Urodynamics in the management of female stress incontinence--which test and when?

PURPOSE OF REVIEW: This article reviews the literature from the last 12 months in the context of our existing knowledge base and reviews the contentious issue of the role of preoperative urodynamics for stress urinary incontinence, with particular reference to the choice of urodynamic investigations for diagnostic differentiation between intrinsic sphincter deficiency and urethral hypermobility, assessing symptom severity and predicting postoperative prognosis.

RECENT FINDINGS: While there are significant conflicting data regarding the role of urodynamics, particularly in the functional assessment of the urethra, it is clear that these diagnostic techniques can provide clinically useful data. It is in this context that recent guidelines advising on restricted use of invasive urodynamics preoperatively should be carefully reviewed.

SUMMARY: There is a pressing need for randomized controlled trials to be performed to fully assess the role of urodynamics in the preoperative assessment of stress urinary incontinence, especially at this time of rapid change in the surgical treatments available.