Does Preoperative Urodynamic Testing Improve Surgical Outcomes in Patients Undergoing the Transobturator Tape Procedure for Stress Urinary Incontinence? A Prospective Randomized Trial

Abstract

PurposeUrodynamic studies are commonly performed as part of the preoperative work-up of patients undergoing surgery for stress urinary incontinence (SUI). We aimed to assess the extent to which these urodynamic parameters influence patient selection and postoperative outcomes.Materials and MethodsPatients presenting with SUI were randomly assigned to two groups: one undergoing office evaluation only and the other with a preoperative urodynamic work-up. Patients with unfavorable urodynamic parameters (detrusor overactivity [DO] and/or Valsalva leak point pressure [VLPP]<60 cm H2O and/or maximum urethral closure pressure [MUCP]<20 cm H2O) were excluded from the urodynamic testing group. All patients in both groups underwent the transobturator midurethral sling procedure. Evaluation for treatment success (reductions in urogenital distress inventory and incontinence impact questionnaire scoring along with absent positive stress test) was done at 6 months and 1 year postoperatively.ResultsA total of 72 patients were evaluated. After 12 patients with any one or more of the abnormal urodynamic parameters were excluded, 30 patients were finally recruited in each of the "urodynamic testing" and "office evaluation only" groups. At both the 6- and the 12-month follow-ups, treatment outcomes (reduction in scores and positive provocative stress test) were significantly better in the urodynamic testing group than in the office evaluation only group (p-values significant for all outcomes).ConclusionsOur findings showed statistically significantly better treatment outcomes in the urodynamic group (after excluding those with poor prognostic indicators such as DO, low VLPP, and MUCP) than in the office evaluation only group. We recommend exploiting the prognostic value of these urodynamic parameters for patient counseling and treatment decisions.

The role of urodynamics in the management of female stress urinary incontinence

“…Urodynamic examination can even detect the patients at risk to develop postoperative urgency and urge urinary incontinence . Finally, Agarwal et al in a prospective RCT evaluating the role of preoperative urodynamic testing in women undergoing the TOT surgical procedure for SUI, demonstrated that the treatment outcomes were significantly superior in urodynamic group, in comparison to the office evaluation only group …”

“…24 Finally, Agarwal et al in a prospective RCT evaluating the role of preoperative urodynamic testing in women undergoing the TOT surgical procedure for SUI, demonstrated that the treatment outcomes were significantly superior in urodynamic group, in comparison to the office evaluation only group. 25 On the basis of these findings, all international guidelines (ICI; AUA/SUFU; EAU; NICE), recommend the use of UDS in complicated stress urinary incontinence forms. [26][27][28][29] The recommendations in case of patients with uncomplicated SUI are less homogeneous: ICS recommends UDS testing when the results may change the management.…”

Urodynamics Useless in Female Stress Urinary Incontinence? Time for Some Sense—A European Expert Consensus

“…Between 2009 and 2017, several retrospective and prospective studies [13,14,[36][37][38][39][40][41][42][43] and one small RCT [44] have demonstrated that UDS can guide appropriate decision making in female SUI (Table 2). These studies have confirmed the following:…”

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

“…Full articles were reviewed for 26 studies. Seven RCTs were included [23,[26][27][28][29][30][31], with six having suitable data to be included in the meta-analysis [26][27][28][29][30][31]. One of the studies [27] was a feasibility study, which included a multi-centre randomised pilot trial with relevant outcomes being reported.…”

“…One of the studies [27] was a feasibility study, which included a multi-centre randomised pilot trial with relevant outcomes being reported. Another study, Agarwal et al, [31] made a postrandomisation exclusion of 12 women (28.6%) in the urodynamics arm in accordance with their pre-specified RCT protocol for women with unfavourable urodynamics parameters. Four RCTs [23,27,29,30] were conducted in European countries, two in the United States of America [26,28] and one in India [31].…”