Constructing trials to show whether urodynamic studies are necessary in lower urinary tract dysfunction
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AIMS: This report reviews the evidence for the utility of urodynamic studies (UDS) in lower urinary tract dysfunction and tries to identify the necessity of constructing trials to show whether UDS are necessary. METHODS: An outline for a think tank discussion was prepared by the chairman of the session. Several experts selected relevant papers from a literature review of the Pubmed/Medline database (January 1966 to August 2010) and prepared a presentation of the evidence for the utility of UDS in the evaluation of several conditions, the prediction of treatment outcome, the prediction of complications and/or cost-effectiveness. The following conditions were considered: urinary incontinence, symptoms suggestive of benign prostatic obstruction (LUTS/BPO), overactive bladder (OAB) and urogenital prolapse. Summary presentations were discussed by a large group of opinion leaders and experts and audio-recorded. The proceedings of this process are the basis for this manuscript. RESULTS: The structured sessions resulted in detailed statements about the existing evidence for the utility of UDS in men after radical prostatectomy, men with uncomplicated LUTS/BPO, patients with OAB, female stress urinary incontinence (SUI) and urogenital prolapse. CONCLUSIONS: UDS should be used for investigation of new treatment modalities and establishment of diagnoses whenever they are in doubt. UDS do not appear to be necessary before pelvic floor muscle training, medical treatment of LUTS/BPO or OAB, surgical treatment of primary female SUI or prolapse. RCT's with non-inferiority design should be conducted to investigate UDS in patients before surgical treatment of the prostate, SUI or OAB.
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