Skip Urodynamics Before Incontinence Surgery.

SCOTTSDALE, ARIz. -- Routine preoperative urodynamic testing does not improve cure rates for stress urinary incontinence and is not cost effective, in women scheduled for pelvic organ prolapse repair, a computer-modeling study suggests.

Both the basic office evaluation and urodynamic testing would lead to an incontinence cure in 96% of cases after initial and secondary treatments. A single extra cure of urinary incontinence would be achieved by urodynamic testing at an approximate cost of $329,000, study investigator Dr. Anne M. Weber said at a urogynecology conference sponsored by the Mayo Clinic Scottsdale.

"That's extreme enough to say the numbers, on balance, don't require that additional level of testing," said, Dr. Weber of the University of Pittsburgh, whose study was published last year (Am. J. Obstet. Gynecol. 183[6]:1338-46, 2000).

The decision-analysis study assumed that all patients scheduled for pelvic organ prolapse surgery would get a basic office preoperative assessment for incontinence: a postvoid residual urine volume measurement, urinalysis, and a cough stress test. This is the minimum assessment recommended by the Agency for Healthcare Research and Quality.

Additional urodynamic testing theoretically could be helpful in identifying patients whose incontinence symptoms are due to detrusor instability alone because in these patients merely adding an anti-incontinence procedure to the prolapse repair would not improve incontinence symptoms, Dr. Weber noted.

Nevertheless, fewer than 5% of patients with a positive cough stress test will have detrusor instability alone. "It occurs so infrequently that you can just about disregard it," she commented.

Nearly all patients with a positive cough stress test have genuine stress incontinence, mixed incontinence (genuine stress incontinence with ...