Although urodynamic testing is frequently performed as part of the evaluation of SUI, the benefits obtained by performing such testing have not been well defined. Advocates of a “minimalist” approach argue that direct observation of stress incontinence on physical examination is sufficient to allow the treating physician to proceed with surgery in the majority of patients. Some studies have indicated that routine performance of urodynamics in the evaluation of female stress incontinence is not cost-effective (12,13).
This opinion has perhaps become more prevalent with the advent of minimally invasive midurethral sling procedures, which have yielded good continence results in large, heterogeneous patient samples. Advocates for urodynamic testing argue that important information about concomitant bladder dysfunction (detrusor overactivity, compliance abnormalities, poor detrusor contractile function) may significantly alter the treatment approach in certain patients.
Furthermore, identification of urodynamic intrinsic sphincter deficiency does appear to significantly reduce the stress incontinence cure rate for midurethral slings (14,15).
Currently, it is not known if routine urodynamic assessment improves outcomes prior to stress incontinence surgery. Therefore, the decision to perform this testing is individualized based on the availability of the testing equipment, the expertise of the treating physician, and the complexity of the patient.
The utility of preoperative urodynamic testing will continue to be controversial until definitive studies are carried out to examine the issue. Ideally, these would be multicenter, prospective, randomized trials involving women who have undergone standardized urodynamic testing, with the treating physician blinded to the urodynamic outcomes in one group and aware of the outcomes in the other.
Kelly M. Maxwell, MD, and J. Quentin Clemens, MD, MSCI