De-implementation of urodynamics in The Netherlands after the VALUE/VUSIS-2 results: a nationwide survey

Excerpt

The authors conducted a cross-sectional survey in The Netherlands to evaluates national practice regarding routine preoperative urodynamic studies (UDS) before stress urinary incontinence (SUI) surgery following the Value of Urodynamics prior to Stress Incontinence Surgery-II (VUSIS-II) and the Value of Urodynamic Evaluation (ValUE) studies using an online questionnaire targeting all gynecologists and urologist in The Netherlands who manage women with SUI in daily practice. Response rate was 33% for gynecologists (79/238) and 69% for urologists (48/70), resulting in a total response rate of 41%. Most respondents replied they would not perform routine preoperative UDS in women with primary uncomplicated (predominant) SUI, in line with the outcomes from the VUSIS-II and ValUE studies, underlining that there is no need for a further de-implementation strategy. The qualitative part of the study revealed that contributors to following VUSIS-II/ ValUE were the VUSIS-II study design and recommendations from these trials. Barriers to de-implementation of routine UDS were the opinion that UDS was of additional value, especially the pressure–transmission ratio and detrusor overactivity. The belief in the importance of UDS and the satisfaction with the current logistic flow of the patients are additional barriers to de-implementation. …