Wednesday, May 2, 2012

Expensive Diagnostic Test may not be Necessary before Stress Incontinence Surgery

Loyola study challenges common practice

MAYWOOD, Ill.  -- A routine but expensive test for women who undergo stress incontinence surgery may not always be necessary, according to a study published in the latest issue of The New England Journal of Medicine. This test, known as urodynamics, determines how the bladder stores and releases urine. The study found that women who underwent a doctor’s evaluation and urodynamics versus a doctor’s evaluation alone did not have better outcomes after stress incontinence surgery.

“Urodynamic tests are commonly performed in women before stress incontinence surgery despite their high cost and a lack of evidence that the test improves outcomes for patients,” said Linda Brubaker, MD, MS, study co-author, division of Female Pelvic Medicine and Reconstructive Surgery, Loyola University Health System (LUHS). “This study provides the first good indication that this test is not necessary for many of these patients."

The study evaluated 630 women with stress incontinence at 11 centers across the country. Half of the study participants underwent an office evaluation plus urodynamics and the other half underwent an office evaluation alone before surgery. Treatment success was determined using a 20-item, patient-reported tool that assesses presence and degree of urinary incontinence, urgency, frequency and difficulty urinating. The proportion of women who achieved treatment success after one year was 76.6 percent versus 77.2 percent, respectively. There also were no significant differences between groups in urinary incontinence severity, quality of life, patient satisfaction or other side effects.

Stress incontinence surgery corrects urine leakage from physical activity, such as laughing, coughing, sneezing or exercise. Approximately 260,000 women underwent this surgery in 2010. Urodynamic studies were performed in many of these patients. In addition to the cost and the lack of evidence to support use of this test, urodynamics also causes discomfort and an increased risk of urinary-tract infections in women.

“These results have the potential to positively influence care and minimize testing-associated problems,” said Dr. Brubaker, who also is dean of Loyola University Chicago Stritch School of Medicine. “These findings also represent a significant cost savings for patients and the health-care system.”

About Loyola University Health System

Loyola University Health System (LUHS) is a member of Trinity Health. Based in the western suburbs of Chicago, LUHS is a quaternary care system that includes Loyola University Medical Center (LUMC), located on a 61-acre campus in Maywood, Gottlieb Memorial Hospital (GMH), on a 36-acre campus in Melrose Park, and convenient locations offering primary and specialty care services throughout Cook, Will and DuPage counties. At the heart of LUMC is a 547-licensed-bed hospital that houses the Center for Heart & Vascular Medicine, the Cardinal Bernardin Cancer Center, a Level 1 trauma center, a burn center, a children's hospital, Loyola Outpatient Center, and Loyola Oral Health Center. The campus also is home to Loyola University Chicago Stritch School of Medicine, Loyola University Chicago Marcella Niehoff School of Nursing and the Loyola Center for Fitness. The GMH campus includes a 254-licensed-bed community hospital, a Professional Office Building with 150 private practice clinics, an adult day care program, the Gottlieb Center for Fitness, the Loyola Center for Metabolic Surgery and Bariatric Care and the Loyola Cancer Care & Research at the Marjorie G. Weinberg Cancer Center at Melrose Park.

Trinity Health is one of the largest multi-institutional Catholic health care delivery systems in the nation. It serves people and communities in 22 states from coast to coast with 93 hospitals, and 120 continuing care locations — including home care, hospice, PACE and senior living facilities — that provide nearly 2.5 million visits annually.