Urodynamics useless in female stress urinary incontinence? Time for some sense : a European expert consensus

Background: Routine use of urodynamics (UDS) for the assessment of female stress urinary incontinence (SUI) appears to be in decline across Europe. The reasons for this trend appear multifactorial, but the implications are of significant concern. Objectives: To achieve an expert consensus viewpoint on the value of UDS in female SUI and current barriers to its use. Methodology: A multidisciplinary group of UDS experts from six European countries was convened, and a modified version of the Delphi method was utilised to reach a consensus viewpoint structured around five key questions. Results: Consensus was achieved on all five questions. The group was unanimous that the decline in routine use of UDS is unjustified and misguided, driven by restrictions in funding and accelerated by the publication—and subsequent influence—of two trials that had major limitations. Limitations: The authors comprised a selected group of UDS experts and the analysis is not a formal systematic review. Conclusions: Extensive experience and observational studies have demonstrated the value of UDS for the assessment of female SUI and the dangers of empiric management. This evidence base should not be eclipsed by the findings of two randomised controlled trials that had numerous shortcomings. Patient summary: A group of experts were worried that, even though the cause of incontinence varies, doctors seem to be skipping a diagnostic test called urodynamics (UDS) in some patients and just providing treatment—even surgery—without knowing exactly what is wrong. These experts analysed the situation in detail and reached agreement that UDS testing should not be skipped. It is a fundamental medical principle that interventions must be guided by proper diagnosis. Urinary incontinence is no exception. The value of urodynamics in female stress urinary incontinence has been amply demonstrated, and its current underuse is unjustified and misguided.