Urodynamic testing can change treatment plan.

HOLLYWOOD, FLA. -- The addition of multichannel urodynamic testing data changed treatment recommendations for medical and surgical management of women with urinary incontinence in one small study.

To determine if the additional information provided by this technology was likely to change treatment recommendations, Dr. Renee M. Ward and associates randomly selected charts of 39 women whose chief complaint was urinary incontinence.

Four fellowship-trained urogynecologists reviewed charts in randomized order--excluding multichannel urodynamic findings--for 156 physician evaluations. Inter-reader variability was 3% or less. Charts were labeled with false patient names. Mean patient age was 57 years; median parity was two. A total of 10% reported urge incontinence symptoms, 21% had stress symptoms, and 69% had mixed symptoms.

"Each urogynecologist reviewed the history and physical data, and then made recommendations for diagnosis and treatment," Dr. Ward said at the annual meeting of the American Urogynecologic Society.

Two weeks later, the charts were rerandomized, patient names were changed again, and the multichannel urodynamic data were added. Then the same urogynecologists again made diagnosis and treatment recommendations.

"The diagnosis changed significantly with the addition of multichannel urodynamics," said Dr. Ward of Brown University and Women and Infants' Hospital, both in Providence, R.I. The probability that an initial urge incontinence diagnosis would change was 41%; for a stress incontinence or mixed incontinence diagnosis, probability was 36%. The probability that medical management would change was an average 27%, and that surgical management would change was 46%.

BY DAMIAN MCNAMARA

Miami Bureau