title: Assessing professional equipoise and views about a future clinical trial of invasive urodynamics prior to surgery for stress urinary incontinence in women: a survey within a mixed methods feasibility study.
abstract: OBJECTIVE
  To determine surgeons' views on invasive urodynamic testing (IUT) prior to surgery for stress (SUI) or stress predominant mixed urinary incontinence (MUI).
  
  
  METHODS
  Members of British Society of Urogynaecology (BSUG) and British Association of Urological Surgeons Section of Female, Neurological and Urodynamic Urology (BAUS-SFNUU) were sent an email invitation to complete an online "SurveyMonkey®" questionnaire regarding their current use of IUT prior to surgical treatment of SUI, their view about the necessity for IUT in various clinical scenarios, and their willingness to randomize patients into a future trial of IUT. A purposive sample of respondents was invited for telephone interview to explore further how they use IUT to inform clinical decisions, and to contextualize questionnaire responses.
  
  
  RESULTS
  There were 176/517 (34%) responses, 106/332 (32%) from gynecologists/urogynecologists and 67/185 (36%) from urologists; all respondents had access to IUT, and 89% currently arrange IUT for most women with SUI or stress predominant MUI. For a variety of scenarios with increasingly complex symptoms the level of individual equipoise ("undecided" about IUT) was very low (1-6%) and community equipoise was, at best, 66:34 (IUT "essential" vs. "unnecessary") even for the simplest scenario. Nevertheless, 70% rated the research question underlying the proposed studies "very important" or "extremely important;" 60% recorded a "willingness to randomize" score ≥8/10.
  
  
  CONCLUSIONS
  Most urogynecologists and urologists consider IUT essential before surgery in SUI with or without other symptoms. Most however recognize the need for further research, and indicated a willingness to recruit into multicenter trials addressing this question.
authors.affiliation: Directorate of Women's Services, Royal Victoria Infirmary, Newcastle upon Tyne, UK. paul.hilton@ncl.ac.uk
authors.forename: Paul
authors.initials: P
authors.lastname: Hilton
authors.forename: Andy
authors.initials: A
authors.lastname: Bryant
authors.forename: Denise
authors.initials: D
authors.lastname: Howel
authors.forename: Elaine
authors.initials: E
authors.lastname: McColl
authors.forename: Brian S
authors.initials: BS
authors.lastname: Buckley
authors.forename: Malcolm
authors.initials: M
authors.lastname: Lucas
authors.forename: Douglas G
authors.initials: DG
authors.lastname: Tincello
authors.forename: Natalie
authors.initials: N
authors.lastname: Armstrong
mesh_terms: D001291:Attitude of Health Personnel; D005240:Feasibility Studies; D005260:Female; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D010865:Pilot Projects; D010818:Practice Patterns, Physicians'; D011237:Predictive Value of Tests; D011300:Preoperative Care; D016032:Randomized Controlled Trials as Topic / Q000379:methods*; D012955:Societies, Medical; D011795:Surveys and Questionnaires; D057212:Therapeutic Equipoise; D001743:Urinary Bladder / Q000503:physiopathology* / Q000601:surgery; D014550:Urinary Incontinence, Stress / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D014563:Urodynamics; D013520:Urologic Surgical Procedures; D014572:Urology