Urodynamics before stress urinary incontinence surgery

In patients with symptoms of stress urinary incontinence, there is still a debate regarding the benefit of a multichannel urodynamic investigation prior to surgical management. The purpose of this article is to review recent evidence on this topic.

Results of two large randomized controlled trials provided evidence that preoperative urodynamics do not improve outcome of incontinence surgery in women with uncomplicated stress urinary incontinence. Furthermore, in this selected group of women, urodynamics hardly lead to deviation of surgery as a primary treatment in case of an indication for operation based on symptoms and signs. Low urethral closure pressures and detrusor overactivity are urodynamic parameters which were associated with impaired cure of symptoms of stress urinary incontinence after surgery.

Preoperative urodynamics do not improve outcome in women with complaints of stress incontinence and do hardly alter the treatment plan. It remains questionable whether a more accurate counselling on the postoperative perspectives counterbalances the disadvantages attended with urodynamics. The routine use in women with uncomplicated stress incontinence should no longer be advised. Preoperative urodynamic evaluation should only be used to answer a specific clinical question or if the results are likely to influence the choice of treatment.