The value of preoperative urodynamics according to gynecologists and urologists with special interest in stress urinary incontinence

Abstract

Introduction and hypothesisThe aim of this study is to assess variations in practice in the use of preoperative urodynamics in women with stress urinary incontinence (SUI).MethodsWe performed an E-survey among all Dutch gynecologists and urologists who have SUI as focus in daily practice. The questions concerned the common policy and preferred policy. Descriptive statistics were used.ResultsOf the 260 targeted specialists, 163 (63%) responded. We found that 37% of the respondents performed standard preoperative urodynamics; in the preferred practice, this would reduce to only 18%. Eighty percent indicated they would operate a patient with a positive stress test without urodynamic SUI, whereas 21% would do this also in case the clinical stress test was negative. Only 9% of the respondents indicated they adapted the choice of the type of sling based on urethral pressure profilometry parameters.ConclusionsUrodynamics are not routinely performed, and outcomes hardly influence the choice of treatment.Electronic supplementary materialThe online version of this article (doi:10.1007/s00192-011-1565-2) contains supplementary material, which is available to authorized users.

Does pre-operative urodynamics lead to better outcomes in management of urinary incontinence in women? A linked systematic review and meta-analysis

“…Interestingly, a Dutch survey in 2011 completed by gynaecologists (n = 103) and urologists (n = 60) representing 80 hospitals, has shown that only 37% performed urodynamics as part of routine investigation prior to SUI surgery, while 88% stated that a positive stress test during clinical examination would be sufficient for them to proceed with surgery. In this review, the commonest indications for urodynamics prior to surgery were symptoms indicating possible DO such as urgency [37]. Another survey in 2012 of gynaecologists (n = 400) and urogynaecologists (n = 200) conducted in the UK showed that the majority of surgeons agreed that urinary diary (95.8%), free uroflowmetry (94.2%), multichannel subtraction filling cystometry (99.5%), and voiding cystometry (98%) should be amongst the tools for UI assessment when contemplating secondary surgery [38].…”

Urodynamics prior to surgery for urinary stress incontinence

“…80% of them indicated that they would operate on a patient with a positive stress test without urodynamics SUI, whereas only 21% would do this also in case the clinical stress test was negative. Many would not undertake primary surgical treatment when pre-operative DO is found 6 .…”

Authors' response re: Do preoperative urodynamics still have a role in female stress urinary incontinence? Neurourol Urodyn 2013;32:1144–5

“…However, recent evidence‐based recommendations for the treatment of stress incontinence did not utilize intrinsic sphincter deficiency and bladder neck hypermobility as primary determinants in the selection of the type of sling . Furthermore, in a survey among gynecologists and urologist, treating SUI in daily practice, we found that only 9% of the specialists differentiate in the choice of sling on measurement of the closure mechanism . The majority of specialists apply only one type of sling procedure, which is possibly due to surgeon's experience and familiarity with that specific type.…”