SUFU 2019: Has the Use of Pre-Operative Urodynamics for Stress Urinary Incontinence Surgery Changed Following the VALUE Study?

Miami, FL ( The Value of Urodynamic Evaluation (VALUE) study, a multi-institutional, randomized controlled trial published in 2012, suggested that routine urodynamic evaluation (URD) was not beneficial for pre-operative evaluation of uncomplicated, stress-predominant urinary incontinence (SUI). Consequently, many organizations have advocated against the routine use of pre-operative URD in index SUI patients. However, it has been unclear whether the results from the VALUE study made a clinical impact on physicians treating SUI.

Jacqueline M. Zillioux, MD, and her peers at the University of Virginia School of Medicine assessed the usage of URD in patients undergoing urethral slings through analysis of patient claims data following the 2012 VALUE study.

Data from the Virginia All Payers Claims Database was examined from May 2011-December 2016, using female patients with the diagnosis of SUI (ICD codes N39.3 or 625.6). CPT codes were then used to select the subset undergoing URD and/or slings. Pre-operative URD was defined as URD performed within six months of sling placement. Non-index patients, defined as those with concurrent diagnosis of overactive bladder, urge incontinence, mixed incontinence, or neurogenic bladder, were excluded from the study. Longitudinal analyses were performed to assess the impact of the VALUE study on the rate of URD usage prior to sling placement. 

44,347 patients with a SUI diagnosis were identified over the study period, of whom 18,900 underwent URD evaluation and 7,204 had a urethral sling procedure. After exclusion of non-index patients, it was determined 4112 (62.9%) patients undergoing a sling procedure had preoperative URD.

A decrease in the annual number of slings, both with and without pre-operative UDS, was seen beginning in mid-2012 (Figure 1). The proportion of slings with pre-operative URD demonstrated a small decrease over the study years (68%, 2011; 58%, 2016). In addition, the time-series model (ARIMA 0,1,5 with drift) demonstrated a significant decrease in the number of slings with pre-operative URD starting in May 2012 (p=0.037, Figure 2). From the time of publication, there was a decrease of 0.93% per month of slings with pre-operative UDS (p<0.001, based on a beta regression model). 
UroToday SUFU2019 VALUE study
UroToday SUFU2019 VALUE study SUI

Based on the findings, the authors at the University of determined that the majority of index SUI patients undergoing sling placement in Virginia have preoperative UDS, but there has been a modest decline in the usage of URD prior to surgery following the publication of the VALUE study in May 2012.

Presented by: Jacqueline M. Zillioux, MD, the University of Virginia School of Medicine

Written by: Judy Choi, MD, Assistant Professor, Department of Urology, University of California, Irvine @judymchoi at the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction Winter Meeting, SUFU 2019, February 26 - March 2, 2019, Miami, Florida