The role of invasive urodynamics in female stress urinary incontinence

Stress urinary incontinence (SUI) is a complaint of involuntary loss of urine on effort or physical exertion including sporting activities, or on sneezing or coughing. We aimed to evaluate the indications of urodynamic studies (UDS) in female SUI based on relevant literature, concentrating on randomized controlled trials (RCTs) and contemporary guidelines with a particular emphasis on its clinical utility, practical and financial aspects. This narrative review did not address urinary incontinence variants beyond female SUI, male urinary incontinence, neurogenic disorders, or articles written in languages other than English. In complicated cases, performing UDS with strict adherence to the International Continence Society (ICS) good urodynamic practices can offer valuable insights to improve diagnostic precision, shared decision-making, patient counseling, and reduce financial burden. While it is suggested in current guidelines and RCTs that UDS may not be required for uncomplicated female SUI, it is important to note that uncomplicated SUI represents only a small portion of all females experiencing SUI. Furthermore, current RCTs exhibit significant methodological concerns, including discrepancies between patient populations in clinical trials and real-world settings, inadequate documentation of baseline lower urinary tract symptoms beyond urinary incontinence, underpowered statistical analyses, and absence of long-term follow-up data. Therefore, complete disregard for UDS should not be considered even in uncomplicated patients, given the current data. Additional RCTs, free from the methodological shortcomings identified in existing literature, have the potential to further supplement the role of UDS in the management of female SUI.