Clarifying the Role of Urodynamics in the Preoperative Evaluation of Stress Urinary Incontinence

It has not yet been definitively demonstrated that preoperative evaluation of women with stress urinary incontinence (SUI) with urodynamic testing (UDS) enhances surgical outcomes. Nonetheless, UDS is frequently utilized in the assessment of women with SUI in the hopes that results will shed light on preoperative risk factors for failure or postoperative voiding dysfunction. Poorer outcomes for stress incontinence surgery are primarily attributed to intrinsic sphincter deficiency (ISD), detrusor overactivity (DO), and voiding dysfunction. The ability of UDS to identify and characterize those parameters reliably remains under investigation. Furthermore, debate continues regarding the association of each of those factors with postoperative success for various SUI procedures. Since UDS is invasive, costly, and not always available, it is imperative that its benefit be carefully explored. In this review, we discuss the value of UDS in identifying risk factors for poor outcome and how those risk factors are associated with surgical failure.

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Preoperative Urodynamics Testing in Stress Urinary Incontinence

50 Studies Every Obstetrician-Gynecologist Should Know ◽

10.1093/med/9780190947088.003.0036 ◽

2021 ◽

pp. 197-201

Author(s):

Megan Bradley ◽

Linda Burkett

Keyword(s):

Urinary Incontinence ◽

Clinical Practice ◽

Stress Urinary Incontinence ◽

Preoperative Evaluation ◽

Secondary Data ◽

Patient Characteristics ◽

Urodynamic Testing ◽

Incontinence Surgery ◽

Scientific Methods ◽

Stress Incontinence Surgery

This article outlines the scientific methods, results, and conclusions for the ValUE trial, “A Randomized Trial of Urodynamic Testing before Stress-Incontinence Surgery.” The ValUE trial compared patients with stress urinary incontinence (SUI) who underwent office evaluation with or without preoperative urodynamics (UDS) testing prior to an anti-incontinence procedure. The majority of patients in the study underwent a mid-urethral sling. The study showed no difference in surgical or treatment outcomes for patients with uncomplicated SUI, signifying UDS may not be necessary in preoperative evaluation. Patient characteristics of uncomplicated SUI are discussed for translation into clinical practice. Reviews of related articles with secondary data analysis are summarized.

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Surgical Management of Stress Urinary Incontinence

10.2310/obg.19150 ◽

2018 ◽

Author(s):

Danielle Patterson

Keyword(s):

Urinary Incontinence ◽

Stress Urinary Incontinence ◽

Midurethral Sling ◽

Preoperative Evaluation ◽

Urine Volume ◽

Urodynamic Testing ◽

Fascial Sling ◽

Urethral Bulking ◽

Postvoid Residual Urine ◽

Distressing Condition

Stress urinary incontinence (SUI) is a prevalent and distressing condition that affects up to 50% of women over their lifetime. If nonsurgical treatments are not effective, surgery is highly successful. Preoperative evaluation includes at minimum a thorough history and physical examination, urinalysis, demonstration of SUI, assessment of urethral mobility, and measurement of postvoid residual urine volume. The midurethral sling is the most studied surgical procedure for urinary incontinence and is safe and highly effective. With the recent concern about permanent mesh in urogynecologic surgery, many patients might choose a laparoscopy- or robot-assisted Burch colposuspension or fascial sling. This review contains 5 figures, 5 tables and 38 references Key words: intrinsic sphincter deficiency, mesh, midurethral sling, minimally invasive surgery, preoperative evaluation, retropubic colposuspension, stress urinary incontinence, urethral bulking, urodynamic testing

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Stress urinary incontinence after transvaginal mesh surgery for anterior and apical prolapse: preoperative risk factors

International Urogynecology Journal ◽

10.1007/s00192-020-04363-9 ◽

2020 ◽

Vol 32 (1) ◽

pp. 111-117

Author(s):

Mathilde Bideau ◽

Lucie Allègre ◽

Geertje Callewaert ◽

Brigitte Fatton ◽

Renaud de Tayrac

Keyword(s):

Risk Factors ◽

Urinary Incontinence ◽

Stress Urinary Incontinence ◽

Transvaginal Mesh ◽

Apical Prolapse ◽

Preoperative Risk ◽

Preoperative Risk Factors ◽

Mesh Surgery

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A Randomized Trial of Urodynamic Testing Before Stress Incontinence Surgery

50 Studies Every Urologist Should Know ◽

10.1093/med/9780190655341.003.0041 ◽

2021 ◽

pp. 233-238

Author(s):

Colby A. Dixon ◽

Giulia I. Lane ◽

Cynthia S. Fok ◽

M. Louis Moy

Keyword(s):

Urinary Incontinence ◽

Stress Urinary Incontinence ◽

Randomized Trial ◽

Success Rate ◽

Stress Incontinence ◽

Surgical Planning ◽

Urodynamic Testing ◽

Incontinence Surgery ◽

Additional Testing ◽

Stress Incontinence Surgery

This chapter summarizes the results of the VALUE trial, in which women with stress urinary incontinence scheduled to undergo incontinence surgery were randomized to undergo preoperative urodynamic testing versus office evaluation alone. Treatment was considered successful in a similar, large proportion of women in both groups. A diagnosis of stress urinary incontinence was confirmed in most of the women who underwent urodynamic testing; changes were made to their surgical planning on the basis of the additional testing in very few of them. These findings suggested that urodynamic testing may not contribute to the overall success rate of surgery in healthy women with uncomplicated stress urinary incontinence.

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