ICS 1999, Denver
Informally discussed posters
Urodynamics
Comparison of multichannel and video urodynamic studies in patients with overt an/or latent stress urinary incontinence and/or voiding dysfunction

J.A. Schulz, K.M. Smith, H.P. Drutz
Urogynecology Unit, Mount Sinai Hospital, Toronto, Canada

Aims of Study: Symptoms of urinary incontinence often do not correlate well with the urodynamics diagnosis. Video urodynamics has been described as the "gold standard" investigation for patients with lower urinary tract symptoms; however, latent stress urinary incontinence (SUI) may be missed during urodynamic investigations. Multiple techniques, including the use of pessaries, vaginal packs, and cotton swabs, have been described to reduce vaginal prolapse and unmask SUI. The aim of our study was to compare the results of multichannel and video urodynamic studies in patients with overt and/or latent SUI and/or voiding dysfunction referred to a tertiary care urogynecology unit.

Methods: We retrospectively reviewed 30 women who had both standard multichannel and video urodynamic studies in 1997 and 1998. Patients were excluded if their studies had been separated by more than 12 months, or if they had had any significant intervention, such as surgery, between tests. All patients had a complete history and pelvic floor assessment. The investigators completing each urodynamic study were blinded to the clinical diagnosis, physical findings, and the other urodynamics diagnosis. International Continence Society standards were followed for completion of the urodynamics investigations. Multichannel studies were completed in the supine position, and video studies were performed sitting on a commode. All studies were performed without any device in the vagina.

Results: The median patient age was 61 years (range 14-79), with a median duration of lower urinary tract problems of 6 years (range 0.5-41). 28 women had a primary complaint of urinary incontinence, 1 had irritative urinary symptoms but no incontinence, and 1 had retention and suprapubic pressure. 24 were postmenopausal, but only 17 were on some form of hormone replacement therapy. Patients had had a median number of 2 previous bladder surgeries (range 0-5). 5 women had latent SUI demonstrated on physical examination. Of these 5 women, 3 had SUI on the multichannel only, 1 on both the multichannel and the video, and 1 on neither urodynamic study. Only 8 patients (27%) had the same diagnosis made form both investigations. 3 video studies detected detrusor instability that was not demonstrated on the multichannel studies. 11 video studies did not detect stress incontinence that was demonstrated on multichannel studies; 3 video studies demonstrated stress incontinence that was not demonstrated on multichannel studies.

SI on multichannel SI on video
(n=21) (n=13)
overt SI on exam 12 11
(n=19)
latent SI on exam 4 1
no SI on exam 5 1

Conclusions: Urodynamics investigations are a tool that we may use to assist in the diagnosis of urinary incontinence and voiding dysfunction. However, no investigation exists at this time that can be classified as a "gold standard". Further studies are required to determine the best method to detect latent stress incontinence.