Urodynamic testing of no benefit in stress incontinence surgery
MedWire News: Urodynamic testing before surgery for uncomplicated, demonstrable stress urinary incontinence does not improve patient outcomes, the results of a US study indicate.
Despite being uncomfortable, costly, and associated with a risk for urinary tract infection, urodynamic investigations are often performed before surgery for stress urinary incontinence, explain Charles Nager (University of California, San Diego) and colleagues.
The team tested their ability to predict outcome by assessing 1-year outcomes in 630 women undergoing planned surgery for uncomplicated, stress-predominant urinary incontinence. The patients were randomly assigned to receive office evaluation with or without urodynamic testing. Testing included noninstrumented uroflometry with a comfortably full bladder, filling cystometry, and a pressure-flow study.
Treatment success at 1 year was defined as a 70% or greater reduction in the Urogenital Distress Inventory, and a response of "much better" or "very much better" on the Patient Global Impression of Improvement. These criteria were achieved by 76.9% of women receiving urodynamic testing and by 77.2% of the other women. This difference met the predetermined criteria for noninferiority of office evaluation of less that 11%.
The findings were not altered by taking into account differences in the duration of incontinence, Incontinence Severity Index score, smoking status, history of nonsurgical treatment, current use of hormone replacement therapy, and urethral mobility.
There were also no outcome differences between women with or without urodynamic testing regarding incontinence severity, quality of life, patient satisfaction, rates of positive provocative stress tests, voiding dysfunction, and adverse events.
Women who underwent urodynamic testing were more likely to have a diagnosis of overactive bladder with incontinence, overactive bladder without incontinence, or suspected intrinsic sphincter deficiency than other women, but these had no effect on surgical outcomes.
The team concludes in The New England Journal of Medicine: "With respect to success of treatment at 1 year, this study showed that a basic office assessment for women with uncomplicated stress-predominant urinary incontinence who have stress incontinence on office evaluation is noninferior to a preoperative evaluation that also includes urodynamic testing.
"These results argue against routine preoperative urodynamic testing in patients with uncomplicated stress urinary incontinence."
By Liam Davenport