Abstract
The use of preoperative urodynamics as a standard investigation for urinary incontinence
(UI) has long been a subject of debate, with a lack of robust evidence to demonstrate
improved patients’ outcomes. We aim to compare the clinical and cost effectiveness
of urodynamics versus office clinical evaluation only, prior to the treatment of UI.
We conducted three linked systematic reviews and meta-analyses of randomised controlled
trials (RCTs) comparing urodynamics assessment versus clinical evaluation only in
women prior to 1) non-surgical treatment of UI, 2a) surgical treatment of stress urinary
incontinence (SUI) and 2b) invasive treatment for overactive bladder (OAB). Women
with severe pelvic organ prolapse, previous continence surgery and neuropathic bladder
were excluded. Primary outcomes were patient-reported and objective success post-treatment.
Secondary outcomes were adverse events, quality of life, sexual function and health
economic measures. We searched MEDLINE, Embase and Cochrane Central Register of Controlled
Trials databases for each category, which was last updated on January 2019. Study
selection, risk of bias assessment and data extraction were performed independently
by two reviewers. The random effects model was used to assess risk ratio and mean
difference with 95% confidence interval. Statistical heterogeneity was assessed by
I2 statistics and the quality of evidence by the Grading of Recommendations, Assessment,
Development, and Evaluation (GRADE) approach.
Four RCTs compared urodynamics versus clinical evaluation only prior to non-surgical
management of UI. Treatment consisted of pelvic floor muscle training, with or without
pharmacological therapy. Meta-analysis of 150 women showed no evidence of significant
difference in the patient-reported and objective success rates between groups (P = 0.520,
RR: 0.91, 95% Cl 0.69–1.21, I2 = 0% and P = 0.470, RR:0.87, 95% Cl 0.59–1.28, I2 = n/a, respectively). Seven RCTs were identified for surgical management of SUI.
The majority of women underwent mid-urethral tape procedures (retropubic or transobturator
approach). Meta-analysis of 1149 women showed no evidence of significant difference
in patient-reported (P = 0.850, RR:1.01, 95% CI 0.88–1.16, I2 = 53%) and objective success between groups (P = 0.630, RR:1.02, 95% CI 0.95–1.08,
I2 = 28%). There was no significant difference in incidence of voiding dysfunction,
de novo urgency, and urinary tract infection between groups. No RCTs were identified
for invasive management of OAB.
In conclusion, limited evidence shows that routine urodynamics prior to non-surgical
management of UI or surgical management of SUI is not associated with improved treatment
outcomes, when compared to clinical evaluation only. Well-designed clinical trials
are needed to evaluate the clinical and cost-effectiveness of routine urodynamics
prior to surgical management of SUI and OAB.
Keywords
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Article info
Publication history
Published online: November 15, 2019
Accepted:
November 13,
2019
Received in revised form:
November 10,
2019
Received:
July 9,
2019
Identification
Copyright
© 2019 Elsevier B.V. All rights reserved.
