Outcomes of Multichannel Urodynamic Study-Guided Concomitant Burch Colposuspension During Abdominal Sacrocolpopexy: A Retrospective Cohort Study.

BACKGROUND: This study aimed to evaluate outcomes following a preoperative strategy in which invasive multichannel urodynamic testing guided the decision to perform concomitant Burch colposuspension during abdominal sacrocolpopexy. A secondary objective was to assess whether a non-invasive diagnostic test could predict urodynamic stress urinary incontinence (USUI) in patients with severe apical pelvic organ prolapse scheduled for abdominal sacrocolpopexy. METHODS: A retrospective review of medical records was performed for patients who underwent abdominal sacrocolpopexy. Patients with USUI underwent concomitant Burch colposuspension (Group 1), while those without underwent abdominal sacrocolpopexy alone (Group 2). Both groups were assessed for postoperative satisfaction, pre- and postoperative stress urinary incontinence status and changes in symptom questionnaire scores. In addition, non-invasive parameters were identified to predict the presence of USUI, as detected by multichannel urodynamic study across the entire cohort. RESULTS: Groups 1 and 2 consisted of 53 (48.6%) and 56 (51.4%) patients, respectively. The median follow-up time was 16 months (interquartile range: 12-21). Based on the Patient Global Impression of Improvement, satisfaction rates (defined as responses of "a little better" or greater) were 92.5% and 94.6% in Groups 1 and 2, respectively. Postoperative symptom questionnaire scores significantly improved in both groups; notably, postoperative stress urinary incontinence (SUI) status significantly improved only in Group 1 (p < 0.001). Multivariable logistic regression and modified Poisson regression analyses demonstrated that a positive provocative stress test with prolapse reduction was independently associated with USUI. CONCLUSIONS: When preoperative multichannel urodynamic study identified USUI, combining abdominal sacrocolpopexy with Burch colposuspension yielded favorable surgical outcomes. Although the provocative stress test with prolapse reduction may serve as a screening tool for predicting preoperative USUI in patients with severe apical pelvic organ prolapse undergoing abdominal sacrocolpopexy, it cannot yet be considered a substitute for multichannel urodynamic study.