This worldwide survey had the aim to evaluate the role of invasive urodynamics (UD) in women candidates for stress urinary incontinence (SUI) surgery.

This is an online worldwide survey on current trends in use of preoperative invasive UD in women undergoing SUI surgery (April 2021-still ongoing). Social media (Twitter, Medical Group on Facebook, WhatsApp, Messenger), emails, were used to collect data by a link referring to a database. Demographic respondent’s data, whether routine invasive UD is performed before surgery and its diagnostic role were investigated. In some questions more than one answer was possible.

A total of 420 respondents completed the survey. Urologists were 80.7% (339/420), and the remaining 19.3% were gynaecologists. A fellowship in female urology/urogynaecology was completed by half of the respondent (49.8%). Age and geographical location of responders is reported in table 1. Female urology/urogynaecology was practiced <10 years by 64.3%. 
In females with SUI undergoing surgery 56.6% of respondents reported performing UD, but this rate decreased to 20.2% in cases of uncomplicated SUI. The majority of respondents (64.5%) performed UD in cases of mixed urinary incontinence (MUI), table 2. The components of UD testing are rated in table 3. Among UD data (table 4), the most impactful was detrusor overactivity (86.2%), while the least was urethral pressure profile (26.7%). Urodynamics findings were reported influencing the surgical decision in 84.3% of the cases. Table 5 and 6 report how often UD influences the surgical choice and what UD findings have the greatest impact on surgical management. Urodynamic findings may change the planned surgical treatment in 72.4%, UD may discourage it in 43.6%, and may change surgical expectations in 55.5%. The vast majority of respondents (96.6%) considered UD a useful tool for preoperative counseling.

This survey was able to give a worldwide picture of the use of UD before SUI surgery. We found a very low rate (20.2%) of routine performance of UD for uncomplicated SUI. This data may be a consequence of the recent debate on this topic. The most impactful UD findings were related to the conditions of detrusor contractility, overactivity and underactivity. Among voiding disorders, dyssynergia was considered the most relevant dysfunction. Valsalva Leak Point Pressure was the most reported tool to investigate urethral function. The surgical management was influenced by UD findings in the vast majority of the cases (84.3%), although 60.3% reported that a relevant impact of the UD occurred in less than 40% of the investigations. The crucial effect of UD on surgical management was higher than expected, considering the data reported in the literature. This latter finding showed that for many respondents UD still has a pivotal role before SUI surgery.

For many physicians, urodynamics still has a crucial role when evaluating women with SUI. However, this appears to be less so in women with uncomplicated SUI. In real life practice UD investigation influences surgical management. Whether it influences outcomes is unclear.