ABSTRACT
OBJECTIVE: To compare the diagnostic accuracy of two voiding trial methods to predict postoperative voiding dysfunction. METHODS: Women undergoing operations for urinary incontinence, prolapse, or both urinary incontinence and prolapse from November 2009 and March 2010 were randomized into one of two groups: retrograde or spontaneous. All patients underwent both techniques of voiding trials with randomization determining order. RESULTS: Fifty women were randomized to 25 per group. Failure rates were 62% for retrograde and 84% for spontaneous. Women who failed both had 12.6±14.4 days of retention compared with 2.5±2.1 days for those who failed only one method (P=.004). The retrograde method had 94.4% sensitivity and 58.1% specificity to detect postoperative voiding dysfunction lasting at least 7 days compared with the spontaneous method with 100% sensitivity and 25.8% specificity. Positive and negative predictive values for the retrograde method were 56.7% and 94.7%, respectively, compared with the spontaneous method with 43.9% and 100%. Retrograde was preferred by patients (51.1% compared with 44.4%) regardless of randomization. CONCLUSION: The retrograde method is more accurate in evaluating postoperative voiding dysfunction, although both tests had a low positive predictive value. A longer period of retention was seen with failure of both methods. Retrograde was preferred by patients and provides an efficient alternative to the spontaneous method of voiding trial. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT01091844. LEVEL OF EVIDENCE: I.
Subject(s)
Postoperative Complications/diagnosis , Urinary Incontinence/surgery , Urinary Retention/diagnosis , Uterine Prolapse/surgery , Cross-Over Studies , Female , Humans , Patient Satisfaction , Postoperative Complications/epidemiology , Postoperative Complications/physiopathology , Recovery of Function/physiology , Sensitivity and Specificity , Urinary Retention/epidemiology , Urinary Retention/physiopathology , Urodynamics/physiologySubject(s)
Interleukin-2/analysis , Interleukin-6/analysis , Obstetric Labor, Premature/diagnosis , Receptors, Interleukin-2/analysis , Biomarkers/analysis , Body Fluids/chemistry , Cervix Uteri/chemistry , Cohort Studies , Female , Humans , Predictive Value of Tests , Pregnancy , Retrospective Studies , Vagina/chemistrySubject(s)
Amniotic Fluid/chemistry , Bilirubin/analysis , Blood , Female , Hemoglobins/analysis , Hemolysis , Humans , Pregnancy , SpectrophotometryABSTRACT
BACKGROUND: Because respiratory distress syndrome (RDS) affects 1% of live births, accurate and rapid assessment of markers of fetal lung maturity is critical to clinicians in deciding whether to deliver a preterm infant. Our objective was to determine the optimal diagnostic cutoff value for the TDx-FLM II assay (Abbott Laboratories) for predicting clinically significant RDS. METHODS: Amniotic fluid TDx-FLM II data were collected retrospectively over 4 years. Women were included in the study if they had delivered within 72 h of TDx-FLM II testing and both the mother and infant charts could be reviewed. Women who had been treated with steroids and delivered unaffected infants were excluded from the analysis. The diagnosis of RDS was defined as infants who either were treated with surfactant and/or were placed on a ventilator and/or required continuous positive airway pressure for >1 day. RESULTS: A total of 185 women met all entry criteria (15 RDS, 170 non-RDS). A cutoff value for a mature result of >or=45 mg/g gave a sensitivity of 100% (95% confidence interval, 82-100%) and a specificity of 90% (95% confidence interval, 78-89%). CONCLUSIONS: The TDx-FLM II appears to predict clinically significant RDS when a cutoff of >or=45 mg/g is used for mature results. Further studies will be required to confirm these findings.