Urodynamics allows a functional diagnosis and can help predict the results of surgery in women undergoing surgical treatment for stress incontinence. The current recommendation of most clinical practice guidelines is that it is not necessary to rou-tinely perform urodynamic studies before surgery for female urinary incontinence in women. However, the degree of prevalence is not high and there is no consensus in the available literature.
	Our objective was to evaluate the available evidence and to establish a position as a scientific society on the usefulness and indications of performing urody-namic studies before surgery for stress urinary incontinence in women.

A search was conducted using PubMed, Web of Science and Scopus databases for articles published between January 1979 and June 2023. Inclusion criteria were manuscripts in English with the terms "female urinary incontinence" and "urodynam-ics". The literature search found 147 studies. After eliminating duplicates and those that did not meet criteria, only 25 were included.

Regarding the usefulness of urodynamic study in female patients undergoing stress urinary incontinence, two randomised, multicentre, non-inferiority controlled trials (RCTs) have been published showing that preoperative urodynamics does not improve the results of stress incontinence surgery. The review of data from the ValUE study and data from different series of surgical treatment of female urinary incontinence shows that up to 36% of patients undergoing surgery for SUI will be cases of inconti-nence complicated by previous anti-incontinence surgery, radiotherapy or pelvic sur-gery, pelvic prolapse that exceeds the hymen. On the other hand, the performance of a urodynamic study prior to treatment of urinary incontinence leads to a change in diag-nostic orientation in 74% of patients with complicated SUI and 40% in the case of un-complicated SUI. The effect of the recommendation made by the ValUE and VUSIS-II studies demonstrates a significant decrease in the number of urodynamic studies per-formed before surgery for female stress incontinence. It should be noted that the uro-dynamic study modifies the proposed treatment in 23.8% and 11% of patients with complicated and uncomplicated SUI. A review by Serati et al on 263 women with pure stress urinary incontinence shows that the urodynamic study is congruent with the clinical diagnosis in 74.5% of cases. However, there is overactive detrusor in 10.6%, mixed urinary incontinence in 8% of cases and the results of the urodynamic study are inconclusive in 6.8% of cases. 
The different studies have been evaluated in a systematic review of eight randomised studies showing that women who undergo urodynamic study prior to surgery are more likely to change management (17% compared to 3% in those who have not undergone urodynamic study) and that management is with medical treatment.

The urodynamic study is a diagnostic test that provides information, if properly performed, and is important for the pathophysiological understanding of SUI. 
In patients with urinary incontinence it is necessary to perform a detailed study that includes clinical history, voiding diary, physical and pelvic floor examination, flowmetry and urine residue. These non-invasive studies represent the basis of the diagnostic study. Once this is completed, we must define whether it is purely compli-cated or uncomplicated stress incontinence. We also consider that the role of urody-namic studies should be evaluated in more detail in complicated patients. It may mod-ify the proposed treatment and allow optimisation of information on outcomes and expectations.

In women who consult for stress urinary incontinence, it is necessary to individualise the indication for urodynamic study prior to surgical correction.
The urodynamic study is a complementary test within the diagnostic frame-work to be considered after a non-invasive study of the patient with a detailed clinical history, physical examination and other complementary tests such as a voiding diary, specific questionnaires and flowmetry with residual urine. The indication must be con-textualised and integrated into the clinical context of the patient.
We consider it necessary in cases of complicated or non-pure stress urinary in-continence. If there is no congruence between the referred symptomatology and the urodynamic results, the patient's evaluation, the diagnosis and the established thera-peutic plan should be reconsidered.

van Leijsen, S. a. L. et al. Can preoperative urodynamic investigation be omitted in women with stress urinary incontinence? A non-inferiority randomized controlled trial. Neurourol. Urodyn. 31, 1118–1123 (2012).
Serati, M. et al. Urodynamics useless before surgery for female stress urinary inconti-nence: Are you sure? Results from a multicenter single nation database. Neurourol. Urodyn. 35, 809–812 (2016).
Agarwal, A. et al. Does preoperative urodynamic testing improve surgical outcomes in patients undergoing the transobturator tape procedure for stress urinary incontinence? A prospective randomized trial. Korean J. Urol. 55, 821–827 (2014).