Clarifying the Role of Urodynamics in the Preoperative Evaluation of Stress Urinary Incontinence

It has not yet been definitively demonstrated that preoperative evaluation of women with stress urinary incontinence (SUI) with urodynamic testing (UDS) enhances surgical outcomes. Nonetheless, UDS is frequently utilized in the assessment of women with SUI in the hopes that results will shed light on preoperative risk factors for failure or postoperative voiding dysfunction. Poorer outcomes for stress incontinence surgery are primarily attributed to intrinsic sphincter deficiency (ISD), detrusor overactivity (DO), and voiding dysfunction. The ability of UDS to identify and characterize those parameters reliably remains under investigation. Furthermore, debate continues regarding the association of each of those factors with postoperative success for various SUI procedures. Since UDS is invasive, costly, and not always available, it is imperative that its benefit be carefully explored. In this review, we discuss the value of UDS in identifying risk factors for poor outcome and how those risk factors are associated with surgical failure

Stress urinary incontinence surgery trends in academic female pelvic medicine and reconstructive surgery urology practice in the setting of the food and drug administration public health notifications

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/136665/1/nau23080.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/136665/2/nau23080_am.pd

Use of urodynamics prior to surgery for urinary incontinence: How helpful is preoperative testing?

It has not yet been definitively demonstrated that preoperative evaluation of women with stress urinary incontinence with urodynamic testing enhances presurgical counseling, more effectively models patients' expectations or improves postoperative outcome. Nonetheless, urodynamic testing is frequently utilized in the assessment of women with stress urinary incontinence and clearly accomplishes a number of goals when utilized for this purpose. For example, there are data to suggest that the risk of voiding dysfunction can be mitigated by utilizing data obtained from urodynamic testing to identify women more likely to void ineffectively after conventional stress incontinence procedures. Furthermore, it has been suggested though not proven, that patients with more severe forms of stress incontinence as identified by urodynamic testing, might be less likely to improve after surgery compared to others with more modest degrees of incontinence. Since urodynamic testing is invasive, costly and not always available, it is imperative that the usefulness of such testing be carefully explored and its utility appropriately defined. In this review, we discuss urodynamic techniques to assess stress urinary incontinence, particularly focusing on the ability of leak point pressure testing and urethral pressure profilometry to predict which patients would most likely benefit from surgery and which might be more likely to experience adverse events following surgery