SUFU 2019: Sling Revision for Bladder Outlet Obstruction in Women with Primarily Storage Symptoms: What are the Best Urodynamic Criteria to Predict Outcomes?

Miami, FL ( Bladder outlet obstruction (BOO) is a known complication following procedures for the treatment of stress urinary incontinence, occurring ranging from 2.5-24%. Urodynamics has often been employed to better evaluate the lower urinary tract in these cases, although its role remains unclear. However, it may be useful in patients who primarily have storage symptoms after anti-incontinence procedures. Five urodynamic criteria have been proposed to define BOO in females based on pressure-flow studies (Zimmern criterion, Blaivas-Groutz nomogram, BOO index (BOOi), Solomon nomogram) or video-fluoroscopy (Nitti video-urodynamic (VUD) criteria).

Christina Escobar, MD, of New York University, sought to determine which of the five urodynamic criteria best predicts surgical outcomes of women who undergo sling revision for storage symptoms. A retrospective chart review was performed for 33 female patients who underwent sling revision for storage symptoms between 2010 and 2018 at her institution. The primary outcome was patients’ reported changes in post-operative storage symptoms after surgery, including frequency, urgency, and urge incontinence. ROC curves were generated to compare the predictive values of each of the five urodynamic criteria.

Of the 33 women included in the study, 25.8% underwent sling excision, 2.6% underwent sling incision, and 6.2% underwent urethrolysis. 15.1% of patients had complete resolution of symptoms (cured), 48.5% were improved, 27.3% were unchanged, and 9.1% were worsened, such that 63.6% of patients met the primary endpoint (storage symptoms cured/improved).

Of patients with primary storage symptoms who were clinically thought to be obstructed from a sling, 45.5% met Zimmern criteria, 66.7 % met Blaivas criteria, 24.2% met BOOi criteria for obstruction, and 39.4 % were classified as “obstruction almost certain”using Solomon criteria.  48.4% met Nitti VUD criteria. The ROC curves of all 5 criteria were generated, as seen in Figure 1. The VUD criteria had the best predictive value with a specificity of 67% and a sensitivity of 57.9%, although it did not reach statistical significance (p=0.16).
UroToday SUFU2019 Sling Revision for Bladder Outlet Obstruction

The authors concluded that when utilizing the various criteria for BOO in females, there was no significant evidence to support their predictive value for favorable outcomes in patients with clinical obstruction and storage symptoms.

Presented by: Christina Escobar, MD, NYU Langone Health

Written by: Judy Choi, MD, Assistant Professor, Department of Urology, University of California, Irvine @judymchoi at the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction Winter Meeting, SUFU 2019, February 26 - March 2, 2019, Miami, Florida