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Wednesday, April 17, 2013

Trailers (47): Value of urodynamics before SUI surgery

van Leijsen, et al. Value of urodynamics before stress urinary incontinence surgery: a randomized controlled trial

Why should you read about this topic?

Urodynamics testing is complex, expensive, and uncomfortable.  Is it really needed before stress urinary incontinence surgery?

What were the authors trying to do?

To compare results of immediate surgery with individualized therapy based on urodynamics in women with stress urinary incontinence

Who participated and in what setting?

Women (N=126) with predominant stress urinary incontinence at 30 Dutch hospitals between 2009-10, with discordant findings between history and physical exam and urodynamics.   Women with a large post-void residual, prior incontinence surgery, and severe pelvic organ prolapse were excluded.

What was the study design?

Multicenter randomized controlled trial (noninferiority) of immediate surgery or individualized therapy directed by urodynamics results.

What were the main outcome measures?

Improvement on Urogenital Distress Inventory 12 months after baseline

What were the results?

The immediate surgery group had improvement in the Urogenital Distress Inventory that was not inferior to individualized therapy directed by urodynamic results.

What is the most interesting image in the paper?

Table 4

What were the study strengths and weaknesses?

Strengths: randomized trial. Weaknesses: individualized therapy left to the discretion of the physician; physicians and patients aware of group assignment; most women underwent surgery within one year anyway.

What does the study contribute for your practice?

Most women with uncomplicated stress urinary incontinence end up having surgery and have improvement in symptoms regardless of urodynamics findings.