITATIVI
VOIDING DYSFUNCTION

28. Urodinamica: OAB
…Another argument put forward by supporters UDS is that these tests could
predict the persistence of symptoms of overactive bladder…
However, a significantly reduced cure rate with antimuscarinics
in women with OAB and concomitant anterior vaginal wall
descent has been demonstrated

29. Urodinamica: OAB
J Urol. 2001 Dec;166(6):2263-6.
Resolution of motor urge incontinence after
surgical repair of pelvic organ prolapse.
Nguyen JK, Bhatia NN
…women with POP and concomitant
symptomatic detrusor overactivity (DO)
there is resolution of DO in approximately
two-thirds of women after prolapse
repair

30. Quando farla prima della
chirurgia del prolasso?
Urodinamica
CONCOMITANTE SUI
SINTOMI IRRITATIVI
VOIDING DYSFUNCTION

31. Urodinamica: voiding dysfunction

32. Urodinamica: voiding dysfunction

33. Urodinamica: voiding dysfunction

34. Urodinamica: voiding dysfunction

35. Urodinamica: voiding dysfunction

36. Urodinamica: voiding dysfunction

37. …CONCLUDENDO…
Urodinamica

38. Urodinamica
 OAB
 OSI

39. …but these informations rarely could change the
management plan or the type of surgical procedure…
Urodinamica

40. Urodinamica

41. Non ancora chiaro il suo ruolo nel
management preoperatorio
delle donne con prolasso ±
incontinenza urinaria da sforzo
Prolasso genitale
Urodinamica

42. Sacro Monte di Varese