title: Urodynamic studies for management of urinary incontinence in children and adults.
abstract: BACKGROUND
  Urodynamic tests are used to investigate people who have urinary incontinence or other urinary symptoms in order to make a definitive objective diagnosis. The aim is to help to select the treatment most likely to be successful. The investigations are invasive and time consuming.
  
  
  OBJECTIVE
  The objective of this review was to discover if treatment according to a urodynamic-based diagnosis, compared to treatment based on history and examination, led to more effective clinical care of urinary incontinence and better clinical outcomes.
  
  
  METHODS
  We searched the Cochrane Incontinence Group Specialised Trials Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and CINAHL, and handsearching of journals and conference proceedings (searched 24 May 2011), and the reference lists of relevant articles.
  
  
  METHODS
  Randomised and quasi-randomised trials comparing clinical outcomes in groups of people who were and were not investigated using urodynamics, or comparing one type of urodynamics against another. Trials were excluded if they did not report clinical outcomes.
  
  
  METHODS
  Two reviewers independently assessed trial quality and extracted data.
  
  
  RESULTS
  Seven small trials involving around 400 people were included but data were only available for 385 women in five trials, of whom 197 received urodynamics. There was some evidence of risk of bias. The four deaths and 12 dropouts in the control arm of one trial were unexplained.There was some evidence that the tests did change clinical decision making. There was evidence from two trials that women treated after urodynamic investigations were more likely to receive drugs (RR 2.09, 95% CI 1.32 to 3.31) but not, in three trials, surgery (RR 1.75, 95% CI 0.39 to 7.75). Women in the urodynamic arms of two trials were more likely to have their management changed but this did not quite reach statistical significance (proportion with no change in management 76% versus 99%, RR 0.79, 95% CI 0.57 to 1.10).However, there was not enough evidence to demonstrate whether or not this resulted in a clinical benefit. For example there was no statistically significant difference in the number of women with urinary incontinence if they received treatment guided by urodynamics (70%) versus those whose treatment was based on history and clinical findings alone (62%) (e.g. RR for number with incontinence after first year 1.23, 95% CI 0.60 to 2.55).No trials reported whether or not there were any adverse effects.
  
  
  CONCLUSIONS
  While urodynamic tests may change clinical decision making, there was not enough evidence to suggest whether this would result in better clinical outcomes. There was no evidence abut their use in men, children or people with neurological diseases. Larger definitive trials are needed, in which people are randomly allocated to management according to urodynamic findings or to standard management based on history and clinical examination.
authors.affiliation: Health Services Research Unit, University of Aberdeen, 3rd Floor, Health Sciences Building,Foresterhill, Aberdeen, Scotland, AB25 2ZD, UK. c.glazener@abdn.ac.uk.
authors.forename: Cathryn M A
authors.initials: CM
authors.lastname: Glazener
authors.forename: Marie Carmela M
authors.initials: MC
authors.lastname: Lapitan
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000503:physiopathology* / Q000628:therapy*; D014563:Urodynamics