Stress incontinence in women under 50: Does urodynamics improve surgical outcome?

The aim of the study was to determine whether urodynamic testing improves t he outcome of retropubic surgery in women aged 50 or younger. A retrospecti ve study was undertaken of 212 women aged 50 or younger who underwent retro pubic surgery at a medical school-affiliated hospital between February 1991 and July 1997. Excluded were patients with prior retropubic urethropexy an d known low urethral closure pressures. The surgery was performed by one ur ogynecologist and two urologists. The minimal evaluation by the urogynecolo gist was a focused incontinence questionnaire, pelvic neurologic examinatio n, pelvic floor grading, cough stress test, urinalysis, postvoid residual, cotton swab test and supine empty stress test. Full urodynamics consisted o f uroflowmetry, subtracted cystometry, urethral closure pressure, cough lea k-point pressure and cystourethroscopy. Subjective postoperative follow-up at 1-4 years was by annual questionnaire. The urogynecologist's patients we re in group I (95 women with full urodynamic studies) and group II (36 wome n with minimal testing). The urologists' patients were in group III (81 wom en with a very minimal workup and cystourethroscopy). A review of seven var iables revealed no difference between the groups. In terms of cured, improv ed and failed, there was also no difference in outcome. There was a differe nce in postoperative voiding problems (though not stress incontinence) in g roup III compared to group I (P = 0.005) and group II (P = 0.002). Our conc lusion was that all women with stress incontinence should undergo a careful minimal evaluation. In women aged 50 or younger urodynamic studies may be avoided unless there is significant stress incontinence, complex symptoms, a positive supine empty stress test, marked prolapse, or a history of prior retropubic urethropexy.