Utility of invasive urodynamics before surgery for stress urinary incontinence

Abstract

The utility of invasive urodynamic testing in the preoperative evaluation of womenwith stress urinary incontinence (SUI) has been challenged by two recent randomized controlled trials (RCTs) [1, 2] that could not document any gain on outcome of surgery. However, both studies have common methodological issues that make it difficult to draw a general conclusion. Urodynamics (UDS) is defined by the International Continence Society (ICS) as the study of the function and dysfunction of the urinary tract by any appropriate method [3]. Accordingly, UDS is the only way to understand why people are continent or incontinent. Treatment that is not carried out blindfolded but based on knowledge requires (noninvasive and/or invasive) UDS [4]. It is well documented that invasive urodynamic testing (in terms of cystometry and pressure-flow study) in women with predominant symptomatic SUI may show either detrusor overactivity (DO) solely or genuine SUI in combination with other urodynamic findings, such as DO and/or voiding difficulties (in terms of obstruction or hypoactive detrusor function). In addition, urethral profilometry or leak-point pressure allows identification of individuals with low urethral pressure [i.e., intrinsic sphincter deficiency (ISD)]. The surgeon who wishes to acquire this knowledge needs to use invasive UDS. Invasive UDS has principally two goals: to confirm clinical and noninvasive UDS impression; to identify parameters that may alter diagnosis or treatment. However, prerequisites for taking advantage of invasive UDS imply: