Women Can Waive Test Before Incontinence Surgery: Study

WEDNESDAY, May 2 (HealthDay News) -- Many women are sent for pricey bladder-function tests before surgery for urinary incontinence. However, a new study suggests that in many cases these tests are not needed.

The tests are designed for patients with stress urinary incontinence -- a leakage of urine caused by muscle weakness in the pelvis and sphincter. But a team from the Urinary Incontinence Treatment Network found that women who had an office visit alone before their operation experienced results that were similar to women who also had these costly and invasive tests.

Bladder function tests assess how well the bladder, sphincter muscles and urethra store and release urine. The tests, however, averaging about $500 and uncomfortable for patients since many involve the insertion of a catheter or filling the bladder with fluid.

In conducting the study, researchers followed 630 women undergoing surgery for stress urinary incontinence. Half of the women had bladder testing and a checkup before their surgery. The others just had a pre-operative visit to their doctor.

The researchers report that the rate of treatment success -- about 77 percent -- was similar for the women regardless of whether or not they got the pre-op test. There was also no significant difference in the women's quality of life, satisfaction, or ability to empty their bladder completely.

The study, funded by the U.S. National Institutes of Health (NIH), was published online May 2 in the New England Journal of Medicine.

"The findings of our study argue against routine pre-operative testing in cases of uncomplicated stress urinary incontinence, as the tests provide no added benefit for surgical treatment success but are expensive, uncomfortable, and may result in complications such as urinary tract infections," the study's lead author, Dr. Charles Nager, director of urogynecology and reconstructive pelvic surgery at the University of California, San Diego, said in an NIH news release.

However, one expert believes the tests do have real value.

"Leaking of urine or urinary incontinence is a very common problem, affecting about 50 percent of women," said Dr. Peter Finamore, a urogynecologist at Winthrop University Hospital in Mineola, NY. "There are different reasons why women leak urine. The reason why we differentiate the types of urinary incontinence is because of how we treat this problem. Some leaking can be treated with physical therapy, some with medication and some with surgery."

These urodynamic screening methods are "a test on the nerve and muscle function of the bladder," Finamore explained. "It is an important test for patients with urinary incontinence that provides a great deal of valuable information that is essential to determine the appropriate treatment options. The test does have a financial cost, but for those of us who treat urinary incontinence that cost is worth it in order to make the appropriate diagnosis and treat patients properly."

Finamore added that, "the risk of complications such as urinary tract infection following urodynamics is very rare and we often give preventative antibiotics at the time of administering this test."

More information

The U.S. National Institute of Diabetes and Digestive and Kidney Diseases provides more information on urinary incontinence in women.

SOURCE: Peter S. Finamore M.D., associate director, division of urogynecology and pelvic reconstructive surgery, and assistant professor, obstetrics/gynecology, Stony Brook University School of Medicine and Winthrop University Hospital, Mineola, N.Y.; U.S. National Institutes of Health, news release, May 2, 2012

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