The vast majority of clinicians, experts, and medical bodies agree that urodynamic studies (UDS) have real clinical value. However, certain clinical studies have questioned the efficacy of urodynamics for certain groups of patients with specific health conditions. 

Many clinicians want to know: Does the data back up the commonly held idea that urodynamic studies are worth it to patients and providers? Are these diagnostic tools merely clarifying complex issues or punching above their weight by helping to deliver deep diagnostic value? 

These questions are by no means simple. To find answers, we looked at a recent meta-analysis that's been making the rounds – Here's what we took away from the experience.

Urinary incontinence is the involuntary leakage of urine. Although it's commonly associated with geriatric health issues, this isn't just something that affects the elderly. For instance, it's more common among women than men – yet regularly used women's treatment plans often prove suboptimal.

There are a few major types of urinary incontinence, including urge, stress, and mixed. With stress urinary incontinence (SUI), caregivers and patients have access to a wide range of treatment options, but it's vital to get the diagnosis right first – and urological medicine plays a major role in effective treatment.

Urodynamics is a panel of tests relating to the lower urinary tract. It is most commonly used in its entirety; however, it is also possible that one or more of the components will be performed separately if symptoms suggest this is necessary.

Urodynamics is the most reliable way to determine the cause of lower urinary tract symptoms and therefore, the best way to determine which treatment methods are most appropriate.

A Care Pathway is an evidenced-based framework to build a treatment plan upon, beginning with the primary physician, continuing to specialist referrals if necessary, and following the patient through to the end of their treatment (including follow-up care).

They typically follow a common path that starts with patient history, followed by clinical assessment, provisional diagnosis, first line management, specialist management, and follow-up care.

Some examples are listed here:

When it comes to conditions of the lower urinary tract, there are key differences to consider in order to determine which form of testing is the most appropriate. While there are striking similarities between methods that can potentially create confusion upon first glance, a practitioner knows which test is most appropriate for the corresponding symptoms.

One area that has the potential to create this confusion is determining the difference between the need for the broader Urodynamics testing panel or the Cystometrogram. While these two procedures involve many of the same elements, they are in fact different.

This post will provide a detailed comparison of the two methods and describe how they are similar, but also different. First, a brief explanation of the two methods before we compare:

Surgical management of stress urinary incontinence (SUI) is a commonplace procedure, usually indicated on the basis of the clinical history and exam findings alone. In fact, Level I evidence from the VALUE trial suggests that urodynamics (UDS) makes no difference in the outcome of SUI surgery in straightforward cases.¹ Nonetheless, in many situations UDS is a critical part of evaluating SUI patients for surgery; moreover, in some instances UDS will spare women surgery that may not be beneficial.²

One clear-cut area where UDS is very helpful is for the patient who has previously undergone surgery for SUI and/or pelvic organ prolapse (POP). These patients may present complex anatomy, obstruction from prior surgery, changes in bladder compliance, and a very high valsalva leak point pressure. UDS may help guide the decision as to what intervention(s) may be necessary in these patients.

When evaluating patients prior to surgery for the treatment of stress urinary incontinence, the presence of detrusor overactivity is presently the main factor that is tested for via urodynamics, if urodynamic assessment happens at all. However, there are numerous factors which could influence the diagnosis of stress urinary incontinence, as well as the surgical procedure and predictions for the outcome of treatment.