Enrico Finazzi-Agro1, Andrew Gammie2, Thomas M Kessler3, Gommert van Koeveringe4, Maurizio Serati5, Eskinder Solomon6, Stefan de Wachter7, Ruth Kirschner-Hermanns8. 1. Department of Experimental Medicine and Surgery, Unit for Functional Urology, Tor Vergata University Hospital, Rome, Italy. 2. Bristol Urological Institute, Southmead Hospital, Bristol, UK. 3. Neuro-urology, Spinal Cord Injury Center & Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland. 4. Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands. 5. Department of Obstetrics and Gynaecology, Urogynaecology Unit, University of Insubria, Varese, Italy. Electronic address: mauserati@hotmail.com. 6. Urology Centre, Guy's and St Thomas NHS Trust, London, UK. 7. Department of Urology, University Hospital Antwerpen, University of Antwerp, Belgium. 8. Neuro-urology/Urology, University Clinic, Friedrich Wilhelms University Bonn and Neurological Rehabilitation Centre, Bonn, Germany.
Abstract
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.
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.
Authors: Maurizio Serati; Andrea Braga; Peter F W M Rosier; Stefan de Wachter; Alan Uren; Enrico Finazzi-Agrò Journal: Neurourol Urodyn Date: 2022-04-14 Impact factor: 2.367
Authors: Nicolas S Bodmer; Carla Wirth; Veronika Birkhäuser; Andrea M Sartori; Lorenz Leitner; Marcio A Averbeck; Stefan de Wachter; Enrico Finazzi Agro; Andrew Gammie; Howard B Goldman; Ruth Kirschner-Hermanns; Peter F W M Rosier; Maurizio Serati; Eskinder Solomon; Gommert van Koeveringe; Lucas M Bachmann; Thomas M Kessler Journal: Eur Urol Open Sci Date: 2022-09-05