Urodynamic testing prior to hysterectomy

dirtboysdadFebruary 11, 2006

Actually, I'm not dirtboysdad, but rather his mother.

Anyway, my GYN wants me to have urodynamic testing done by a urogynecologist before I undergo a hysterectomy for a prolapse. She tells me that it will help to determine if I will suffer from incontinence after the surgery. I have no incontinence now.

I've read about the test - it seems to be extremely invasive and on the verge of humiliating - especially since the doctor is a male and I don't wish go to anyone but a female physician ever again. (I also don't trust that in the absence of symptoms it's not hocus-pocus.)

So, my question: has anyone ever had urodynamic studies for possible post-hysterectomy incontinence? Was it awful? What were the results?


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Do you trust your GYN? If you don't trust her recommendation to take the test, why are you willing to trust her for the surgery? And do you realize that you are about to deny her some important information, because you are embarrassed about urine?

He's a male doctor ... so what? Get a good friend to go with you to the testing for support. If the best doctor to do the procedure were a Martian, your GYN would recommend the alien.

It's less invasive than a thorough pelvic exam, moderately uncomfortable (they use a local anaesthetic for the catheter), and it's only humiliating if you think it will be.

It gives them a baseline for how well the whole bladder/nerve interaction works BEFORE the surgery, which guides them in therapy (and there will be therapy) after the surgery to restore muscle function.

    Bookmark   February 12, 2006 at 2:16PM
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Have you had the test done, lazygardens, or are you just preaching?

Actually, I have inplicit faith in her my GYN's skills as she's operated on me in the past.

Sorry - I don't trust the motive of any male who in this day and age would choose gynecology as a speciality.

    Bookmark   February 12, 2006 at 5:37PM
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Been there, done that. I've had something similar to the extremely similar test that is done for interstitial cystitis: basically they fill the bladder with water and send a small scope into it to examine the inside while it is distended. In my case I was volunteering to TEACH the procedure and report to the resident what their technique was like. Because of that, I was also not under general or spinal anaesthesia and they didn't crank up the pressure as high as usual.

"I don't trust the motive of any male who in this day and age would choose gynecology as a speciality."
Why not? I've known some absolutely outstanding male OB-GYN specialists. The only doctor who ever made unprofessional moves on me was doing an EYE exam. You will note that they will have a nurse in the exam room, and probably won't mind if you ask to have a friend along for support.

Do you also suspect adults who choose to treat children of the opposite sex of being perverts? GYN can be a fairly "happy" specialty, comnpared to ... say ... cardiac surgery or oncology.

    Bookmark   February 13, 2006 at 8:44AM
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Having worked as an assistant to the administrator of a large hospital, I learned very quickly to pick my physicians with extreme care.

Having thoroughly read this physicianÂs website, it immediately strikes me that he is narcissistic as he minces no words in telling readers how wonderful he is  a trait that many more male than female physicians seem to have.

(Motives can be prurient, ego centered or monetary. I once walked out on a pediatrician who was telling me there was no way my child had a strep throat and who started to berate me for wasting his time. I knew my daughter and knew she had a strep throat. After, that we changed doctors  to a good old GP whose philosophy was that I knew my child better than he could ever hope to.)

Further, I would never even think of asking anyone to take time off from work to accompany me to a medical appointment even if any of my friends lived close enough to me to be able to do so. ThatÂs selfish and inconsiderate.

I have also learned that there would seem to be an unspoken agreement that GYNÂs in this area will refer their patients to this particular physician prior to surgery. IÂm not certain that is done with the best interest of the patient in mind but rather has more to do with garnering patients for research purposes  and IÂm not a guinea pig.

Your argument about physicians and children does not apply, as a parent is always present when a child is being treated.

And finally, your post convinced me to not have this testing done as I would never drive 80 miles round trip for any kind of post-op "therapy", therefore making any testing both a waste of time and money  especially the insurance companyÂs money. ItÂs bad enough that I have to make the trip to the hospital twice before surgery let alone do it on a somewhat regular basis for therapy.

    Bookmark   February 13, 2006 at 9:54AM
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I don't understnd something here. You trust your Gyn enough to allow her to treat you and to perform your surgery, yet you distrust her motives when she suggests a Urodynamic procedure. Why?

