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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. _x000D_

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)_x000D_

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.

Funding

none