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The Role of Urodynamics

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Female Pelvic Medicine

Abstract

When evaluating lower urinary tract symptoms (LUTS), patients often present with mixed symptoms, or the symptoms may be attributed to a number of pathologies. Comprehensive basic office evaluation, including a thorough history and physical exam, enables clinicians to selectively perform urodynamics in more complicated situations. Urodynamic evaluation facilitates a more complete understanding of the symptomatology in these challenging patients to support creating a comprehensive treatment plan. This chapter aims to guide clinicians on the appropriate use of a urodynamic study in puzzling clinical scenarios.

Commentary by Kathleen C. Kobashi, Virginia Mason Medical Center, Department of Urology and Renal Transplantation, Seattle, WA, USA

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Author information

Authors and Affiliations

  1. Louisiana State University Health Sciences Center, Department of Urology, New Orleans, LA, USA

    J. Christian Winters & Madeline Rovira Koerner

Authors
  1. J. Christian Winters
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  2. Madeline Rovira Koerner
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Correspondence to J. Christian Winters .

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Editors and Affiliations

  1. Department of Urology, Virginia Mason Medical Center, Seattle, WA, USA

    Kathleen C. Kobashi

  2. Cleveland Clinic Florida, Weston, FL, USA

    Steven D. Wexner

Commentary

Commentary

  • Kathleen C. Kobashi 

Urodynamics (UDS) is an important tool in the evaluation of non-index patients with urinary incontinence and voiding dysfunction. Though UDS is not advocated in the evaluation of the straightforward patient with clear-cut symptoms by any of the applicable AUA/SUFU guidelines (UDS, overactive bladder, or stress urinary incontinence), it is a useful adjunct to the evaluation of patients with less evident clinical pictures. Patients who have a mixed picture, high-grade prolapse, incomplete emptying, and prior pelvic reconstruction or whose diagnoses are not confirmed on initial assessment are examples of those in whom UDS may be helpful.

This chapter nicely presents several commonly encountered but potentially complicated scenarios and discusses the indications for UDS and how the study can be helpful. When presented with a patient in whom several diagnoses are possible, confirmation of the diagnosis is crucial in order to facilitate appropriate treatment planning and assist in thorough counseling about potential outcomes. While diagnoses such as high-grade pelvic prolapse can contribute to symptoms such as voiding dysfunction and incomplete emptying, they can concomitantly mask others, like stress incontinence. In patients with mixed incontinence and voiding dysfunction following an anti-incontinence surgery, elucidation of the components that make up the overall picture can facilitate decisions regarding the order in which the issues should be addressed. UDS in the assessment of patients with neurogenic bladder are key in prognostication for both the upper and lower urinary tracts and in clarifying the situation in patients in whom sensation may not correlate with function. Similarly, in the geriatric population, cognition and processing of sensation may also play a role in continence, and UDS can be a helpful adjunct in the diagnostic assessment.

While it is important to be good stewards of healthcare dollars and avoid overutilization of costly resources, UDS can be invaluable in the evaluation of the non-index patient with urinary incontinence or voiding dysfunction. A good rule of thumb before embarking on a UDS study is for the clinician to consider the unanswered questions for which UDS may be helpful. If UDS would not change the course, it may not be necessary to perform the study. However, in cases in which it could facilitate decision-making, prognostication, or patient counseling, it is a valuable tool to have in the armamentarium.

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Winters, J.C., Koerner, M.R. (2021). The Role of Urodynamics. In: Kobashi, K.C., Wexner, S.D. (eds) Female Pelvic Medicine. Springer, Cham. https://doi.org/10.1007/978-3-030-54839-1_2

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  • DOI: https://doi.org/10.1007/978-3-030-54839-1_2

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  • Publisher Name: Springer, Cham

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  • Online ISBN: 978-3-030-54839-1

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