Expensive diagnostic test may not be necessary before stress incontinence surgery

MAYWOOD -- A routine, but expensive, test for women who undergo stress incontinence surgery may not always be necessary, according to a study published in the latest issue of The New England Journal of Medicine. This test, known as urodynamics, determines how the bladder stores and releases urine. The study found that women who underwent a doctor's evaluation and urodynamics versus a doctor's evaluation alone did not have better outcomes after stress incontinence surgery.

"Urodynamic tests are commonly performed in women before stress incontinence surgery despite their high cost and a lack of evidence that the test improves outcomes for patients," said Linda Brubaker, MD, MS, study co-author, division of Female Pelvic Medicine and Reconstructive Surgery, Loyola University Health System (LUHS). "This study provides the first good indication that this test is not necessary for many of these patients."

The study evaluated 630 women with stress incontinence at 11 centers across the country. Half of the study participants underwent an office evaluation plus urodynamics and the other half underwent an office evaluation alone before surgery. Treatment success was determined using a 20-item, patient-reported tool that assesses presence and bother of urinary incontinence, urgency, frequency and difficulty urinating. The proportion of women who achieved treatment success after one year was 76.6 percent versus 77.2 percent, respectively. There also were no significant differences between groups in urinary incontinence severity, quality of life, patient satisfaction or other side effects.

Stress incontinence surgery corrects urine leakage from physical activity, such as laughing, coughing, sneezing or exercise. Approximately 260,000 women underwent this surgery in 2010. Urodynamic studies were performed in many of these patients. In addition to the cost and the lack of evidence associated with this test, urodynamics also causes discomfort and an increased risk of urinary-tract infections in women.

"These results have the potential to positively influence care and minimize testing-associated problems," said Dr. Brubaker, who also is dean of Loyola University Chicago Stritch School of Medicine. "These findings also represent a significant cost-savings for patients and the health-care system."