Clarifying the Role of Urodynamics in the Preoperative Evaluation of Stress Urinary Incontinence

Fletcher, Sophie; Lemack, Gary E.

doi:10.1100/tsw.2008.159

Cited by 21 publications

(23 citation statements)

References 58 publications

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“…Second, the factors identified on preoperative urodynamic testing that traditionally have been considered to increase the risk of a poor outcome after surgery for stress incontinence (e.g., intrinsic sphincter deficiency, detrusor overactivity, and voiding dysfunction) may not be predictive of a poor outcome. 23 A randomized clinical trial of the Burch colposuspension versus the autologous fascial sling showed that typical urodynamic measures did not predict the likelihood of successful treatment of stress incontinence 24 or the risk of postoperative voiding dysfunction. 25 Even if some urodynamic measures predict worse outcomes in some patients than in others, they may not be indications for a change in surgical management.…”

Section: Discussionmentioning

confidence: 99%

A Randomized Trial of Urodynamic Testing before Stress-Incontinence Surgery

et al. 2012

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BACKGROUND Urodynamic studies are commonly performed in women before surgery for stress urinary incontinence, but there is no good evidence that they improve outcomes. METHODS We performed a multicenter, randomized, noninferiority trial involving women with uncomplicated, demonstrable stress urinary incontinence to compare outcomes after preoperative office evaluation and urodynamic tests or evaluation only. The primary outcome was treatment success at 12 months, defined as a reduction in the score on the Urogenital Distress Inventory of 70% or more and a response of “much better” or “very much better” on the Patient Global Impression of Improvement. The predetermined noninferiority margin was 11 percentage points. RESULTS A total of 630 women were randomly assigned to undergo office evaluation with urodynamic tests or evaluation only (315 per group); the proportion in whom treatment was successful was 76.9% in the urodynamic-testing group versus 77.2% in the evaluation-only group (difference, −0.3 percentage points; 95% confidence interval, −7.5 to 6.9), which was consistent with noninferiority. There were no significant between-group differences in secondary measures of incontinence severity, quality of life, patient satisfaction, rates of positive provocative stress tests, voiding dysfunction, or adverse events. Women who underwent urodynamic tests were significantly less likely to receive a diagnosis of overactive bladder and more likely to receive a diagnosis of voiding-phase dysfunction, but these changes did not lead to significant between-group differences in treatment selection or outcomes. CONCLUSIONS For women with uncomplicated, demonstrable stress urinary incontinence, preoperative office evaluation alone was not inferior to evaluation with urodynamic testing for outcomes at 1 year. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases and the Eunice Kennedy Shriver National Institute of Child Health and Human Development; ClinicalTrials.gov number, NCT00803959.)

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Section: Discussionmentioning

confidence: 99%

A Randomized Trial of Urodynamic Testing before Stress-Incontinence Surgery

et al. 2012

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“…It is also known that persistence or worsening of the UUI after surgery negatively affects the outcome of MUS procedures [21, 22]. Furthermore, DO might play a role in predicting post-operative overactive bladder symptoms [23].…”

Section: Discussionmentioning

confidence: 99%

When to perform urodynamics before mid-urethral sling surgery for female stress urinary incontinence?

et al. 2009

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Introduction and hypothesisDevelopment of a model that can predict in which group of women pre-operative urodynamics can be safely omitted.MethodsThree hundred and eighty-one uncomplicated women who underwent pre-operative urodynamics were evaluated. A multivariate logistic regression model was developed based on medical history and physical examination predicting a high probability group of women with detrusor overactivity or a low (<20 cm H2O) mean urethral closure pressure and, therefore, are likely to benefit from urodynamics.ResultsWomen are likely to benefit from pre-operative urodynamics if they (1) are 53 years of age or older or (2) have a history of prior incontinence surgery and are at least 29 years of age or (3) have nocturia complaints and are at least 36 years of age.ConclusionIf urogynaecologists omitted pre-operative urodynamics in women in the low probability group, in our population, pre-operative urodynamics would be reduced by 29%.

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“…Indeed, published evidence is divided regarding the routine use of UDS for evaluation of SUI [11,12]. Multiple studies have attempted to define specific clinic parameters that predict SUI and would preclude the necessity for UDS.…”

Section: Female Intrinsic Sphincter Deficiencymentioning

confidence: 99%

Current Status of Urodynamics for Evaluation of Incontinence

Whittam

Kaufman

Dmochowski

2010

Curr Bladder Dysfunct Rep

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Urinary incontinence, defined by the International Continence Society as the complaint of any involuntary leakage of urine, remains a condition with profound impact for the individual patient and global medical economics. The etiology of a patient's urinary incontinence can be difficult to determine, even when using a combination approach of symptom appraisal, thorough history and physical examination, and noninvasive testing. Urodynamic evaluation provides an objective analysis of the storage and voiding aspects of detrusor function, often delineating the underlying mechanisms for bladder or sphincter dysfunction resulting in incontinence. This review summarizes current literature regarding recommendations for utilization of urodynamics in the evaluation of incontinence. Herein we recap the available data regarding use of urodynamics in intrinsic sphincter deficiency, overactive bladder, bladder outlet obstruction, and neurological disease. We intend for these data to highlight the need for a structured evaluation and treatment of urinary incontinence and appropriate use of resources to accommodate the dual missions of patient care and fiscal responsibility.

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Clarifying the Role of Urodynamics in the Preoperative Evaluation of Stress Urinary Incontinence

Cited by 21 publications

References 58 publications

A Randomized Trial of Urodynamic Testing before Stress-Incontinence Surgery

A Randomized Trial of Urodynamic Testing before Stress-Incontinence Surgery

When to perform urodynamics before mid-urethral sling surgery for female stress urinary incontinence?

Current Status of Urodynamics for Evaluation of Incontinence

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