Editing AUA: Female SUI (2023) (section)

=== Additional Evaluations ===
* '''<span style="color:#ff0000">Should be considered for patients with the following conditions (8)</span>''':
*# '''<span style="color:#ff0000">Neurogenic lower urinary tract dysfunction</span>''' (known or suspected)
*# '''<span style="color:#ff0000">Inability to demonstrate stress urinary incontinence</span>'''
*# '''<span style="color:#ff0000">Inability to make definitive diagnosis based on symptoms and initial evaluation</span>'''
*# '''<span style="color:#ff0000">Elevated post-void residual</span>''' per clinician judgment
*# '''<span style="color:#ff0000">Evidence of significant voiding dysfunction</span>'''
*# '''<span style="color:#ff0000">Urgency-predominant mixed urinary incontinence</span>'''
*# '''<span style="color:#ff0000">Abnormal urinalysis,</span>''' such as unexplained hematuria or pyuria
*# '''<span style="color:#ff0000">High grade pelvic organ prolapse</span>''' (POP-Q stage 3 or higher) '''if SUI not demonstrated by pelvic organ prolapse reduction'''
* '''May be performed in patients with:'''
** Concomitant overactive bladder symptoms
** Failure of prior anti-incontinence surgery
** Prior pelvic prolapse surgery

==== Cystoscopy ====
* '''<span style="color:#ff0000">Should not be performed in index patients for the evaluation of SUI</span>''' 
*'''<span style="color:#ff0000">Indications (3):</span>'''
*#'''<span style="color:#ff0000">Suspected bladder pathology</span>''' based on history or concerning findings on physical exam or urinalysis (e.g. microhematuria)
*#'''<span style="color:#ff0000">Structural lower urinary tract abnormality</span>'''
*#'''<span style="color:#ff0000">Patients undergoing certain surgical procedures (e.g., midurethral (MUS) or pubovaginal fascial (PVS) slings)</span> to confirm the integrity of the lower urinary tract and the absence of foreign body'''
*#'''<span style="color:#ff0000">History of prior anti-incontinence surgery or pelvic floor reconstruction, particularly if mesh or suture perforation is suspected</span>'''
*#*'''Perforation should be suspected with new onset of lower urinary tract symptoms, hematuria, or recurrent UTI'''

==== UDS ====
* '''<span style="color:#ff0000">May be omitted for the index patient desiring treatment when SUI is clearly demonstrated'''
**'''<span style="color:#ff00ff">VALUE (NEJM 2012)</span>'''
***Population: 630 females with uncomplicated SUI
***Randomized to preoperative office evaluation and urodynamic tests vs. evaluation only
***Primary outcome: Treatment success at 12 months, defined as a reduction in the score on the Urogenital Distress Inventory of 70% or more and a response of “much better” or “very much better” on the Patient Global Impression of Improvement
***Results: preoperative office evaluation alone was not inferior to evaluation with urodynamic testing
***[https://pubmed.ncbi.nlm.nih.gov/22551104/ Nager, Charles W., et al. "A randomized trial of urodynamic testing before stress-incontinence surgery." ''New England Journal of Medicine'' 366.21 (2012): 1987-1997.]
* '''<span style="color:#ff0000">May be performed at the urologist’s discretion in certain non-index patients, including but not limited to (8):'''
*# '''<span style="color:#ff0000">Neurogenic lower urinary tract dysfunction</span>'''
*# '''<span style="color:#ff0000">Unconfirmed SUI</span>'''
*# '''<span style="color:#ff0000">Mismatch between subjective and objective measures</span>'''
*# '''<span style="color:#ff0000">Elevated PVR per clinician judgment</span>'''
*# '''<span style="color:#ff0000">Significant voiding dysfunction</span>'''
*# '''<span style="color:#ff0000">Significant urgency, UUI, overactive bladder (OAB)</span>'''
*# '''<span style="color:#ff0000">History of prior pelvic organ prolapse surgery</span>'''
*# '''<span style="color:#ff0000">History of prior anti-incontinence surgery</span>'''