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

Abstract

A group of experts were worried that, even though the cause of incontinence varies, doctors seem to be skipping a diagnostic test called urodynamics (UDS) in some patients and just providing treatment-even surgery-without knowing exactly what is wrong. These experts analysed the situation in detail and reached agreement that UDS testing should not be skipped.

The role of urodynamics in females with lower urinary tract symptoms

“…The main area of debate is that many clinicians believe that UDS is indicated in refractory OAB and only when initial therapy fails and it should be performed prior to any surgical intervention including minimally invasive procedures, such as sacral neuromodulation or onabotulinumtoxinA injection. They support this opinion with studies that showed that UDS is an invasive expensive tool, time consuming, and does not influence the initial management strategies [36,37].…”

“…A recent expert consensus viewpoint on the value of UDS in female SUI was achieved in a review article that has been published recently. They concluded that extensive experience and observational studies have shown the danger of empiric management for SUI and strongly supported the value of UDS for the assessment of female SUI [36].…”

The bladder is an unreliable witness: The case for urodynamic investigations in female stress urinary incontinence

“…These recommendations, and others [14,15], were strongly influenced by two randomized controlled trials (RCTs) in women with P-SUI published in 2012the ValUE and VUSIS-II studies [16][17][18] which concluded that UDS findings were not useful in this setting. However, both of these studies have sparked considerable controversy and criticism of their design and conclusions, as summarized in a recent European consensus article [19]. 1 The first evident issue is the lack of a standardized definition of uncomplicated SUI.…”

“…A much more likely hypothesis is that, in 34 % of non-P-SUI women, UDS was not seen as a necessary preoperative tool even in these more complex cases, mirroring the findings of the Dutch survey. It is important to recognize not only that the great majority of cases of SUI are not uncomplicated, but that UDS has been shown to have intrinsically greater benefit in complex cases than in P-SUI [23,24] and that a wide range of prospective and retrospective studies have demonstrated the value of UDS in diverse SUI patient cohorts [19].…”

“…Last but not least, should the MUS become reputationally damaged in the way the vaginal mesh was, UDS would be the only investigation able to evaluate the usefulness of other invasive procedures for P-SUI. As stated by Finazzi-Agro et al [19], 'Empiric decision-making is considered bad practice in most other areas of medicine, with good reason'.…”