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Does preoperative urodynamics improve outcomes for women undergoing surgery for stress urinary incontinence? A systematic review and meta‐analysis
Author(s) -
Rachaneni S,
Latthe P
Publication year - 2015
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/1471-0528.12954
Subject(s) - medicine , randomized controlled trial , urinary incontinence , meta analysis , cinahl , relative risk , medline , urodynamic testing , stress incontinence , physical therapy , urology , confidence interval , psychological intervention , nursing , political science , law
Background Urodynamics is widely used in the investigation of urinary incontinence. The existing evidence questions its add‐on value in improving the outcome of surgical treatment for stress urinary incontinence ( SUI ). Objectives To compare the surgical outcomes in women with SUI or stress‐predominant mixed urinary incontinence ( MUI ) based on urodynamic diagnoses compared with diagnoses based on office evaluation without urodynamics. Search strategy We searched Cochrane, MedLine, Embase, CINAHL, LILACS, meta Register of Controlled Trials ( m RCT ) and Google Scholar databases from inception until March 2013. Selection criteria We included randomised controlled trials ( RCT s) comparing surgical outcomes in women investigated by urodynamics and women who had office evaluation only. Data collection and analysis Two independent reviewers (S.R. and P.L.) extracted the data and analysed it using review manager ( revman ) 5.2 software. Main results Of the 388 articles identified, only four RCT s met our criteria. The data from one study are as yet unpublished. In the other three RCT s, the women with SUI or stress‐predominant MUI were randomised either to office evaluation and urodynamics ( n = 388) or to office evaluation only ( n = 387). There was no statistical difference in the risk ratio ( RR ) of subjective cure in the two groups ( RR 1.02, 95% CI 0.90–1.15, P = 0.79, I 2 = 45%), objective cure ( RR 1.01, 95% CI 0.93–1.11, P = 0.28, I 2 = 20%) or complications such as voiding dysfunction ( RR 1.54, 95% CI 0.61–3.89, P = 0.27, I 2 = 18%) or urinary urgency ( RR 0.80, 95% CI 0.28–2.3, P = 0.19, I 2 = 40%). Authors' conclusions In women undergoing primary surgery for SUI or stress‐predominant MUI without voiding difficulties, urodynamics does not improve outcomes – as long as the women undergo careful office evaluation.