Do simple tests before incontinence surgery: special urodynamic testing called often unnecessary in those with obvious gross anatomic pelvic defects.(Gynecology)

ST. LOUIS -- Sophisticated urodynamic testing is rarely necessary before undertaking surgical correction of obvious anterior compartment defects associated with female incontinence, according to Marvin H. Terry Grody, M.D.

Moreover, he noted, such high-level tests should be replaced with simple urethral and bladder function tests as well as an essential bimanual, standing examination.

"The gynecologist can do simple commonsense tests when approached with a patient who has obvious gross anatomic defects in the pelvis, especially in the presence of other pelvic compartmental defects, and is going to definitely require surgery. Special urodynamic testing will not change the original operative plan," Dr. Grody commented during an interview with this newspaper.

"Urodynamic testing in advance of the surgery is not what is needed; it's what the patient is left with after the surgery that you need to concentrate on," Dr. Grody said.

"When you get right down to it, in this setting, technological urodynamic testing offers very little, if any, advance surgical guidance; it is employed routinely for ulterior motives. Although clinical researchers might deem it necessary, it is not a requirement for the competent generalist for primary cases, especially if the physician's office is geographically located far from a major medical center," he added.

Speaking at the 14th International Pelvic Reconstructive and Vaginal Surgery Conference. Dr. Grody, of the Robert Wood Johnson Medical School at Camden (N.J.), outlined the simple urinary function tests that obviate the need for urodynamic testing in these patients. They include:

* a urinalysis and culture;