Comments on “A randomized trial of urodynamic testing before stress‐incontinence surgery” (N Engl J Med. 2012 May 24;366(21):1987–1997) From the Italian Society of Urodynamics

Abstract

4 who showed that only 5% of patients with urinary incontinence at a tertiary care center in the United Kingdom had an isolated diagnosis of ''pure stress urinary

The role of urodynamics in the management of female stress urinary incontinence

“…All these randomized trials presented some biases and in particular their conclusions are applicable only to a selected population of women with SUI, the so‐called “uncomplicated” or index patients. This population, as demonstrated by Serati et al, represents only one‐third of all the female SUI patients evaluated before surgery.…”

Urodynamics Useless in Female Stress Urinary Incontinence? Time for Some Sense—A European Expert Consensus

“…Robustly designed RCTs must always be welcomed, and if their findings challenge accepted clinical practice, they must be taken very seriously. However, no fewer than six major criticisms of the VALUE and VUSIS studies have been highlighted [14,15,[21][22][23][24][25][26][27][28][29][30][31][32][33][34][35], including the fact that the narrow participant cohort was unrepresentative of the SUI population. These criticisms are explained in full in Table 1.…”

“…1. Finazzi-Agro et al [29] have pointed out that the two study arms in the VALUE trial appeared to be imbalanced in terms of many relevant variables. Questions have been raised about the quality of UDS practice undertaken in both the VALUE and VUSIS studies and the possibility of subjective interpretation of findings at contributing study sites.…”

The evidence for urodynamic investigation of patients with symptoms of urinary incontinence

“…This indicates that symptom assessment does not give very sensitive, nor very specific, results with which to define the precise dysfunction of the lower urinary tract. Recruitment of data from a recent large study demonstrates that only a very small proportion of patients referred with urinary incontinence could be diagnosed as “uncomplicated stress-predominant urinary incontinence” on the basis of symptoms and the sign of urinary loss during stress testing [19,20]. Nevertheless, the correlation of the symptom “stress urinary incontinence” (expressed by the patient or concluded after questioning by the physician) with the result of urodynamic investigation is somewhat better than the correlation of urgency urinary incontinence (expressed, or questioned) with urodynamic investigation [21].…”