Urodynamics in the era of tension-free slings: defining the role

The role of urodynamics in the routine preoperative evaluation of women with stress urinary incontinence is controversial. The introduction of tension-free mid-urethral sling procedures has created a new paradigm in surgical management. The capability of performing these procedures on an ambulatory basis has created more uncertainty about the use of urodynamic testing. The long-term results of these procedures in patients with intrinsic sphincteric deficiency, mixed incontinence, and voiding dysfunction are not clearly known. This article reviews the mechanism of action and results of tension-free slings and proposes a rational role for urodynamic testing in patients considered for these procedures.