Why is Urodynamics for Stress Incontinence Controversial?

Stress incontinence remains the most common type of incontinence, and is particularly common in women. Urodynamics is a popular procedure that assists in the diagnosis and understanding of stress incontinence.

Why is it Performed?

Urodynamics is used either to diagnose stress incontinence, or before incontinence surgery to predict the outcome and find out more information. It is often used to measure nerve and muscle function. Doctors also use urodynamics to measure pressure in the bladder, flow rates, and other factors that may explain someone’s incontinence. The procedure can be used to find out what type of incontinence a person may have. The urodynamic test results help diagnose the cause and nature of a lower urinary tract problem, such as stress incontinence.

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What Happens During the Test?

There are different types of urodynamic tests, which can vary depending on a person’s health, physical exam and LUTS. The heath provider decides the type of test that is necessary for a person. For precise measurements, imaging equipment can be used to take images of the bladder filling and emptying, pressure monitors record the pressures inside the bladder, and sensors record muscle and nerve activity. A Doctor may also use uroflowmetry, which is the measurement of urine speed and volume. A professional can then see when the flow rate is highest and how long it takes to get there. Special sensors can also be used to measure the electrical activity of the muscles and nerves around the bladder. Doctors may also use a leak point test to measure the impact of pressure on the bladder. An individual may be asked to apply abdominal pressure to the bladder through coughing or shifting position. Methods can be either simple or more invasive, depending on your circumstance.

Is Urodynamics Testing Beneficial?

There is currently evidence that shows it is unsuccessful for improving surgery outcome in those with straightforward stress incontinence. However, the precise information discovered in urodynamics can be highly beneficial. The Royal College of Obstetricians and Gynaecologists in the UK recommends that women undergoing stress incontinence surgery should have urodynamic investigations. Some studies have found that urodynamic study can provide much more information than demonstration of detrusor overactivity alone. Many specialists believe urodynamics adds more precision to evaluation of patients with stress incontinence. Many people do have complex incontinence symptoms or other indications for urodynamic testing.

Why is it Controversial?

There is ongoing debate on the role of urodynamics as a diagnostic tool for people with stress incontinence. People often find urodynamic testing uncomfortable or embarrassing. The reliability of urodynamics in diagnosing some forms of incontinence can also lead to false-positive or false-negative results. This may lead to failure to treat the symptoms of incontinence correctly. The results of two large randomised trials show that urodynamics does not improve outcome of incontinence surgery in women with uncomplicated stress urinary incontinence. The importance of urodynamics for all patients prior to surgery is also uncertain.

In late 2018, it was observed that there has been a decline in the use of urodynamic testing for stress incontinence diagnosis. This is thought to be due to the following factors:

• It is perceived as technically challenging. There is often a lack of staff who are skilled to do this procedure.
• It has a risk of introducing infection. Urodynamic testing also has a small risk of introducing infection.
• Patient discomfort. People often find the testing uncomfortable and invasive, and the high number of complaints regarding the procedure may have contributed to the decline.
• Risk of methodological errors. Some Doctors have refrained from urodynamic testing unless it is absolutely necessary, due to the high risk of methodological errors. The lack of specialist staff exaggerates this problem.
• Lack of funding. Urodynamics can be complicated and expensive, and a lack of funding has seen it decline.

Although subject to controversy, urodynamic testing remains the best method for assessing bladder function and the lower urinary tract. The procedure is successful in identifying abnormal bladder function, in spite of the risks. There is no evidence to suggest it improves surgery outcome for people with simple stress incontinence. However, it is useful for identifying problems in people with complicated stress incontinence and further bladder problems.