EURURO Vol. 71 No. 4

501 692

EAU Recommendation
The Role of Urodynamics in the Evaluation of Urinary
Incontinence: The European Association of Urology
Recommendations in 2016
Arjun K. Nambiar Gary E. Lemack Christopher R. Chapple Fiona C. Burkhard
on behalf of the European Association of Urology
a Department of Urology, Freeman Hospital, Newcastle-upon-Tyne, UK; bDepartment of Urology, University of Texas Southwestern Medical Centre, TX, USA;
c Royal Hallamshire Hospital, Sheffield, UK; dDepartment of Urology, University Hospital Bern, Bern, Switzerland
Urodynamic studies are defined simply as [2_TD$DIFF]a functional
study of the lower urinary tract, usually comprising free
uroflowmetry, postvoid residual (PVR) measurement, filling
and voiding cystometry The role and utility of
urodynamics as a diagnostic and prognostic tool for
patients with urinary incontinence, and lower urinary
tract symptoms in general, is a topic of on-going debate in
functional urology forums across the globe. The purpose of
this article is to clarify and reiterate the position of the
European Association of Urology (EAU) guideline office on
the matter as it currently stands. We also review some of
the evidence on which these recommendations are based,
as well as some of the controversies in the interpretation of
this evidence.
The overall recommendations from the guidelines
regarding the use of urodynamics in the evaluation of
incontinence can be simply summarised as follows:
A good history and clinical evaluation should be all
that are required to help decide the best treatment for
uncomplicated urinary incontinence.
Urodynamics may help if there is uncertainty about
the best form of invasive treatment to pursue.
Always perform urodynamics to the highest possible
quality standards for the results to be valid and useful.
To arrive at these conclusions, the guideline panel
conducted a thorough and systematic evaluation of the
available evidence. The EAU guidelines are unique in that
the searches are updated annually and therefore there is an
annual appraisal of the evidence to identify any new
important research that may influence or change the
recommendations. [3_TD$DIFF]Consequently, [4_TD$DIFF]it provides readers with
the most up-to-date evaluation of the evidence relating to
urology.
These are not the only international guidelines pertain-
ing to urodynamics, however. For comparison, we examine
the statements and recommendations, in full, of various
guideline groups regarding the role of urodynamics in the
management of urinary incontinence (UI), as shown in
.
Two things are apparent from these recommendations.
First, the assigned evidence grades (where stated) appear to
be low to moderate. Second, it is important not to confuse
recommendations for stress UI (SUI) with urgency UI or UI
in general.
Grades of recommendation tend to be based on the level
of evidence available when reviewing a topic. Urodynamic
studies have not been extensively evaluated in randomised
control trials, for reasons we can only speculate about.
However, a relatively recent trial has been conducted by the
Urinary Incontinence Treatment Network in the USA. Aptly
named the VALUE study , its aim was to assess the value
of urodynamic evaluation in a multicentre, randomised,
noninferiority design comparing the results of office
evaluation alone to office evaluation plus urodynamics
among women for whom surgery was planned for stress-
predominant UI. The primary outcome was a reduction of
more than 70% in the Urogenital Distress Inventory score,
and a response of ‘‘much better’’ or ‘‘very much better’’ for
ava ilable at
journal homepage:
* Corresponding author. Department of Urology, Freeman Hospital, Freeman Road, Newcastle-upon-Tyne, NE7 7DN, UK. Tel.+44 790 7824797.
E-mail address: (A.K. Nambiar).
0302-2838/# 2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.