The bladder is an unreliable witness: The case for urodynamic investigations in female stress urinary incontinence.

For some years, the role of urodynamics (UDS) in female stress urinary incontinence (SUI) has been a topic of intense debate. The findings of the VaLUE and VUSIS-II randomised clinical trials (RCTs) published in 2012 appeared to suggest that UDS is not useful in women with uncomplicated SUI, with the result that several authoritative guidelines were amended and the routine use of UDS in this setting fell sharply. However, many experts have raised concerns about the design of these two RCTs and their subsequent interpretation - including the inappropriate generalisation of the findings beyond uncomplicated cases, which represent only a small minority of the overall patient population. In this paper, we consider a range of issues and confounding factors which raise doubts about how influential these RCTs should have been and reflect on the potential value of UDS both for objective diagnosis and patient counselling in female SUI.

European journal of obstetrics, gynecology, and reproductive biology. 2019 Nov 07 [Epub ahead of print]

Maurizio Serati, Tufan Tarcan, Enrico Finazzi-Agrò, Marco Soligo, Andrea Braga, Stavros Athanasiou, Matteo Balzarro

Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy. Electronic address: ., Department of Urology, Marmara University School of Medicine and Koç University School of Medicine, Istanbul, Turkey., Department of Surgical Sciences, University of Rome Tor Vergata, Urology Unit, Tor Vergata University Hospital, Italy., Department of Women, Mothers and Neonates, Buzzi Children's Hospital, ASST Fatebenefratelli Sacco, University of Milan, Milan, Italy., Department of Obstetrics and Gynecology, EOC - Beata Vergine Hospital, Mendrisio, Switzerland., Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens and Alexandra Hospital, Athens, Greece., Department of Urology, Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.