Abstract
AimsTo determine surgeons' views on invasive urodynamic testing (IUT) prior to surgery for stress (SUI) or stress predominant mixed urinary incontinence (MUI).MethodsMembers of British Society of Urogynaecology (BSUG) and British Association of Urological Surgeons Section of Female, Neurological and Urodynamic Urology (BAUS-SFNUU) were sent an email invitation to complete an online “SurveyMonkey®” questionnaire regarding their current use of IUT prior to surgical treatment of SUI, their view about the necessity for IUT in various clinical scenarios, and their willingness to randomize patients into a future trial of IUT. A purposive sample of respondents was invited for telephone interview to explore further how they use IUT to inform clinical decisions, and to contextualize questionnaire responses.ResultsThere were 176/517 (34%) responses, 106/332 (32%) from gynecologists/urogynecologists and 67/185 (36%) from urologists; all respondents had access to IUT, and 89% currently arrange IUT for most women with SUI or stress predominant MUI. For a variety of scenarios with increasingly complex symptoms the level of individual equipoise (“undecided” about IUT) was very low (1–6%) and community equipoise was, at best, 66:34 (IUT “essential” vs. “unnecessary”) even for the simplest scenario. Nevertheless, 70% rated the research question underlying the proposed studies “very important” or “extremely important;” 60% recorded a “willingness to randomize” score ≥8/10.ConclusionsMost urogynecologists and urologists consider IUT essential before surgery in SUI with or without other symptoms. Most however recognize the need for further research, and indicated a willingness to recruit into multicenter trials addressing this question. Neurourol. Urodynam. 31:?–?, 2012. © 2012 Wiley Periodicals, Inc.
Highlights
Urinary incontinence (UI) whilst rarely life-threatening, may seriously influence the physical, psychological, and social wellbeing of affected individuals
The British Society of Urogynaecology (BSUG) and BAUS-SFNUU membership databases are fluid, with new members joining and others leaving continuously throughout the year; the numbers sent reminder letters were slightly different from initial invitations
Initial invitations went to 332 BSUG members and 185 BAUS-SFNUU members, with most of these, plus a small number of new members, being sent reminder emails to follow up the initial invitation
Summary
Urinary incontinence (UI) whilst rarely life-threatening, may seriously influence the physical, psychological, and social wellbeing of affected individuals. Several methods are used in the assessment of UI to guide management decisions. These include non-invasive tests (such as free urine flow rate and post-void residual volume), Additional supporting information may be found in the online version of this article. P.H.: No current financial interests; previous chair of NICE Guideline Development Group (GDG) on urinary incontinence (UI) in women; previous member NETSCC-HTA Interventional Procedures Panel, and Clinical Evaluations and Trials Prioritization Group; previous commercial research funding for trials of surgery for stress incontinence from Gynecare (1998–2003) and Gyne Ideas ( Mpathy Medical; 2001–2003). M.L.: No current financial interests; previous member of NICE GDG on UI in women and on lower urinary tract symptoms in men; chair European Association of Urology guideline group on UI.
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