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Women don’t need urodynamic tests before surgery for incontinence

N Engl J Med2012; doi:10.1056/NEJMoa1113595

Women having surgery for uncomplicated stress incontinence can be spared the discomfort and inconvenience of preoperative urodynamic tests, according to a clinical trial. Women who had the tests did no better in the year after surgery than controls managed without them—the two groups had similar chances of successful treatment (76.9% (208/272) v 77.2% (206/266)), similar quality of life and symptom scores, and matching impressions of their treatment (91.9% (248/270) v 90.8% (238/262) said they were much better or very much better one year after surgery).

A comprehensive office based work-up is probably enough, say the authors. All the women in this trial had a clear history of stress incontinence, diagnostic symptom scores, normal residual volume, and a positive stress test (visible leakage during coughing or a valsalva manoeuvre). They also had negative urinalysis or culture and an assessment of urethral mobility. The addition of urodynamic tests made no difference to outcomes and little difference to surgical management, although four women switched to non-surgical treatments after the results.

Eleven surgical centres, 53 experienced surgeons, and 630 women took part in …