Urodynamics — structured SAQ (15 marks)

Question

A 54-year-old woman has stress-predominant mixed urinary incontinence after five months of supervised pelvic floor muscle training. Her 3-day bladder diary shows mainly stress episodes, the cough stress test is positive and there is no prolapse. (a) According to NICE NG123, is multichannel filling and voiding cystometry indicated before primary surgery? Justify (4 marks). (b) Two years later she develops anterior vaginal wall prolapse with persistent stress symptoms; how does the indication change? (3 marks) (c) Summarise the randomised evidence on routine urodynamics before primary stress-incontinence surgery (5 marks). (d) What did the FUTURE trial show in refractory overactive bladder? (3 marks)^[1]