NIH: Urodynamics before incontinence surgery may be unnecessary

Urodynamic studies conducted in women prior to stress urinary incontinence surgery may not be necessary, according to a multicenter study funded by the National Institutes of Health.

Researchers from the Urinary Incontinence Treatment Network compared results after both a preoperative check-up in a physician’s office and bladder function tests to results after only the office check-up. Women who had only the office check-up had equally successful outcomes after surgery.

"The findings of our study argue against routine preoperative testing in cases of uncomplicated stress urinary incontinence, as the tests provide no added benefit for surgical treatment success but are expensive, uncomfortable, and may result in complications such as urinary tract infections," said first author Charles Nager, MD, of the University of California, San Diego.

The trial, which was published online in New England Journal of Medicine (May 2, 2012), tested the benefits of urodynamics to improve outcomes 1 year after surgery for predominantly stress incontinence. Treatment success was defined as a patient reporting on a questionnaire that her urinary distress had been reduced by 70% or more, as well as reporting that her urinary tract condition had improved "much" or "very much."

In the study, half of 630 women with uncomplicated stress urinary incontinence had a preoperative office check-up and bladder function testing. The other half had only an office check-up. Treatment success was similar in both groups-76.9% versus 77.2%, respectively-with no significant differences in quality of life, patient satisfaction, or voiding dysfunction.

"These results have the potential to positively influence care and minimize testing-associated problems," said study co-author Linda Brubaker, MD, MS, of Loyola University Health System, Chicago. "These findings also represent a significant cost savings for patients and the health care system."

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