OBJECTIVE: To assess the efficacy of aggressive nonsurgical therapy fo
r urinary incontinence in women and to determine if it is advantageous
to perform invasive urodynamic testing prior to initiating treatment.
STUDY DESIGN: We subjectively assessed 202 incontinent women three mo
nths to four years following non-surgical therapy for urinary incontin
ence. Therapy in all patients included behavioral modification in the
form of timed voiding and pelvic floor exercises. Depending on the sus
pected diagnosis and menopausal state, patients were also treated with
various combinations of pharmacologic agents and estrogen replacement
therapy. Based on initial evaluation, patient preference and referrin
g physician preference, 100 women were started on therapy after a mini
mal evaluation, while 102 women were treated based on invasive urodyna
mic testing. A subjective assessment of treatment outcome was made via
a telephone interview in which patients were asked standardized quest
ions. RESULTS: One hundred nineteen cases (59%) were subjectively impr
oved or cured with nonsurgical therapy. Performing urodynamic testing
prior to initiating therapy did not increase the overall success rate:
69 of 100 patients (69%) treated on the basis of history, physical ex
amination and a minimal office evaluation were improved or cured, whil
e only 50 of 102 patients (49%) having electronic multichannel urodyna
mic testing were improved or cured. CONCLUSION: All women with urinary
incontinence should be initially offered nonsurgical therapy since it
large percentage will obtain satisfactory results. It is not benefici
al or cost-effective to perform electronic urodynamic testing prior to
initiating therapy.