Trends in urodynamic testing prior to midurethral sling placement—What was the value of the VALUE trial?

• Published in: Neurourology and urodynamics 2018-03, Vol.37 (3), p.1046-1052
• Main Authors: Lloyd, Jessica C., Dielubanza, Elodi, Goldman, Howard B.
• Format: Article
• Language: English
• Subjects: Decision making; guidelines; incontinence (female); Patients; Statistical analysis; Surgery; synthetic midurethral sling; Urinary incontinence; urodynamics
• ISSN: 0733-2467; 1520-6777
• DOI: 10.1002/nau.23398

Background Many urologists use urodynamic testing (UDS) to assist clinical decision‐making. The VALUE study, a multi‐institutional, randomized controlled trial published in 2012, demonstrated that UDS prior to midurethral sling placement for uncomplicated stress urinary incontinence (SUI) did not change management. We sought to determine whether use of UDS for evaluation of SUI diminished thereafter. Methods Records of patients who underwent isolated mid‐urethral sling surgery at our tertiary‐care referral center from 2008 to 2009 (pre‐VALUE) and 2014 to 2016 (post‐VALUE) were reviewed. Comorbidities, presenting symptoms, surgeon specialty, use of UDS, UDS results and sling type were recorded. Patients with neurologic comorbidities or prior anti‐incontinence procedures were excluded. Descriptive statistics were calculated and multivariable logistic regression analyses performed. Results Three hundred and eighty‐seven patients met inclusion criteria. Median age was 54 years. Patients most frequently presented with stress urinary incontinence (56% pre, 50% post), followed by stress predominant mixed urinary incontinence (40% pre, 48% post, P = 0.09). Before VALUE, UDS was performed in 70% of patients prior to primary sling; in the later cohort, this decreased to 41% (P