Case Study: How Urodynamics Saved Sarah’s Life

Posted by Clark Love on Oct 20, 2017 11:42:53 AM

How Urodynamics Saved Sarah's LifeIn many instances, urodynamics are performed to diagnose relatively benign lower urinary tract disorders, such as stress urinary incontinence. However, sometimes urodynamics uncovers more serious diseases that require immediate attention, as was the case with Sarah, a 48 year old mother of three from New York. Here, we will share Sarah’s story about unexpectedly finding out she had cervical cancer after a routine urodynamics test.

Sarah’s Symptoms

Like many women with children, Sarah was experiencing stress urinary incontinence in the form of urine leakage when she coughed or sneezed. In addition, she occasionally felt pain during intercourse and had developed abnormal menstrual cycles.

She visited her urogynecologist to discuss the matter. Her doctor suggested she undergo urodynamics testing to address the stress urinary incontinence, which is not uncommon for a woman in her late forties with children. The urogynecologist preliminarily  suggested that Sarah might be experiencing perimenopause, which could explain changes in menstruation and pain during intercourse.

Diagnosing Cervical Cancer

Sarah’s urogynecologist ordered a full urodynamic assessment, which included her detailed medical history, a physical examination, and a multichannel urodynamic study that involved uroflowmetry, filling and voiding, cystometry, and a stress urethral pressure profile. While the test showed that Sarah did indeed have clinical signs of stress urinary incontinence (ultimately due to weak pelvic floor muscles), there were other abnormal findings that Sarah’s doctor found disconcerting.

For instance, while it is common for a woman with stress urinary incontinence to have dysfunction in storing urine, it is not common for a voiding dysfunction to be present as well.  The urodynamic test results showed that Sarah had problems both voiding and storing urine, which tipped off her physician there may be more going on than simply perimenopause as well as stress urinary incontinence. In addition, Sarah also showed severe detrusor instability.

When considered in conjunction with Sarah’s other symptoms of pain during intercourse and a sudden change in her menstruation cycle, Sarah’s doctor ordered more tests. After all, these two symptoms are among the most common indicators of cervical cancer, and 83% of women1 with cervical cancer also have abnormal urodynamic findings. Indeed, 6% of women with cervical cancer have genuine stress incontinence with detrusor instability.

To verify cervical cancer, Sarah’s urogynecologist ordered a Pap test, which indicated that Sarah did in fact have cervical cancer. Further testing showed she was Stage II.

Treatment

Due to the nature of Sarah’s cancer findings, she underwent radical hysterectomy with removal of her pelvic lymph nodes, in addition to chemotherapy. Following surgery and chemotherapy, Sarah underwent additional follow up urodynamic assessments. As could be expected, her bladder function2 was affected post-operatively, as bladder compliance was significantly reduced. In addition, maximal urethral closure pressure was lessened, as well. Hypertonic bladder dysfunction is believed to be brought on by an increase in myogenic tonicity of the detrusor muscle after surgical trauma, or because of neurologic denervation. Due to the worsening of her lower urinary symptoms, she underwent 8 months of clean intermittent catheterization until bladder function was restored to pre-surgical levels.

Following spontaneous bladder recovery, follow up urodynamic exams have shown that Sarah’s lower urinary tract symptoms were not significantly different prior to treatment for cervical cancer.

Outcome

Five years following Sarah’s bout with cervical cancer, she is still cancer free. She still struggles with genuine stress urinary incontinence following chemotherapy and radical hysterectomy, but is not a good candidate for surgery. Pelvic floor exercises and a vaginal pessary have improved Sarah’s quality of life.

How Urodynamics Saved Sarah’s Life

Sarah is a great example of the power of urodynamics testing. Stress urinary incontinence is the most common type of incontinence in women, and affects nearly 1 in 3 women during bouts of activity such as exercise, sneezing, or coughing. Sarah was also in the most common age-range of women diagnosed with stress urinary incontinence, at 48 years old. Her history of three vaginal childbirths also increased the likelihood of this disorder.

Cervical cancer can be asymptomatic for a long period of time, and women may confuse symptoms with other conditions, as Sarah’s doctor assumed she may be experiencing the early stages of menopause. The main symptoms of cervical cancer include pelvic pain, abnormal menstruation, abnormal vaginal discharge, fatigue, nausea, and weight loss. Since Sarah’s cancer had already progressed to stage II and she had not recognized the symptoms, the chances that her cancer would have progressed unnoticed are high. Ultimately, the abnormalities found during Sarah’s urodynamic test for stress urinary incontinence saved her life.

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References

  1. Lin HH, Yu HJ, Sheu BC, Huang SC. Importance of urodynamic study before radical hysterectomy for cervical cancer. Gynecol Oncol. 2001;81(2):270-2.
  2. Seski JC, Diokno AC. Bladder dysfunction after radical abdominal hysterectomy. Am J Obstet Gynecol. 1977;128(6):643-51.

Topics: Urodynamics Testing