title: Could the National Institute for Health and Clinical Excellence guidelines on urodynamics in urinary incontinence put some women at risk of a bad outcome from stress incontinence surgery?
abstract: OBJECTIVE
  To evaluate the potential impact of the UK National Institute for Health and Clinical Excellence (NICE) recommendation that preoperative urodynamics are not necessary for women with 'pure symptoms of stress urinary incontinence' (SUI), by using data from a population of women referred with lower urinary tract symptoms.
  
  
  METHODS
  In a retrospective study of 6276 women with UI, from an electronic database at a tertiary referral centre, information was collected and entered into a urodynamics computer database at the time of history taking and before conducting the tests. The database was used to identify women aged 18-80 years who had multichannel cystometry for UI over a 17-year period (1 January 1990 to 31 December 2006). To apply the NICE criterion of a 'clearly defined clinical diagnosis of pure SUI', strict selection criteria were used to identify patients with pure SUI. The reliability of the patients' history in predicting 'pure' urodynamic SUI in patients with 'pure' SUI was investigated. The correspondence of the symptomatic diagnosis of pure SUI with the urodynamic findings was assessed, and sensitivity, specificity, positive and negative predictive values were calculated using contingency tables.
  
  
  RESULTS
  Only 324 (5.2%) women had pure SUI; moreover, a quarter of those with pure SUI symptoms ultimately had urodynamic diagnoses other than urodynamic SUI, that could affect the outcome of continence surgery.
  
  
  CONCLUSIONS
  These findings indicate that only a small group of women fulfil the NICE criteria of pure SUI. These strict criteria do not ensure that all women with potentially important urodynamic findings are evaluated accordingly. Therefore, we suggest that this NICE recommendation was unwise and, furthermore, was not based on properly acquired expert opinion.
authors.affiliation: Bristol Urological Institute, Southmead Hospital, Bristol, UK. wagur@doctors.org.uk
authors.forename: Wael
authors.initials: W
authors.lastname: Agur
authors.forename: Fadi
authors.initials: F
authors.lastname: Housami
authors.forename: Marcus
authors.initials: M
authors.lastname: Drake
authors.forename: Paul
authors.initials: P
authors.lastname: Abrams
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008875:Middle Aged; D017410:Practice Guidelines as Topic / Q000592:standards*; D011300:Preoperative Care / Q000191:economics / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000191:economics / Q000503:physiopathology / Q000601:surgery*; D014563:Urodynamics; D055815:Young Adult