Randomized Arms
Arm A · n = 315
Office Eval + Urodynamics
Standardized office evaluation plus noninstrumented uroflowmetry, filling cystometry, Valsalva leak-point pressures, pressure-flow study
Arm B · n = 315
Office Evaluation Only
Standardized office evaluation alone (stress test, post-void residual, urinalysis)
Primary Outcome: Treatment Success at 12 Months
76.9%
Urodynamics
203 / 264
vs
77.2%
Eval Only
200 / 259
Favors Urodynamics
Favors Eval Only
Difference: −0.3% (95% CI −7.5 to 6.9)
Secondary Outcomes
PGI-I "Much / Very Much Better"
Positive Stress Test at 12 Months
Patient Satisfaction (0–100 scale)
Key Findings
Diagnostic changes did not alter outcomes. Urodynamics changed clinical diagnoses — fewer diagnosed with OAB with incontinence (25.2% vs 41.6% post-office eval, P<0.001) and more with voiding dysfunction (11.9% vs 2.2%, P<0.001). But these diagnostic changes did NOT alter surgical management or outcomes. ~93% of women in both groups received midurethral slings.
Stress incontinence confirmation: 97% of women in the urodynamics group had stress incontinence confirmed. Surgery cancellation: 5.4% (urodynamics) vs 8.6% (eval only), P = 0.12.
Clinical Bottom Line
For women with uncomplicated, stress-predominant urinary incontinence confirmed by office evaluation with a positive stress test, routine preoperative urodynamics does not improve surgical outcomes at 1 year. A basic office evaluation is sufficient before midurethral sling surgery.