Urodynamic Testing Prior to Surgery

Women presenting with urinary stress incontinence are frequently subjected to urodynamic testing prior to surgery. This appears to be a logical approach, but if stress incontinence is demonstrable on clinical evaluation, does the addition of dynamics make any difference to the eventual outcome of the management? If not, then can the tests be safely omitted, thereby saving the patient time, money, and the risk of instrumentally introduced infection?

Specifically to address these questions a trial was conducted in the use of urodynamic testing in 11 different centers in the United States, allocating half the patients to evaluation only and the other half to evaluation plus urodynamic testing according to standardized protocols.¹ The endpoint was the percentage of each group in whom the treatment was successful, with the principle of noninferiority being set in advance. Over 600 women were randomly entered into the trial and reviewed 1 year after surgery. Both groups had 77% successful outcomes, allowing the researchers to assert that in women with uncomplicated, demonstrable stress urinary incontinence, preoperative urodynamic testing does not affect the result and is therefore unnecessary.