Urodynamics testing is considered the gold standard for assessing disorders of the lower urinary tract. However, knowing exactly when to prescribe a urodynamics test can be confusing depending on which published guidelines are followed. Here, urodynamic assessment and when these tests should be prescribed will be discussed.
What are Urodynamics?
Urodynamics comprises a series of tests1 that are designed to assess how well the bladder and urethra function in regards to storing and releasing urine. These tests include uroflowmetry, post-void residual volume assessment, multichannel cystometry, urethral pressure profilometry, electromyography, and fluoroscopy. One or all of these assessments can be performed when urodynamics testing is prescribed.
Pros and Cons of Urodynamics Testing
Although urodynamics testing is a powerful diagnostic tool, it should not be performed haphazardly. Some of these tests, particularly fluoroscopy, can be expensive to perform and require specialized equipment, as well as specially trained clinical staff. Many of the tests require catheterization, which is invasive and can increase the likelihood of side effects such as urinary tract infection or urethra/bladder damage. Additionally, urodynamics do not provide a simple “yes” or “no” diagnosis. Instead, these tests provide physicians with additional data regarding a patient’s condition in order to make the most informed decision regarding his or her care.
On the other hand, urodynamics can be a powerful assessment tool when performed properly. Underlying causes for conditions such as stress urinary incontinence, urge incontinence, frequent urination, difficulty urinating, painful urination, recurrent urinary tract infections, and other urinary disorders can be determined.
When Should a Urodynamics Test be Prescribed?
The American Urological Association has prepared a guideline to assist clinicians when prescribing urodynamics that is based on an extensive literature review, as well as the opinion of experts in the field of urology. This guideline serves to assist the clinician in the appropriate selection of urodynamic tests only after evaluation and symptom characterization has been performed.
Lower Urinary Tract Symptoms
When patients present with lower urinary tract symptoms such as painful urination, incontinence, urinary discomfort, frequent urination, etc., physicians can prescribe post-void residual tests during the initial exam and during a follow up exam. For male patients, uroflow tests can be used during both initial and ongoing appointments, particularly when symptoms of abnormal urination are described. Multi-channel filling cystometry can be prescribed for patients if detrusor overactivity or bladder abnormalities are suspected, particularly if surgery is to be performed. For patients suffering from a possible bladder neck obstruction, video urodynamics are also an option.
Stress Urinary Incontinence/Prolapse
When patients present for symptoms of stress urinary incontinence, i.e. inability to control urination when coughing, sneezing, or other situations that place stress upon the bladder or urethra muscles, urodynamics testing can be performed. Urethral function should always be assessed when making this diagnosis.
Additionally, patients who experience symptoms of stress urinary incontinence who also have physical signs of the disorder should undergo multi-channel urodynamics. If surgery is to be performed, post-void residual urine volume should be evaluated.
For women with high grade pelvic organ prolapse who do not show symptoms of stress urinary incontinence, multi-channel urodynamics can be prescribed to test for occult stress incontinence and detrusor dysfunction if lower urinary tract symptoms are also reported.
Overactive Bladder, Urge Incontinence, Mixed Incontinence
For patients who are unable to control their bladders once the urge to urinate strikes and are diagnosed with overactive bladder, urge incontinence, or mixed incontinence, urodynamics tests are often prescribed. Multi-channel filling cystometry2 should be performed if is deemed necessary to determine whether bladder compliance, detrusor overactivity, or other urinary tract abnormalities are to blame, particularly for patients who intend to undergo surgery to control their symptoms. Additionally, pressure flow studies can be prescribed in patients with symptoms of urge incontinence following bladder outlet procedures to test for bladder outlet obstruction.
For patients who lack control of their bladder due to brain, spinal cord, or nerve disorders, urodynamic assessment can be crucial in determining the cause of their symptoms. Post-void residual urine assessment should be prescribed for any patient with a relevant neurological condition that also reports lower urinary tract symptoms3. A complex cystometrogram, as well as pressure flow analysis, should also be prescribed. If an elevated post-void residual urine volume is determined, fluoroscopy and/or electromyography may also be appropriate.
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- Vignoli, G. (2016). Urodynamic Testing: When and Which. Urodynamics, 49-52. doi:10.1007/978-3-319-33760-9_4 Link
- Wyndaele, J. (1992). Are Sensations Perceived during Bladder Filling Reproducible during Cystometry? Urologia Internationalis, 48(3), 299-301. doi:10.1159/000282354 Link
- Rosier, P. F. (2013). The evidence for urodynamic investigation of patients with symptoms of urinary incontinence. F1000Prime Reports, 5, 8. http://doi.org/10.12703/P5-8 Link