Do preoperative urodynamics still have a role in female stress urinary incontinence? Re: Van Leijsen SA, Kluivers KB, Mol BW, et al. Can Preoperative Urodynamic Investigation be Omitted in Women with Stress Urinary Incontinence? A Non-Inferiority Randomized Controlled Trial. Neurourol Urodyn 2012;31:1118-23

摘要

The interesting randomized controlled trial by van Leijsen et al. concerns one of the most relevant and actually debated issue in urogynecology, the role of urodynamics in the preop-erative evaluation of women with stress urinary incontinence (SUI). Some articles, also very recently published, seem to show that preoperative urodynamics do not improve the effectiveness of surgery in patients treated with midurethral slings placements for SUI. However, the last recommendations of the International Consultation on Incontinence suggest to perform urodynamic assessment before SUI surgery. The article by Van Leijsen et al. could be an important intellectual and clinical impact in the preoperative management of SUI. However, this trial presents some relevant limitations that could partially invalidate the obtained finding. The authors included in their study population also women with mixed urinary incontinence and they did not specify how they determined predominant stress incontinence. In spite of this potentially biasing enlargement of the patients recruitment and of the involvement of 10 different hospital, the authors enrolled in their trial only 59 women with SUI; this is a very small subset of patients, thus resulting in a very low statistical power for a minimal clinically relevant difference. Moreover, the study did not include or describe the women that more likely could benefit from urodynamics, patients with low leak point pressure, low MUCP, pelvic organ prolapse, previous failed incontinence or prolapse surgery or voiding dysfunction. Several papers identified new and classical urodynamic parameters to predict the sling outcomes (MUCPP, VLPP, open vesical pressure) and to offer to the patients a more accurate preoperative counselling.