Women with uncomplicated stress incontinence who undergo invasive, expensive urodynamic testing prior to surgery are no better off than those merely evaluated in a physician office, according to a study published in the May 24 New England Journal of Medicine.
Health System was one of 11 centers in the country, and the only in Michigan, participating in the research funded by the National Institute of Diabetes and Digestive and Kidney Diseases and the Eunice Kennedy Shriver National Institute of Child Health and Human Development.
A total of 630 women with stress urinary incontinence, leakage of urine from physical exertion, were randomly assigned to have urodynamic bladder testing or office evaluation only. Their treatment success rates, measured by outcomes at one year, were nearly identical - 76.9 percent success in urodynamic-tested group versus 77.2 percent in the evaluation-only group. Incontinence severity, quality of life, and satisfaction were also no different as measured through a patient survey.
“This study shows that we can provide high quality care to many women with stress incontinence without invasive, expensive bladder testing that is uncomfortable and may put them at risk of infection,” says Larry Sirls, M.D., study co-author and Beaumont’s director for Female Pelvic Medicine and Reconstructive Surgery. “This is high-value, health care at its best. By changing this common pattern of care, we can maintain high quality treatment while lowering cost.”
In 2010, about 260,000 women in the United States had surgical treatment for stress urinary incontinence. Urodynamic studies assess bladder storage and emptying. They are commonly performed before surgery to aid in diagnosis and guide treatment decisions. Medicare payment is greater than $500 for the three-part urodynamic study.
The study findings suggest that for women with uncomplicated stress urinary incontinence a basic office evaluation is sufficient. The study did not address urodynamic testing in women with more challenging medical issues, such as urge incontinence, previous incontinence surgery, neurologic disease or those having surgery for pelvic organ prolapse.
Beaumont urologists offer endoscopic, robotic and laparoscopic surgical options as well as traditional surgeries. They also specialize in treatment for kidney stones; painful bladder conditions such as overactive bladder and incontinence; sexual dysfunction; urologic cancer; prostate conditions; male infertility; voiding dysfunction; and erectile dysfunction. In 2010, Beaumont opened the Women’s Urology Center, the first center in the Midwest dedicated and designed for women’s urological care and sexual dysfunction. Beaumont, Royal Oak is ranked on U.S. News & World Report’s “America’s Best Hospitals” 2011-12 list for urology.
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