Although urodynamic testing has been an important tool in diagnosing disorders of the urinary tract1, the tests and techniques have undergone minimal changes in the past few years. One recent development that has changed the way urologists, primary care physicians, and gynecologists diagnose disorders of the bladder and urethra is video urodynamics. Here, video urodynamics and traditional urodynamics are compared.
Traditional urodynamics includes the following tests:
To perform these tests, a catheter is inserted into the bladder via the urethra and measurements such as urine volume, bladder pressure, rectal pressure, and muscle strength are recorded using sophisticated urodynamics equipment.
Video urodynamics involves urodynamic testing as described above but also leverages x-ray. The following tests can be performed with video urodynamics:
During a video urodynamics test, the traditional urodynamic tests are performed (i.e. with the use of a catheter to fill the bladder and determine pressure differences, etc.); however, moving x-ray is used simultaneously in order to image the bladder and urethra for more complex measurements and additional visualization.
Whereas during a traditional urodynamics test the filling medium for the bladder is water or saline solution, radiographic contrast is used for video urodynamics testing. In addition, video urodynamics requires a more expensive and elaborate setup, as well as specially trained clinicians. The procedure also typically takes much longer than traditional urodynamics. For women who are pregnant, video urodynamics is not an option.
However, video urodynamics can provide additional important details about a patient’s condition, particularly in the case of incontinence or bladder obstruction.
Video urodynamics can improve diagnostic accuracy3 for a patient whose condition is difficult to determine. For instance, video urodynamics allows for real time measurement of exact detrusor pressure during urinary leakage, and shows important images such as bladder outline which can help pinpoint more uncommon problems. When urinary incontinence is concerned, video urodynamics is superior because even small amounts of urinary leakage can be observed in conjunction with stress or bladder volume. Other advantages of video urodynamics over traditional urodynamic studies include:
As video urodynamics becomes more popular, additional benefits of this technique are likely to arise.
While video urodynamics provides additional information over traditional urodynamic studies, it should be noted that this technique is not recommended for most patients. These tests are expensive and should be reserved for the most complex situations, after traditional urodynamics have been performed. Additionally, this procedure may be more embarrassing and uncomfortable for the patient, as the genitals must be handled and exposed throughout the procedure. Another drawback is that the treating physician should be present during the video urodynamics study in order to observe the real-time results. This significantly increases the innate costs of the procedure. Finally, due to the additional measurements and additional equipment setup, the procedure typically takes twice as long as a traditional urodynamics test, further increasing costs.
Guidelines have been put forth to recommend when the use of video urodynamics is appropriate. Appropriate situations include when:
Traditional urodynamics are most appropriate for almost all simple lower urinary tract questions that need addressing. For instance, questions of postvoid urine retention, urine flow, and abdominal pressures are best left to traditional urodynamics. Only when additional information is required, or there is difficulty in determining the exact location of bladder obstruction should more complex tests be performed. Ultimately, one of the biggest limitations for video urodynamics testing currently is proper patient selection.
Money, time, and resources can be needlessly wasted when this choice is not properly made, so judicious consideration must be utilized. According to a 2013 study4, “traditional” urodynamic testing is still the gold standard to objectively evaluate lower urinary tract function.
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If you liked the above article, you may also like our blog article Urodynamics in Benign Prostatic Hyperplasia (BPH) Patients.