urodinamica prima della chirurgia per prolasso

MAURIZIO SERATI Clinica Ostetrica e GinecologicaUniversità degli Studi dell’Insubria - Varese

URODINAMICA PRIMA DELLA CHIRURGIA

PER PROLASSO

CONTRO

PERCHE’ PROPRIO IO?

PERCHE’ PROPRIO IO?

It’s better to be tormented by

doubts, rather than run the risk of living

with the wrong conviction

PERCHE’ PROPRIO IO?

PROLASSO GENITALE

Urodinamica

Prolasso genitaleUrodinamica

CONCOMITANTE SUISINTOMI IRRITATIVIVOIDING

DYSFUNCTION

Quando farla prima della chirurgia del prolasso?

Urodinamica

Quando farla prima della chirurgia del prolasso?

Urodinamica

CONCOMITANTE SUISINTOMI IRRITATIVIVOIDING

DYSFUNCTION

Urodinamica CONCOMITANTE SUI

Diagnosi Terapia

Urodinamica CONCOMITANTE SUI

Manifesta Occulta

Urodinamica CONCOMITANTE SUI

Urodinamica: USI

2000

342 euro

Urodinamica: USIOPUS trial 2012

Urodinamica: USI

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.

Urodinamica: USI

Urodinamica: USI

CONCLUSIONS

Urodinamica: USIOPUS 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.

Urodinamica

2007OSI is diagnosed in about 50% of the patients

with genital prolapse not reporting stress incontinence before surgery

Urodinamica

2007

Urodinamica: USI

Urodinamica: USI

Urodinamica: USI

Urodinamica: USI

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

Quando farla prima della chirurgia del prolasso?

Urodinamica

CONCOMITANTE SUISINTOMI IRRITATIVIVOIDING

DYSFUNCTION

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

Urodinamica: OABJ 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

Quando farla prima della chirurgia del prolasso?

Urodinamica

CONCOMITANTE SUISINTOMI IRRITATIVIVOIDING

DYSFUNCTION

Urodinamica: voiding dysfunction

Urodinamica: voiding dysfunction

Urodinamica: voiding dysfunction

Urodinamica: voiding dysfunction

Urodinamica: voiding dysfunction

Urodinamica: voiding dysfunction

…CONCLUDENDO…

Urodinamica

Urodinamica

OAB OSI

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

Urodinamica

Urodinamica

Non ancora chiaro il suo ruolo nel management preoperatorio delle donne con prolasso ±

incontinenza urinaria da sforzo

Prolasso genitaleUrodinamica

Sacro Monte di Varese