Invasive Bladder Pressure Tests for Refractory Overactive Bladder May Be Avoided
TUESDAY, April 1, 2025 -- Urodynamics plus comprehensive clinical assessment (CCA) is not superior to CCA only for women with refractory overactive bladder or urgency predominant mixed urinary incontinence, according to a study published in the March 29 issue of The Lancet to coincide with the 40th Annual European Association of Urology Congress, held from March 21 to 24 in Madrid.
Mohamed Abdel-Fattah, M.D., from the University of Aberdeen in the United Kingdom, and colleagues conducted a superiority trial in 63 U.K. hospitals to compare the clinical effectiveness and cost-effectiveness of urodynamics plus CCA versus CCA only in the management of women with refractory overactive bladder symptoms. Women aged 18 years or older with refractory overactive bladder or urgency predominant mixed urinary incontinence, with failed conservative management and being considered for invasive treatment, were randomly assigned to urodynamics plus CCA versus CCA only (550 and 549 patients, respectively).
The researchers found that the participant-reported success rates of "very much improved" or "much improved" were not superior in the urodynamics plus CCA group versus the CCA-only group at the final follow-up time point at 15 months after randomization. Low and similar serious adverse events were seen between the groups. Per quality-adjusted life year (QALY) gained, the incremental cost-effectiveness ratio was £42,643. At a willingness-to-pay threshold of £20,000 per QALY gained, the cost-effectiveness acceptability curve showed urodynamics had a 34 percent probability of being cost-effective, which reduced further when extrapolated over the patient's lifetime.
"Significantly more women who underwent CCA only report earlier improvement in their symptoms," the authors write.
Several authors disclosed ties to the biopharmaceutical industry.
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