Urodynamic Testing: Is It Needed Before Incontinence Surgery?

There is much debate about whether pre-operative urodynamic testing (or bladder function testing) is clinically useful in patients with pure stress urinary incontinence, with some professional organizations recommending for the use of routine urodynamics and some recommending against routine use of these tests. In cases of uncomplicated stress urinary incontinence, routine pre-operative urodynamic testing provides no additional benefit for surgical outcomes, according to results of a new study conducted by researchers in the Urinary Incontinence Treatment Network.¹

The multicenter clinical trial tested whether preoperative urodynamic testing improved outcomes 1 year after surgery for uncomplicated stress urinary incontinence.1 Of 630 women with stress urinary incontinence, 315 women had a pre-operative office check-up and urodynamic testing and 315 had only the office check-up. Noninstrumented uroflowmetry with a comfortably full bladder, filling cystometry with Valsalva leak-point pressures, and a pressure-flow study were used in the urodynamic testing group. Treatment was considered successful if a patient reported on a questionnaire that she experienced at least a 70% reduction in urinary distress and considered her urinary tract condition to have improved “much” or “very much.”

Final analysis included 264 women in the urodynamic-testing group and 203 women in the check-up-only group. Both groups had similar rates of treatment success (76.9 in the urodynamic-testing group vs 77.2% in the check-up-only group).¹ In addition, there were no significant differences in quality of life, patient satisfaction, or voiding dysfunction. Many women who underwent urodynamic studies, which may involve the insertion of catheters, found them to be uncomfortable or even painful. In addition, the risk of urinary tract infection increases with catheter use. Of note is that more than 90% of the 53 participating surgeons (38 urogynecologists and 15 urologists) were fellowship-trained, which probably means they have more experience with clinical evaluations than other surgeons with less training, according to the study authors.

In another recent study, however, researchers in Korea concluded that urodynamic studies should be considered necessary before anti-incontinence surgery.² This conclusion was based on their finding that among all identified cases of pure stress urinary incontinence, one fifth of the women had some pathophysiology that could affect the surgical outcome.

Pertinent Points:

- Despite a lack of evidence that pre-operative urodynamic testing improves surgical outcomes, these tests are commonly performed in women with stress urinary incontinence.

References:

References
1. 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 May 2. [Epub ahead of print.]
2. Jeong SJ, Kim HJ, Lee BK, et al. Women with pure stress urinary incontinence symptoms assessed by the initial standard evaluation including measurement of post-void residual volume and a stress test: Are urodynamic studies still needed? Neurourol Urodyn. 2012;31:508-512.