Across medical fields, objective diagnosis is the cornerstone of clinical decision-making. There is no reason why functional urology should be an exception. While incontinence may not be life-threatening, it can significantly impact quality of life – as can its management.

In most cases, the bladder is an unreliable witness with regard to the underlying cause of incontinence,¹ meaning that clinical guesswork is usually not in patients’ best interests. Indeed, tertiary referral centres report that they commonly see patients who have received inappropriate management for their incontinence – including irreversible surgery – and are desperate for specialist help.

Urodynamics is the only way to gain objective diagnostic insight into the underlying cause of a patient’s lower urinary tract symptoms (LUTS) but, in recent years, the value of urodynamics in guiding management decision-making has been questioned. This largely stems from the findings of two randomised controlled trials (RCTs) in female stress urinary incontinence (SUI) which – despite their narrow and atypical patient cohorts – have adversely influenced opinion about urodynamics in general.²

In addition, clinicians may wrongly assume that patients prefer not to undergo urodynamics because it is ‘unpleasant’. A newly published review article shows that, on the contrary, urodynamics is generally very well tolerated once its purpose has been properly explained – and patients widely welcome the insight it provides.³

Without objective diagnosis, recommended management for incontinence may not work – and may even cause lasting harm.

The vaginal mesh scandal is an unwelcome reminder of the harm invasive intervention can do. At the very least, a clinician should be as sure as they can that their patient really is an appropriate candidate for the management they intend to propose.

Should you wish to gain insight from patients who have undergone urodynamics about its acceptability and value to them, the ICIQ has developed a new validated questionnaire for this purpose: https://iciq.net/modules/iciq-s-uds

 

References

1. Serati M, Tarcan T, Finazzi-Agrò E et al. The bladder is an unreliable witness: The case for urodynamic investigations in female stress urinary incontinence. Eur J Obstet Gynecol Reprod Biol. 2020;244:35-37.
2. Finazzi-Agrò E, Gammie A, Kessler TM et al. Urodynamics useless in female stress urinary incontinence? Time for some sense: A European Expert Consensus. Eur Urol Focus 2020; 6: 137–45
3. Serati M, Braga A, Rosier PFWM et al. Acceptability and perceived value of urodynamics from the patient perspective: A narrative review. Neurourol Urodyn 2022 Apr 14. doi: 10.1002/nau.24932.