Thank you for your request for clarification. Even before the VALUE trial, a lack of correlation among preoperative urodynamics findings and postoperative voiding dysfunction and continence outcomes has been described. A secondary analysis of 597 patients from the Trial of Midurethral Slings (in which all patients had preoperative urodynamics before midurethral sling) did not show a correlation of preoperative urinary flow characteristics with postoperative outcome. We agree that it is reasonable to obtain noninvasive uroflow data before performing a stress incontinence procedure, particularly in patients who report a slow or hesitating urinary flow, a feeling of incomplete bladder emptying, or other symptoms of voiding dysfunction. The VALUE trial specifically excluded women who were most likely to demonstrate obstructive symptoms: those with significant anterior vaginal wall prolapse and/or previous pelvic surgery. Based on the level 1 evidence from the VALUE trial, we are confident in offering stress incontinence surgery without preoperative urodyamics to women who meet the inclusion criteria of the original trial (uncomplicated stress urinary incontinence with postvoid residual of <150 mL). Providers should assess for symptoms of voiding dysfunction and, if symptoms are present, proceed with further cystometric evaluation, even in the setting of a normal postvoid residual.