Conclusions and Recommendations
Stress urinary incontinence is common in women, and obstetrician–gynecologists play an important role in its diagnosis and treatment. The College and the American Urogynecologic Society recommend performance of the following basic six-step evaluation of a patient with symptoms of uncomplicated SUI before primary surgical repair with a midurethral sling: 1. History 2. Urinalysis 3. Physical examination with an assessment for POP 4. Cough stress test 5. Assessment of urethral mobility 6. Measurement of postvoid residual urine volumeFor women with uncomplicated SUI in whom conservative treatment has failed and who desire midurethral sling surgery, evidence indicates that the performance of preoperative multichannel urodynamic testing versus a basic evaluation does not affect treatment outcomes (11). However, women with complicated SUI may benefit from additional diagnostic evaluation with multichannel urodynamic testing, particularly before surgical treatment. In these women, the results of the basic six-step evaluation and clinical judgment should guide the decision to perform preoperative multichannel urodynamictesting.