Urodynamics: State of Art Review of Literature and Recent Controversies

Introduction

Urinary incontinence is a common condition affecting adult women of all ages with a reported age-related prevalence up to a third of all women. At least half of these women would suffer from stress urinary incontinence. This debilitating condition places considerable burden on the psychosocial functioning and affects the quality of life significantly. Moreover, as the population ages, the prevalence of urinary incontinence is expected to rise even further.

Abstract

INTRODUCTION

There is ongoing debate about the diagnostic utility of urodynamic studies (UDS) in the management of women with urinary incontinence given the conflicting statements by various governing bodies. Most patients with urinary incontinence will respond well to conservative measures and/or minimally invasive anti-incontinence surgery without the need for routine urodynamic testing. Furthermore several controversies continue to exist on the utility of UDS in the preoperative investigation value, degree of detrusor- or bladder neck-related voiding dysfunction, application of leak point pressures and urethral pressure profile, and the need for UDS in healthy, treatment-naive woman with no history of prior incontinence or prolapsed surgery.

OBJECTIVES

To highlight the arguments surrounding the current controversies and explore the value of UDS based on published literature.

MATERIALS AND METHODS

The Pubmed and Medline database were searched for recent articles published over the last 5 years. Only peer-reviewed articles published in English were evaluated and specific emphasis on major international guidelines, statements from major urinary and continence organizations, and published studies from randomized controlled multicenter trials were placed. The search terms were urodynamics, recent controversies, preoperative and surgical outcome, valsalva leak point pressure, and cost-effectiveness.

RESULTS

Many issues pertaining to UDS remain unresolved but UDS should be considered in women with prior stress-incontinent and/or pelvic surgery or radiation, concomitant large pelvic organ prolapse, or who have history of neurological conditions.

CONCLUSION

Further research is needed to determine the role of UDS in preoperative patient counseling and surgical success.

Keywords

Urodynamics, stress urinary incontinence, surgical outcome, controversies