Federal guidelines for the management of urinary incontinence in the United States: Which patients should undergo urodynamic testing?

Abstract

In 1992, the United States Agency for Health Care Policy and Research (AHCPR) proposed a guideline for the management of adults with urinary incontinence. The purpose of this study is to evaluate the criteria proposed by the AHCPR for the selective use of urodynamic testing in women complaining of stress incontinence. In order to examine the efficacy of these criteria, we retrospectively determined urodynamic diagnoses for 101 women presenting with the complaint of stress incontinence. These were then compared to the AHCPR recommendations for each subject's management. We found that the AHCPR algorithm would have recommended treatment without urodynamic testing for 65% of the population. If the AHCPR guideline had been followed, 32% of the overall population could have received inappropriate treatment. These results suggest that the implementation of the AHCPR guideline could result in inappropriate treatment for onethird of women presenting with symptoms of stress incontinence.