Urodynamics in stress incontinence: when are they necessary and how do we use them?

Do urodynamic findings influence the approach to mid-urethral sling surgery for stress urinary incontinence?

Recent press coverage on vaginal mesh surgery has resulted in a change in how patients are counselled, managed and treated in the UK. For stress urinary incontinence surgical procedures such as insertion of tension-free vaginal tape are commonplace and generally performed as a day-case procedure. Effective and successful management of female urinary incontinence is difficult, even when using diagnostic testing where all conservative managements have failed, and this indicates a need to investigate further. Specialist texts in the fields of urology and urogynaecology argue that urodynamics can help inform the success of surgical intervention for stress urinary incontinence. The aim of this review was to look for evidence of practice where urodynamic findings are used to determine the successful outcome of mid-urethral sling surgery in females. A literature search to identify research on this topic was performed with appraisal of qualifying literature. The qualifying research included attitudes towards urodynamic studies among urogynaecologists and urologists, demonstration that urodynamics has been proven to influence changes in diagnosis and surgical approaches, and the capacity for urodynamics to predict successful outcomes in mid-urethral sling surgery. Analysis of the literature found no evidence to suggest that urodynamic findings can be used to determine successful outcomes following mid-urethral sling surgery.

The Role of Urodynamics in Elderly Patients

Urodynamic testing is the study of the function of the bladder and its outlet. Geriatric patients are at greater risk for lower urinary tract dysfunction owing to age or neurologic disease, such as Parkinson disease or stroke. Although urodynamic testing may best diagnose an individual patient's bladder storage and emptying function, the tests should be tailored to answer the question being asked and the test should only be done when the outcome of the test is going to impact decision making regarding management or treatment.