The role of urodynamics in women with stress urinary incontinence

Objective: To examine the role of urodynamic (UDS) investigations in women with stress urinary incontinence (SUI). Methods: Emphasis will be placed on indications for UDS assessment as well as UDS techniques and findings which apply to women with this condition. Topics such as female bladder outlet obstruction (BOO), the utility of urethral pressure (P_ure) and valsalva leak point pressure (VLPP) measurements, and the prognostic value of UDS in this patient population will also be explored. Results: Noninvasive uroflowmetry (NIF), post-void residual (PVR) measurement, filling cystometrogram (CMG), valsalva leak point pressure (VLPP) and pressure-flow studies (PFS) can provide the urologist with a wealth of information which may be used to refine treatment decisions in complex cases of female urinary incontinence. The utility of P_ure measurements in the pre- and postoperative work-up of stress incontinent women does not appear to be supported by the majority of urologic and urogynecologic studies to date. Conclusion: Prospective randomized controlled trials to evaluate the clinical efficacy, cost-effectiveness and effect on quality of life of a full pre-operative UDS assessment compared to a less invasive, more accessible basic office evaluation in different populations of women with SUI need to be conducted before any firm conclusion can be drawn regarding the superiority of one of these clinical approaches over the other.