A randomized controlled trial of urodynamic investigations prior to conservative treatment of urinary incontinence in the female

Sixty patients complaining of frequency, urgency, nocturia, urge incontinence and stress incontinence were randomly allocated to either undergo conservative treatment by way of combined physiotherapy and bladder retraining as an inpatient without prior urodynamics, or to have urodynamic investigations and treatment tailored to the urodynamic diagnosis. The assessment period was 3 months and assessment was made pre- and posttreatment by urinary diary, pad testing and subjective questionnaire. There was a significant improvement posttreatment for each parameter studied, with the exception of pad testing. There was no significant difference between the two groups for any parameter. Two-thirds of patients were cured to the extent that they did not require further treatment, and again there was no difference between the two groups. We conclude that patients attending for the first time with an uncomplicated story of urinary incontinence can be effectively treated conservatively without prior urodynamics.EDITORIAL COMMENT: The treatment of urinary incontinence based on symptoms rather than urodynamic diagnosis has long been used by physicians, although the validity and success of this approach has been questioned. Dr Ramsay and associates attempt to address this issue of conservative management of urinary incontinence prior to urodynamic evaluation. The study design is clean cut, although the number of patients enrolled is small and the treatment regimen initially requires hospitalization. With more and more emphasis being placed on managed care, empiric therapy based on symptoms rather than the results of expensive urodynamic testing may become the standard approach to female urinary incontinence. Large randomized studies looking at clearly defined outcome measures will be necessary to support this approach.