In this area when most MDs refer to the same specialist it's because he's the best in the field. Especially when
they send their family members as well as their patients. No hidden agenda; just the best doctor for the job.

This procedure may affect the outcome of your surgery. Won't you reconsider?

    Bookmark   February 21, 2006 at 9:08PM
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Interestingly, I've spoken with one person who has had the procedure done for the same problem I have.

She said that had she known what it was going to be like she never would have had it done - said the procedure was in her words "degrading" and the doctor very unlikeable. She had the surgery done and learned afterwards that the failure rate for the surgery she had is about 12-15%; incontinence after hysterectomy runs a bit less from what I've read, about 10%.

Further, she was also told that she should never again pick up anything that weighs over 20 lbs. That came as a shock to her as it did to me as she works at a job that can entail heavy lifting and I, as a gardener, am accustomed to lifting bags of mulch, sand, compost, etc. that tend to weigh well over 40 lbs. let alone 20 lbs.

With this knowledge in mind, I am rethinking the surgery totally.

I have a friend who had a TVT done 3 years ago, at UC Davis, and her procedure is already beginning to fail, even though she was told it should last 5 years.

    Bookmark   February 22, 2006 at 6:57PM
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The results should be better than you're quoting. What kind of prolapse do you have? Vaginal/Uterine/Bladder? Is the doctor talking about inserting a mesh support? Being at a normal weight is a great benefit after the surgery for longer lasting results. Are you overweight?
There are surgeons who have a lower success rate than others. If you want to know which doctor to select, then surgical nurses are the ones to ask. Ask which doctor they would have perform their surgery.
Does your surgeon perform many of these procedures or only a few a year? Are there any Gyn/Urologists in your area? They might be more expert in treating your condition than your regular MD.

You distrust male Gyn's but have you ever considered that a female Gyn might be gay? We have one or two here in our town. We also have a couple of male Gyn's that are gay.

I'm just asking if this would make a difference in your choice of doctors. Just curious.

    Bookmark   February 22, 2006 at 11:19PM
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I've been to two lesbian medical practitioners - one was so frightening that I would never go back (and she was an eye doctor!); the other was a wonderful nurse practitioner - the only reason I left her was because I moved.

BTW, one poster insisted there would be therapy after surgery if I allowed the urogyn to join the surgical team - just wanted to let her know that post-surgical therapy was never mentioned to the woman I reference in an above post.

    Bookmark   February 23, 2006 at 7:35AM
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Well, three weeks ago I had my surgery and all went well without any urodynamic testing.

And interestingly, just today, I was trying to find an e-mail addy for the patient rep at the hospital where I had my surgery and while I could not find the addy, I did come across a page of "non-accredited" urogynecology programs - and guess which one is not accredited - the one to which I was referred. Just confirms my suspicion that all gyns planning to do hysterectomies are asked (required?) to refer their patients to this particular program. They need the patient numbers in order to become accredited.

    Bookmark   April 15, 2006 at 10:31AM
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Interesting. I had wondered just why bother with the testing at all. If you need the hysterectomy, then that's what you need. Whether or not it will make a woman incontinent should not be a deciding factor. A large number of women will have trouble with leaking because of the aging body, not because of a hysterectomy. There are also degrees of problems....a dribble now and then when sneezing or no control at all are two very different things.

    Bookmark   April 15, 2006 at 10:44AM
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You said it all, Agnespuffin. I think the premise of all this, which I called hocus-pocus and I stand by that, is that this "testing" would be able to determine if the patient might have certain perameters that could portend incontinence. If so, then this urogynecologist would participate in the surgery and do whatever it is that he does in an attempt to stave off the onset of incontinence.

But no matter what he might have done, it's not permanent and at this time, there is no follow-up surgery to repair the repair. That is the case with what my surgeon did also.

Had I had serious symptoms, I would have considered the testing. But in the absence of any symptoms, I just could not see going through a degrading series of tests.

    Bookmark   April 15, 2006 at 12:18PM
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For others in this same situation I'd suggest visiting the choice for prolapse site at http://groups.msn.com/ChoiceforProlapse.
I am experiencing prolapse and find that this site offers a great deal of advice coming from experience.

    Bookmark   February 28, 2007 at 12:16PM
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