A randomized trial of urodynamic testing before stress-incontinence surgery
Charles W Nager, Linda Brubaker, Heather J Litman, Halina M Zyczynski, R Edward Varner, Cindy Amundsen, Larry T Sirls, Peggy A Norton, Amy M Arisco, Toby C Chai, Philippe Zimmern, Matthew D Barber, Kimberly J Dandreo, Shawn A Menefee, Kimberly Kenton, Jerry Lowder, Holly E Richter, Salil Khandwala, Ingrid Nygaard, Stephen R Kraus, Harry W Johnson, Gary E Lemack, Marina Mihova, Michael E Albo, Elizabeth Mueller, Gary Sutkin, Tracey S Wilson, Yvonne Hsu, Thomas A Rozanski, Leslie M Rickey, David Rahn, Sharon Tennstedt, John W Kusek, E Ann Gormley, Urinary Incontinence Treatment Network, E Ann Gormley, Larry Sirls, Salil Khandwala, Linda Brubaker, Kimberly Kenton, Holly E Richter, L Keith Lloyd, Michael Albo, Charles Nager, Toby C Chai, Leslie Rickey, Halina M Zyczynski, Wendy Leng, Philippe Zimmern, Gary Lemack, Stephen Kraus, Amy Arisco, Peggy Norton, Ingrid Nygaard, Sharon Tennstedt, Anne Stoddard, Debuene Chang, John Kusek, Rebekah Rasooly, Cindy Amundsen, Matthew Barber, Cheryl Iglesia, Lily Arya, Alexander Gomelsky, Kathryn L Burgio, Melissa Fischer, MaryPat Fitzgerald, Chiara Ghetti, Patricia S Goode, Robert L Holley, Yvonne Hsu, Margie Kahn, Jerry Lowder, Karl Luber, Emily Lukacz, Alayne Markland, Shawn Menefee, Pamela Moalli, Elizabeth Mueller, Pradeep Nagaraju, Kenneth Peters, Thomas Rozanski, Joseph Schaffer, Gary Sutkin, R Edward Varner, Emily Whitcomb, Tracey S Wilson, Julie E Burge, Laura Burr, JoAnn Columbo, Tamara Dickinson, Rosanna Dinh, Judy Gruss, Alice Howell, Chaandini Jayachandran, Kathy Jesse, Michelle Kinglee, Barbara Leemon, Jean Maynor, Karen Mislanovich, Jennifer Moran, Doni Murphy, Joanna Peterson, Caren Prather, Mary Raynor, Elle Rich, Jennifer Tabaldo, Tia Thrasher, Mary Tulke, Ryan Wilkerson, Robin Willingham, Kimberly Woodson, Gisselle Zazueta-Damian, Kimberly J Dandreo, Liyuan Huang, Rose Kowalski, Heather Litman, Marina Mihova, Chad Morin, Anne Stoddard, Kerry Tanwar, Sharon Tennstedt, Yan Xu, J Quentin Clemens, Paul Abrams, Deidre Bland, Timothy B Boone, John Connett, Dee Fenner, William Henderson, Sheryl Kelsey, Deborah J Lightner, Deborah Myers, Bassem Wadie, J Christian Winters, Firouz Daneshgari, Stuart Pocock, Charles W Nager, Linda Brubaker, Heather J Litman, Halina M Zyczynski, R Edward Varner, Cindy Amundsen, Larry T Sirls, Peggy A Norton, Amy M Arisco, Toby C Chai, Philippe Zimmern, Matthew D Barber, Kimberly J Dandreo, Shawn A Menefee, Kimberly Kenton, Jerry Lowder, Holly E Richter, Salil Khandwala, Ingrid Nygaard, Stephen R Kraus, Harry W Johnson, Gary E Lemack, Marina Mihova, Michael E Albo, Elizabeth Mueller, Gary Sutkin, Tracey S Wilson, Yvonne Hsu, Thomas A Rozanski, Leslie M Rickey, David Rahn, Sharon Tennstedt, John W Kusek, E Ann Gormley, Urinary Incontinence Treatment Network, E Ann Gormley, Larry Sirls, Salil Khandwala, Linda Brubaker, Kimberly Kenton, Holly E Richter, L Keith Lloyd, Michael Albo, Charles Nager, Toby C Chai, Leslie Rickey, Halina M Zyczynski, Wendy Leng, Philippe Zimmern, Gary Lemack, Stephen Kraus, Amy Arisco, Peggy Norton, Ingrid Nygaard, Sharon Tennstedt, Anne Stoddard, Debuene Chang, John Kusek, Rebekah Rasooly, Cindy Amundsen, Matthew Barber, Cheryl Iglesia, Lily