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Aims To assess whether routine urodynamic testing (UDT) in women undergoing slings for uncomplicated stress urinary incontinence (SUI) has decreased following publication of the landmark VALUE study, which recommended against routine UDT in uncomplicated SUI. Methods We identified women in the Virginia All Payers Claims Database diagnosed with SUI between 2011 and 2016 using International Classification of Disease (ICD) codes (N39.3, 625.6). Appropriate ICD/CPT (current procedural terminology) codes were used to exclude non‐index patients (prior anti‐incontinence/prolapse surgery, urge incontinence, neurogenic bladder). Beta regression was used to assess for changes in the monthly proportion of urethral slings with preoperative UDT. Interventional ARIMA modeling was used to assess for a relationship between the date of VALUE (The Value of Urodynamic Evaluation) publication and the incidence of slings with preoperative UDT. Results Analysis identified 6740 women with SUI undergoing sling placement, with 343 non‐index patients excluded. Of 6397 remaining women, 4026 (62.9%) underwent preoperative UDT. The annual number of slings with preoperative UDT declined from 748 to 402 between 2011 and 2016. Beta regression analysis demonstrated a decrease in the proportion of slings with preoperative UDT over the study (68%, 2011; 58%, 2016), with a statistically significant decrease in the proportion of slings with UDT after May 2012 (β coefficient, −.0093; P < .001). Interventional ARIMA models showed a trend toward decreasing slings with preoperative UDT after the VALUE trial (P = .057). Conclusions Our analysis demonstrated a decrease in the proportion of women undergoing preoperative UDT in uncomplicated SUI patients following the VALUE study. Further research is needed to examine factors underlying UDT utilization trends and promote value‐driven care.

superior to C&S in terms of pathogen detection being a highly sensitive tool to detect a few pathogens in every urine sample. This sometimes remained unclear which one contributes to the ensuing flare-up of UTI and thus more aggressive in each case. Although, the defining of resistance genes to different groups of antibiotics seems promising in antibiotic stewardship but warrant more robust clinical trials to prove.

Evaluation (VALUE) study suggested that routine urodynamics (URD) are not beneficial for pre-operative evaluation of uncomplicated, stress-predominant incontinence (SUI). Accordingly, professional organizations have advocated against routine pre-operative URD (pre-URD) in "index" SUI patients. We assessed URD rates in patients undergoing slings through analysis of patient claims data with focus on use following the VALUE study.METHODS: We identified female patients in the Virginia All Payers Claims Database with diagnosis of SUI from May 2011-December 2016 using appropriate ICD codes. CPT codes were used to select the subset undergoing URD and/or slings. Pre-URD was defined as URD within six months of sling placement. Non-index patients were defined as those with concurrent diagnosis of overactive bladder, urge incontinence, or neurogenic bladder, and were excluded from analysis. We analyzed longitudinal rate of URD in patients undergoing sling placement and fitted an interventional ARIMA model with a step function after the time of the VALUE study publication. To evaluate changes in proportion of slings with pre-URD, we fitted a beta regression model using a logit link.RESULTS: A total of 44,347 patients with a SUI diagnosis were identified over the study period, with a mean of 7391 patients/year. Of index patients with a SUI diagnosis, 5,944 underwent sling procedures. The mean number of slings and URD per year was 1236 and 3488, respectively. A decrease in the annual number of slings, both with and without pre-UDS, was seen beginning in mid-2012 (Figure 1). In addition, interventional ARIMA models confirmed significant decreases in in number of slings with (p[0.02) and without (p<0.001) pre-URD. The proportion of slings with pre-URD demonstrated a small decrease over the study years (68%, 2011; 58%, 2016), with an estimated decrease in pre-operative URD by 0.85%/month (p<0.001).CONCLUSIONS: Our study demonstrates a decrease in the number of slings both with and without pre-URD in uncomplicated patients following publication of the VALUE study in May 2012. Notably, there was a small but significant decrease in the proportion of slings with pre-URD among index patients. Further research is needed to examine trends of pre-URD and underlying influences.