Are Urodynamic Studies Necessary in Patients With Stress Urinary Incontinence?

Urodynamic studies prior to surgery in women with well-characterized stress urinary incontinence (SUI) may be unnecessary, according to the findings of a recent study conducted in The Netherlands.¹
   
For most conditions that involve the lower urinary tract, which include the bladder and urethra, urodynamic studies are considered to be among the most definitive tests for determining the source of symptoms. However, in women with predominant SUI who are eligible for surgical treatment, the benefit of urodynamic studies has been questioned because there is no good evidence showing that these studies are associated with improved outcomes.
   
Data from women with predominant SUI who were eligible for surgery based on clinical assessment were collected from 30 Dutch hospitals to determine whether immediate surgery was noninferior to a treatment strategy based on discordant urodynamic study findings followed by individualized therapy in women with SUI. Urodynamic studies were conducted in all patients.
   
In cases in which the findings from the urodynamic studies were in discord with those of the clinical assessment, the patients were randomly assigned to either immediate surgery or individualized therapy based on urodynamic study findings. After 12 months, clinical improvement from baseline was assessed with the Urogenital Distress Inventory. The treatments were considered noninferior if the mean improvement score differed 5 points or less.
   
A total of 578 women with SUI were included in the study, with nearly half of the women (268 [46%]) having discordant findings. Because only 126 patients consented to randomization, 64 patients were allocated to immediate surgery and 62 patients were allocated to individualized therapy.
   
After 12 months, the mean improvement from baseline was 44 points in the group receiving immediate surgery and 39 points in the group receiving individualized therapy. The study authors reported no differences in cure rates or complication rates between study groups. The study authors concluded that immediate surgical treatment (placement of a midurethral sling) is not inferior to individualized therapy based on urodynamic findings. The results of this study confirm those of a previous study that showed urodynamic studies seem to offer little clinical benefit in terms of outcomes in patients with uncomplicated SUI.²

Pertinent Points:
- Immediate surgical placement of a midurethral sling is not inferior to individualized treatment based on urodynamic studies in women with uncomplicated stress urinary incontinence, especially when the results of the clinical assessment and urodynamic studies are in discord.
- These results indicate that there may be little value in conducting urodynamic studies before surgery in patients with uncomplicated stress urinary incontinence.
 

References:

1. van Leijsen SA, Kluivers KB, Mol BW, et al. Value of urodynamics before stress urinary incontinence surgery: a randomized controlled trial. Obstet Gynecol. 2013;121:999-1008.
2. Nager CW, Brubaker L, Litman HJ, et al, for the Urinary Incontinence Treatment Network. A randomized trial of urodynamic testing before stress-incontinence surgery. N Engl J Med. 2012;366:1987-1997.