Abstract
Introduction and hypothesisWe aimed to estimate the level of de-implementation of preoperative routine urodynamics (UDS) before stress urinary incontinence (SUI) surgery in The Netherlands and to analyze facilitators and barriers. Routine UDS was performed by 37% of the medical specialists in 2010. We hypothesized that the recommendations from the recent Value of Urodynamics prior to Stress Incontinence Surgery (VUSIS) and Value of Urodynamic Evaluation (ValUE) studies would have been followed by a reduction of routine UDS.MethodsA national survey was performed among all Dutch gynecologists and urologists dealing with SUI in daily practice. The questionnaire contained two parts: (1) respondents’ characteristics and their actual care concerning preoperative UDS, and (2) facilitators and barriers.ResultsThe response rate was 41% (127/308). Of the respondents, 93% (n = 118) did not perform routine UDS in the preoperative workup for women in this group. Professional characteristics associated with not following the recommendations were profession urologist, academic hospital, and a lower number of midurethral sling (MUS) placed yearly. Facilitators to follow the recommendation not to perform routine UDS were adequate design of the VUSIS-II study and outcome and recommendations from the studies. Barriers not to follow the recommendation were believe in the additional value of UDS, especially the pressure transmission ratio, and the presence of detrusor overactivity.ConclusionAccording to respondents to this questionnaire, VUSIS-II and ValUE study results are well implemented in The Netherlands. The vast majority of respondents replied as not performing routine preoperative UDS in women with primary, uncomplicated (predominant) SUI. Therefore, there is no need for a further de-implementation strategy.
Highlights
Introduction and hypothesisWe aimed to estimate the level of de-implementation of preoperative routine urodynamics (UDS) before stress urinary incontinence (SUI) surgery in The Netherlands and to analyze facilitators and barriers
When UDS were discordant with clinical assessment, these women were randomized to either immediate midurethral sling (MUS) surgery or an individually tailored treatment based on urodynamic findings
In the survey reported here, we evaluated the actual position of routine preoperative UDS in The Netherlands
Summary
We aimed to estimate the level of de-implementation of preoperative routine urodynamics (UDS) before stress urinary incontinence (SUI) surgery in The Netherlands and to analyze facilitators and barriers. We hypothesized that the recommendations from the recent Value of Urodynamics prior to Stress Incontinence Surgery (VUSIS) and Value of Urodynamic Evaluation (ValUE) studies would have been followed by a reduction of routine UDS. The VUSIS-II trial was conducted in The Netherlands by our study consortium in a group of female patients who all received UDS prior to surgery. When UDS were discordant with clinical assessment, these women were randomized to either immediate midurethral sling (MUS) surgery or an individually tailored treatment based on urodynamic findings. The conclusion of the VUSIS trial was that MUS surgery in uncomplicated SUI without UDS was not inferior to the individually tailored treatment based on urodynamic findings [2]. The ValUE study concluded that preoperative office evaluation was not inferior to evaluation with additional urodynamic testing after 1 year [3]
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