AimsTo assess in women with stress urinary incontinence (SUI) the value of urodynamics prior to treatment.MethodsWe performed a multicenter non‐inferiority randomized controlled trial. Women with SUI were randomly allocated to management based on a workup with or without urodynamics. The primary outcome was clinical reduction of complaints as measured with the Urogenital Distress Inventory urinary incontinence subscale (UDI‐UI) at 12 months after the onset of treatment. A mean difference in improvement of less than 8 was considered non‐inferior. The study was analyzed according to intention‐to‐treat.ResultsThe trial was stopped prematurely because of slow recruitment. We randomly allocated 59 women to a strategy with (N = 31) or without (N = 28) urodynamics. The mean difference in improvement on the UDI‐UI was 14 in favor of the group without urodynamics (48 SD ± 22 vs. 34 SD ± 22, 95% CI: −28 to −0.26), confirming non‐inferiority. Addition of urodynamics did not result in a lower occurrence of de novo overactive bladder complaints compared to a workup without urodynamics (6/31 vs. 1/28; RR 5.4, 95% CI: 0.70–42). In the group allocated to urodynamics, initial surgical management was more often abandoned compared to the group not allocated to urodynamics (5/31 vs. 1/28; RR 4.5, 95% CI: 0.56–36).ConclusionsIn this relatively small study, the omission of urodynamics was not inferior to the use of urodynamics in the preoperative workup of women with SUI. Women with SUI undergoing urodynamics had the risk of a choice for more prudent treatment, which seemed to result in a delay until effective treatment. Neurourol. Urodynam. 31:1118–1123, 2012. © 2012 Wiley Periodicals, Inc.

Introduction and hypothesis The aim of our study was to provide a systematic literature review of clinical studies on pelvic organ prolapse staging with use of dynamic magnetic resonance (MR) imaging. Methods The databases EMBASE and PubMed were searched. Clinical studies were included in case they compared pelvic organ prolapse stages as assessed on dynamic MR imaging (using a reference line) with a standardized method of clinical prolapse staging. Results Ten studies were included, which made use of seven different reference lines in relation to a wide variety of anatomical landmarks. Conclusions Only few studies have compared pelvic organ prolapse stages as assessed by dynamic MR imaging and clinical examination in a standardized manner. The available evidence suggests that prolapse assessment on dynamic MR imaging may be useful in the posterior compartment, but clinical assessment and dynamic MR imaging seem interchangeable in the anterior and central compartment.

Introduction and hypothesis This study evaluates the agreement in prolapse staging between clinical examination, dynamic magnetic resonance (MR), imaging and perineal ultrasonography. Methods Anatomical landmarks in the anterior, central, and posterior compartment were assessed in relation to three reference lines on dynamic MR imaging and one reference line on dynamic ultrasonography. These measurements were compared to the according POP-Q measurements. Agreement between the three methods was analyzed with Spearman's rank correlation coefficient (r s ) and Bland and Altman plots. Results Correlations were good to moderate in the anterior compartment (r s range=0.49; 0.70) and moderate to poor (r s range = −0.03; 0.49) in the central and posterior compartment. This finding was independent of the staging method and reference lines used. Conclusion Pelvic organ prolapse staging with the use of POP-Q, dynamic MR imaging, and perineal ultrasonography only correlates in the anterior compartment.

The reproducibility of same session repeated urodynamic measurements in women with symptoms of urinary incontinence was good to excellent. Our results provide the scientific support for guidelines that recommend the omission of repeated filling cystometries and pressure-flow studies in cases where the first test confirms the pathology expected.

Protocol for the value of urodynamics prior to stress incontinence surgery (VUSIS) study: a multicenter randomized controlled trial to assess the cost effectiveness of urodynamics in women with symptoms of stress urinary incontinence in whom surgical treatment is considered AbstractBackground: Stress urinary incontinence (SUI) is a common problem. In the Netherlands, yearly 64.000 new patients, of whom 96% are women, consult their general practitioner because of urinary incontinence. Approximately 7500 urodynamic evaluations and approximately 5000 operations for SUI are performed every year. In all major national and international guidelines from both gynaecological and urological scientific societies, it is advised to perform urodynamics prior to invasive treatment for SUI, but neither its effectiveness nor its cost-effectiveness has been assessed in a randomized setting.