Moderated Poster

Poster, Podium & Video Sessions

MP63-13: Does videourodynamic classification depend on patient positioning in patients with stress urinary incontinence?

Sunday, May 14
3:30 PM - 5:30 PM
Location: BCEC: Room 153

Presentation Authors: Hazel Ecclestone*, Eskinder Solomon, Rizwan Hamid, Mahreen Paksad, Daniel Wood, Tamsin Greenwell, Jeremy Ockrim, London, United Kingdom

Introduction: Videourodynamic studies (VUDS) are often used to assess stress urinary incontinence (SUI). Treatment options are based on the degree of hypermobility and intrinsic sphincter deficiency. The most common classification on VUDS of SUI by Blaivas-Olsson is described in the semi-oblique position. However, most urodynamics are performed supine or standing with advocates of standing position suggesting that this stance permits gravity to enhance prolapse and aid diagnosis. We assessed the difference in Blaivas-Olsson grading in either positions.

Methods: 121 consecutive women with SUI underwent videourodynamic study prior to operative intervention. SUI was assessed in both supine and standing positions and the extent of descent was classified according to Blaivas-Olsson criteria. Differences between the positions was assessed using Fisher's exact test with p <0.05 being significant. 

Results: 72 of 121 SUI classifications remained the same in both lying and standing positions. 49 gradings were upgraded with position (40%); no patients were downgraded. Of the 49 patients whose grading changed, 20 (16.5%) had non-demonstrable SUI converted to demonstrable (i.e. grade 0 converted to I, IIa, IIb or III); 22 patients with SUI in the supine position were upgraded by one grade (I -IIa (10) and IIa-IIb (12)) and 7 were upgraded by two grades from I to IIb (Figure).The difference in the distribution of SUI grading between supine and standing positions was statistically significant (p < 0.01)

Conclusions: 16.5% of patients only had SUI demonstrable in the standing position. 40% Blaivas-Olsson classifications were upgraded with patients in the standing position. This has important implications for practice. To best replicate symptoms, and minimise the chance of underestimating both incontinence and the degree of descent, we suggest that videourodynamics are performed using standardised methodology in both lying and standing positions.

Source Of Funding: none

Tamsin J. Greenwell, MB ChB, MD, FRCS (Urol)

University College London Hospital

Tamsin Greenwell has been a Consultant Urological Surgeon with Special Interest in Female, Functional and Restorative Urology ay University College London Hospitals, London UK since 2002. Her particular interests are; vesico-vaginal fistula, urethral diverticulum, male and female urethral and ureteric stricture, male and female recurrent urinary incontinence. She has an extensive interest in surgical education and was Postgradate Tutor for Urology for University College London from 2002-2008, the Royal College Surgeons of England Urology Tutor from 2006-2011 and British Association of Urological Surgeons Director of Education from 2011-2013. She runs the internationnally acclaimed Female Urology and Urogynaecology Masterclass at University College London Hospital anually in November each year with live surgical demonstrations. She is currently chair of the Functional Neur-Urology and Urodynamics section of the British Association of Urological Surgeons.


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MP63-13: Does videourodynamic classification depend on patient positioning in patients with stress urinary incontinence?

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