Urodynamics useless before surgery for female stress urinary incontinence: Are you sure? Results from a multicenter single nation database E. Finazzi Agrò 1, E. Costantini 2, A. Pietropaolo 3, G. Palleschi 4, A. Carbone 4, L. Topazio 5, M. Soligo 6, G. Del Popolo 7, V. Li Marzi 8, S. Salvatore 9, M. Serati 10 (1) Tor Vergata University, Dept. of Experimental Medicine and Surgery, Rome, Italy, (2) University of Perugia, Dept. of Urology, Perugia, Italy, (3) University of Perugia, School of Spec. in Urology, Perugia, Italy, (4) University of Rome, Dept. of Urology, Latina, Italy, (5) Tor Vergata University, School of Spec. in Urology, Rome, Italy, (6) Buzzi Hospital, Dept. of Obstetrics and Gynaecology, Milan, Italy, (7) Careggi University Hospital, Spinal Unit, Florence, Italy, (8) Careggi University Hospital, Dept. of Urology, Florence, Italy, (9) University Vita E Salute, Dept. of Obstetrics and Gynaecology, Milan, Italy, (10) University Insubria, Dept. of Obstetrics and Gynaecology, Varese, Italy Poster number 386 Introduction & Objectives Recently the VALUE trial [1] has questioned the role of the urodynamic evaluation (UE) before surgery for female urinary stress incontinence. Aim of this retrospective multicenter study was to investigate the percentage of “uncomplicated” patients coming to UE in several referral centers of a single nation. Secondary aims of our study were to assess in how many women the UE obtains findings that differ from the pre-urodynamic clinical picture and in how many women these findings could affect following management. Material & Methods This is a retrospective multicentric single-nation study. Data were extracted from the urodynamic databases of six referral centers of a single nation; history, objective examination, urodynamic report and traces of female patients who underwent an urodynamic evaluation prior to surgery for stress urinary incontinence in the last five years were considered. Patients were classified according to the VALUE trial inclusion/exclusion criteria in “uncomplicated” or “complicated”. The urodynamic observations were compared with pre-urodynamic data and considered different if: a different type of incontinence was diagnosed (e.g. stress instead of mixed or vice versa or pure urge incontinence) or a voiding dysfunction was diagnosed. Different urodynamic observations were separately evaluated in the group of patients “uncomplicated” and “complicated”. The percentage of patients in whom the planned surgery was changed or cancelled after UD was also recorded. Results Data of 2053 female patients were extracted. o 740/2053 patients (36.0%) were considered “uncomplicated” according to the definition used in the VALUE trial. o Urodynamic findings were considered different from the pre-urodynamic diagnosis in 1276 out of 2053 patients (62.2%). o A voiding dysfunction was diagnosed in 394 patients (19.2%). o Urodynamic findings differed from the pre-urodynamic clinical picture significantly more frequently in the “complicated” than in “uncomplicated” patients (74.6% vs. 40%, p=0.0001). o The same was observed for the diagnosis of a voiding dysfunction, present in the 22.5% and in the 13.4% of the “complicated” and “uncomplicated” patients, respectively (p=0.0001). o In 151 (9.5%) and 153 (9.7%) on 1582 patients in whom data about clinical management after UE were available, planned surgery was cancelled or modified, respectively. o The management strategy was modified more frequently in the “complicated” patients (23.8% vs. 11%, p=0.0001). Conclusions According to our data, coming from databases of six referral centers in a single nation, the “uncomplicated” patients represent a minority (36%) of the patients evaluated before surgery for female stress incontinence. In the majority of them, the “complicated” ones, UE is able to provide new informations, in comparison to the clinical examination, in 74.6% of cases and to change the consequent management in 23.8% of cases. In our opinion, these data should contribute to reconsider the importance of UE, particularly in "complicated" patients before surgery for female stress incontinence. References [1] Nager CW, Brubaker L, Litman HJ, Zyczynski HM, Varner RE, Amundsen C, Sirls LT, Norton PA, Arisco AM, Chai TC, Zimmern P, Barber MD, Dandreo KJ, Menefee SA, Kenton K, Lowder J, Richter HE, Khandwala S, Nyggard I, Kraus SR, Johnson HW, Lemack GE, Milhova M, Albo ME, Mueller E, Sutkin G, Wilson TS, Hsu Y, Rozanski TA, Rickey LM, Rahn D, Tennstedt S, Kusek JW, Gormley EA; Urinary Incontinence Treatment Network. A randomized trial of urodynamic testing before stress-incontinence surgery. N Engl J Med 2012 May 24;366(21): Epub 2012 May 2. FINDINGSUNCOMPLICATEDCOMPLICATED P value Number of Pts examined740/2053 (36.0%)1313/2053 (64%) Number of Pts with a different UDM observation from the pre-UDM clinical picture 296/740 (40%)979/1313 (74.6%) Diagnosis of voiding dysfunction99/740 (13.4%)295/1313 (22.5%) Change in the pre-UDM management strategy 81/740 (11%)312/1313 (23.8%)