Results from a recent clinical trial suggest that invasive and costly tests commonly performed in women before surgery for stress urinary incontinence (SUI) may not be necessary in many cases. Millions of American women suffer from SUI, in which urine leaks from the bladder through the urethra during a physical stress, such as coughing, laughing, sneezing, or exercise. Treatment for SUI includes surgical procedures to support and compress the urethra to stop urine from leaking. Prior to surgery, many women not only receive an office evaluation to diagnose their incontinence, but also undergo specialized bladder function tests called urodynamic studies. These tests help assess how well the bladder, urethra, and muscles that support and compress the urethra work together to store and release urine. Similar to other office bladder procedures, the urodynamic tests can be uncomfortable or painful, and can increase risk for urinary tract infections. Although the urodynamic tests were found to refine a doctor’s diagnosis, the tests have not been proven to guide decisions about treatments or improve surgical outcomes.
To test whether urodynamic studies influenced the likelihood of treatment success, researchers conducted a study in 630 women who were planning to have surgery for SUI. Participants were women who had SUI that was not complicated by other health factors, such as previous incontinence surgery or pelvic irradiation. Women who also had urge incontinence (urine leakage at the time of a very strong desire to urinate, as opposed to physical stress) were not excluded as long as SUI was their predominant type of incontinence. Women with uncomplicated, predominantly SUI were randomly assigned to receive either (1) both a pre-operative evaluation in a doctor’s office and urodynamic tests, or (2) the office evaluation only. One year after the surgical procedure, the researchers assessed treatment success, which was defined as a participant reporting on a questionnaire that her urinary distress had been reduced by 70 percent or more, as well as reporting that her urinary tract condition had improved “much” or “very much.” The researchers found that the proportion of women in whom treatment was successful was similar in both groups—76.9 percent versus 77.2 percent in the women who had urodynamic testing and the women who received the office evaluation only, respectively— with no significant differences in quality of life, patient satisfaction, or problems voiding. While urodynamic testing did lead to changes in diagnoses for some of the women, the researchers observed that this did not lead to significant differences in either the selection of surgical treatments or the one-year outcomes between the two groups. These results indicate that, for women with uncomplicated SUI who are receiving care from urologists and gynecologists with advanced training in bladder problems, specialized bladder function tests are not necessary to achieve surgical treatment success—information that women and their physicians can consider in planning treatment.
Nager CW, Brubaker L, Litman HJ, et al. A randomized trial of urodynamic testing before stress-incontinence surgery. NEngl J Med 366: 1987-1997, 2012.