Arya, Alexander Gomelsky, Kathryn L Burgio, Melissa Fischer, MaryPat Fitzgerald, Chiara Ghetti, Patricia S Goode, Robert L Holley, Yvonne Hsu, Margie Kahn, Jerry Lowder, Karl Luber, Emily Lukacz, Alayne Markland, Shawn Menefee, Pamela Moalli, Elizabeth Mueller, Pradeep Nagaraju, Kenneth Peters, Thomas Rozanski, Joseph Schaffer, Gary Sutkin, R Edward Varner, Emily Whitcomb, Tracey S Wilson, Julie E Burge, Laura Burr, JoAnn Columbo, Tamara Dickinson, Rosanna Dinh, Judy Gruss, Alice Howell, Chaandini Jayachandran, Kathy Jesse, Michelle Kinglee, Barbara Leemon, Jean Maynor, Karen Mislanovich, Jennifer Moran, Doni Murphy, Joanna Peterson, Caren Prather, Mary Raynor, Elle Rich, Jennifer Tabaldo, Tia Thrasher, Mary Tulke, Ryan Wilkerson, Robin Willingham, Kimberly Woodson, Gisselle Zazueta-Damian, Kimberly J Dandreo, Liyuan Huang, Rose Kowalski, Heather Litman, Marina Mihova, Chad Morin, Anne Stoddard, Kerry Tanwar, Sharon Tennstedt, Yan Xu, J Quentin Clemens, Paul Abrams, Deidre Bland, Timothy B Boone, John Connett, Dee Fenner, William Henderson, Sheryl Kelsey, Deborah J Lightner, Deborah Myers, Bassem Wadie, J Christian Winters, Firouz Daneshgari, Stuart Pocock
Abstract
Background: Urodynamic studies are commonly performed in women before surgery for stress urinary incontinence, but there is no good evidence that they improve outcomes.
Methods: We performed a multicenter, randomized, noninferiority trial involving women with uncomplicated, demonstrable stress urinary incontinence to compare outcomes after preoperative office evaluation and urodynamic tests or evaluation only. The primary outcome was treatment success at 12 months, defined as a reduction in the score on the Urogenital Distress Inventory of 70% or more and a response of "much better" or "very much better" on the Patient Global Impression of Improvement. The predetermined noninferiority margin was 11 percentage points.
Results: A total of 630 women were randomly assigned to undergo office evaluation with urodynamic tests or evaluation only (315 per group); the proportion in whom treatment was successful was 76.9% in the urodynamic-testing group versus 77.2% in the evaluation-only group (difference, -0.3 percentage points; 95% confidence interval, -7.5 to 6.9), which was consistent with noninferiority. There were no significant between-group differences in secondary measures of incontinence severity, quality of life, patient satisfaction, rates of positive provocative stress tests, voiding dysfunction, or adverse events. Women who underwent urodynamic tests were significantly less likely to receive a diagnosis of overactive bladder and more likely to receive a diagnosis of voiding-phase dysfunction, but these changes did not lead to significant between-group differences in treatment selection or outcomes.
Conclusions: For women with uncomplicated, demonstrable stress urinary incontinence, preoperative office evaluation alone was not inferior to evaluation with urodynamic testing for outcomes at 1 year. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases and the Eunice Kennedy Shriver National Institute of Child Health and Human Development; ClinicalTrials.gov number, NCT00803959.).
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Source: PubMed