Does preoperative urodynamics improve outcomes for women undergoing surgery for stress urinary incontinence? A systematic review and meta-analysis

Background Urodynamics is widely used in the investigation of urinary incontinence. The existing evidence questions its add-on value in improving the outcome of surgical treatment for stress urinary incontinence (SUI). Objectives To compare the surgical outcomes in women with SUI or stress-predominant mixed urinary incontinence (MUI) based on urodynamic diagnoses compared with diagnoses based on office evaluation without urodynamics. Search strategy We searched Cochrane, MedLine, Embase, CINAHL, LILACS, metaRegister of Controlled Trials (mRCT) and Google Scholar databases from inception until March 2013. Selection criteria We included randomised controlled trials (RCTs) comparing surgical outcomes in women investigated by urodynamics and women who had office evaluation only. Data collection and analysis Two independent reviewers (S.R. and P.L.) extracted the data and analysed it using REVIEW MANAGER (REVMAN) 5.2 software. Main results Of the 388 articles identified, only four RCTs met our criteria. The data from one study are as yet unpublished. In the other three RCTs, the women with SUI or stress-predominant MUI were randomised either to office evaluation and urodynamics (n = 388) or to office evaluation only (n = 387). There was no statistical difference in the risk ratio (RR) of subjective cure in the two groups (RR 1.02, 95% CI 0.90-1.15, P = 0.79, I-2 = 45%), objective cure (RR 1.01, 95% CI 0.93-1.11, P = 0.28, I-2 = 20%) or complications such as voiding dysfunction (RR 1.54, 95% CI 0.61-3.89, P = 0.27, I-2 = 18%) or urinary urgency (RR 0.80, 95% CI 0.28-2.3, P = 0.19, I-2 = 40%). Authors' conclusions In women undergoing primary surgery for SUI or stress-predominant MUI without voiding difficulties, urodynamics does not improve outcomes - as long as the women undergo careful office evaluation.