Urodynamics for Female Stress Urinary Incontinence: When and Why.

Aims: To discuss the use of urodynamic testing for female stress urinary incontinence and provide a narrative review of the current evidence regarding the utility of urodynamics across the spectrum of clinical presentations.

Methods: A nonsystemic, extensive literature review via PubMed was performed on the use of urodynamics for female stress urinary incontinence.

Results: Findings from several large multicenter trials and subsequent secondary analyses have significantly influenced treatment patterns away from the routine use of urodynamics in female patients with uncomplicated stress urinary incontinence. Much of the current literature focuses on selected patients with uncomplicated stress urinary incontinence that are subsequently treated with midurethral sling placement. These studies comprise the foundational evidence supporting multiple national and international guidelines on the topic. In uncomplicated patients, these guidelines do not support the routine use of urodynamics. However, in more complicated presentations, urodynamic studies are more often valuable for diagnosis and management.

Conclusions: Routine use of urodynamic testing is not currently recommended in guidelines for evaluating uncomplicated female stress urinary incontinence. It is important to recognize that much of the evidence supporting these recommendations is derived from a select population of uncomplicated patients, which may limit generalizability to more complex cases. In such cases, urodynamic testing may be more useful to guide diagnosis and management, though further research is needed to identify which findings have the greatest impact on clinical outcomes.