Use of urodynamics prior to surgery for urinary incontinence: How helpful is preoperative testing?

Abstract

It has not yet been definitively demonstrated that preoperative evaluation of women with stress urinary incontinence with urodynamic testing enhances presurgical counseling, more effectively models patients' expectations or improves postoperative outcome. Nonetheless, urodynamic testing is frequently utilized in the assessment of women with stress urinary incontinence and clearly accomplishes a number of goals when utilized for this purpose. For example, there are data to suggest that the risk of voiding dysfunction can be mitigated by utilizing data obtained from urodynamic testing to identify women more likely to void ineffectively after conventional stress incontinence procedures. Furthermore, it has been suggested though not proven, that patients with more severe forms of stress incontinence as identified by urodynamic testing, might be less likely to improve after surgery compared to others with more modest degrees of incontinence. Since urodynamic testing is invasive, costly and not always available, it is imperative that the usefulness of such testing be carefully explored and its utility appropriately defined. In this review, we discuss urodynamic techniques to assess stress urinary incontinence, particularly focusing on the ability of leak point pressure testing and urethral pressure profilometry to predict which patients would most likely benefit from surgery and which might be more likely to experience adverse events following surgery.

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

“…Urodynamic testing is frequently utilized in the assessment of women with SUI, and urodynamic findings can predict disease severity (influence treatment recommendations) or postoperative outcome. The extent to which a complete urodynamic evaluation impacts outcomes after treatment of SUI is controversial, however [ 5 ]. Symptoms are an unreliable indicator of urodynamic findings [ 6 ], and therefore some have argued that performing urodynamic studies might improve outcome following surgery.…”

Urodynamic assessment of urinary incontinence

“…No statistical association between abdominal leak point pressure and maximum urethral closure pressure was found; suggesting they are measuring different pathophysiological events. Lemack has subsequently published many papers concerning the diagnostic accuracy and clinical usefulness of both abdominal leak point pressure and urethral profile profilometry[ 27 28 ] in which he questions the validity of comparing data from different centers given variation in technique and comments on the conflicting data regarding their usefulness. In addition the clinical need to differentiate between intrinsic sphincter deficiency and urethral hypermobility on the basis of using different surgical techniques has been questioned.…”

Cystometrogram: the low-cost method for rural areas and its benefits

“…The American Urological Association has provided guidelines for performing these studies. 4 However, owing to the high costs of the available testing equipment, 5 many practitioners treat patients without proper workup. Commercial urodynamic testing may cost in the range of US$400–500.…”