title: The effect of urodynamic testing on clinical diagnosis, treatment plan and outcomes in women undergoing stress urinary incontinence surgery.
abstract: OBJECTIVE
  We evaluated the influence of preoperative urodynamic studies on diagnoses, global treatment plans and outcomes in women treated with surgery for uncomplicated stress predominant urinary incontinence.
  
  
  METHODS
  We performed a secondary analysis from a multicenter, randomized trial of the value of preoperative urodynamic studies. Physicians provided diagnoses before and after urodynamic studies and global treatment plans, defined as proceeding with surgery, surgery type, surgical modification and nonoperative therapy. Treatment plan changes and surgical outcomes between office evaluation and office evaluation plus urodynamic studies were compared by the McNemar test.
  
  
  RESULTS
  Of 315 subjects randomized to urodynamic studies after office evaluation 294 had evaluable data. Urodynamic studies changed the office evaluation diagnoses in 167 women (56.8%), decreasing the diagnoses of overactive bladder-wet (41.6% to 25.2%, p <0.001), overactive bladder-dry (31.4% to 20.8%, p = 0.002) and intrinsic sphincter deficiency (19.4% to 12.6%, p = 0.003) but increasing the diagnosis of voiding dysfunction (2.2% to 11.9%, p <0.001). After urodynamic studies physicians canceled surgery in 4 of 294 women (1.4%), changed the incontinence procedure in 13 (4.4%) and planned to modify mid urethral sling tension (more or less obstructive) in 20 women (6.8%). Nonoperative treatment plans changed in 40 of 294 women (14%). Urodynamic study driven treatment plan changes were not associated with treatment success (OR 0.96, 95% CI 0.41, 2.25, p = 0.92) but they were associated with increased postoperative treatment for urge urinary incontinence (OR 3.23, 95% CI 1.46, 7.14, p = 0.004).
  
  
  CONCLUSIONS
  Urodynamic studies significantly changed clinical diagnoses but infrequently changed the global treatment plan or influenced surgeon decision to cancel, change or modify surgical plans. Global treatment plan changes were associated with increased treatment for postoperative urgency urinary incontinence.
authors.affiliation: Department Urology, William Beaumont Hospital, Royal Oak, Michigan 48073, USA. lsirls@mac.com
authors.forename: Larry T
authors.initials: LT
authors.lastname: Sirls
authors.forename: Holly E
authors.initials: HE
authors.lastname: Richter
authors.forename: Heather J
authors.initials: HJ
authors.lastname: Litman
authors.forename: Kimberly
authors.initials: K
authors.lastname: Kenton
authors.forename: Gary E
authors.initials: GE
authors.lastname: Lemack
authors.forename: Emily S
authors.initials: ES
authors.lastname: Lukacz
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Kraus
authors.forename: Howard B
authors.initials: HB
authors.lastname: Goldman
authors.forename: Alison
authors.initials: A
authors.lastname: Weidner
authors.forename: Leslie
authors.initials: L
authors.lastname: Rickey
authors.forename: Peggy
authors.initials: P
authors.lastname: Norton
authors.forename: Halina M
authors.initials: HM
authors.lastname: Zyczynski
authors.forename: John W
authors.initials: JW
authors.lastname: Kusek
mesh_terms: D005260:Female; D006801:Humans; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000175:diagnosis* / Q000601:surgery*; D014563:Urodynamics