Skip to main content

Advances in Ambulatory Urodynamics

Current Urology Reports volume 21, Article number: 41 (2020) Cite this article

Abstract

Purpose of Review

This manuscript reviews recent technological advances in ambulatory urodynamics.

Recent Findings

Ambulatory urodynamics is currently recommended by the International Continence Society as a second-line diagnostic tool in patients with nondiagnostic traditional urodynamics. Novel techniques involving telemetric monitoring are in development, which utilize catheter-free wireless systems to address several recognized shortcomings of inoffice urodynamic studies. Current research in catheter-free bladder pressure measurements involves either an intravesical, intradetrusor, or transdetrusor approach. Real-time bladder volume estimation may be performed using ultrasonography, near-infrared spectroscopy, or bladder volume conductance measurement.

Summary

Ambulatory urodynamics can measure bladder function in the “real world” setting, capturing physiological bladder filling and emptying and allowing patients to reproduce the activities that may trigger their symptoms. Telemetric devices being developed represent further advances in this field and focus upon improving diagnostic capabilities, evaluating patient response to treatment, and facilitating closed-loop bladder control with neuroprosthetic integration.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. •• Schäfer W, Abrams P, Liao L, et al. Good urodynamic practices: uroflowmetry, filling cystometry, and pressure-flow studies. Neurourol Urodyn. 2002;21(3):261–74 ICS guidelines on basic urodynamic testing including standardized protocols.

    PubMed  Google Scholar 

  2. Mosso A, Pellacani P. Sur les fonctions de al vessie. Arch Ital Biol. 1882;1:205–12.

    Google Scholar 

  3. Davis DM, Zimskind P. Progress in urodynamics. J Urol. 1962;87:243–8.

    CAS  PubMed  Google Scholar 

  4. Davis DM. The hydrodynamics of the upper urinary tract (urodynamics). Ann Surg. 1954;140:839–49.

    CAS  PubMed  PubMed Central  Google Scholar 

  5. Clifford GD, Clifton D. Wireless technology in disease management and medicine. Annu Rev Med. 2012;63:479–92.

    CAS  PubMed  Google Scholar 

  6. Warrell DW, Watson BW, Shelley T. Intravesical pressure measurement in women during movement using a Radiopill and Air-probe. J Obstet Gynaecol Br Comm. 1963;70:959–67.

    CAS  Google Scholar 

  7. Griffiths CJ, Assi MS, Styles RA, Ramsden PD, Neal DE. Ambulatory monitoring of bladder and detrusor pressure during natural filling. J Urol. 1989;142(3):780–4.

    CAS  PubMed  Google Scholar 

  8. van Waalwijk van Doorn ES, Gommer ED. Ambulatory urodynamics. Curr Opin Obstet Gynecol. 1995;7:378–81.

    Google Scholar 

  9. Klingler HC, Madersbacher S, Djavan B, Schatzl G, Marberger M, Schmidbauer CP. Morbidity of the evaluation of the lower urinary tract with transurethral multichannel pressure-flow studies. J Urol. 1998;159(1):191–4.

    CAS  PubMed  Google Scholar 

  10. Suskind AM, Clemens JQ, Kaufman SR, Stoffel JT, Oldendorf A, Malaeb BS, et al. Patient perceptions of physical and emotional discomfort related to urodynamic testing: a questionnaire-based study in men and women with and without neurologic conditions. Urology. 2015;85(3):547–51.

    PubMed  PubMed Central  Google Scholar 

  11. Abelson B, Majerus S, Sun D, Gill BC, Versi E, Damaser MS. Ambulatory urodynamic monitoring: state of the art and future directions. Nat Rev Urol. 2019;16(5):291–301.

    PubMed  PubMed Central  Google Scholar 

  12. •• Radley SC, Rosario DJ, Chapple CR, Farkas AG. Conventional and ambulatory urodynamic findings in women with symptoms suggestive of bladder overactivity. J Urol. 2001;166:2253–8 A prospective, randomized crossover study comparing conventional versus ambulatory urodynamics in 106 female patients.

    CAS  PubMed  Google Scholar 

  13. Pannek J, Pieper P. Clinical usefulness of ambulatory urodynamics in the diagnosis and treatment of lower urinary tract dysfunction. Scand J Urol Nephrol. 2009;42:428–32.

    Google Scholar 

  14. Digesu GA, Gargasole C, Hendricken C, Gore M, Kocjancic E, et al. ICS teaching module: ambulatory urodynamic monitoring. Neurourol Urodyn. 2015;36:364–7.

    PubMed  Google Scholar 

  15. •• Gammie A, Clarkson B, Constantinou C, Damaser M, Drinnan M, et al. International Continence Society guidelines on urodynamic equipment performance. Neurourol Urodyn. 2014;33(4):370–9 ICS guidelines for benchmarking performance of urodynamic equipment.

    PubMed  Google Scholar 

  16. Salvatore S, Khullar V, Cardozo L, Anders K, Zocchi G, Soligo M. Evaluating ambulatory urodynamics: a prospective study in asymptomatic women. BJOG. 2001;108:107–11.

    CAS  PubMed  Google Scholar 

  17. Byun SS, Kim HH, Lee E, Paick JS, Kamg W, Oh SJ. Accuracy of bladder volume determinations by ultrasonography: are they accurate over entire bladder volume range? Urology. 2003;62:656–60.

    PubMed  Google Scholar 

  18. Macnab A, Shadgan B. Biomedical applications of wireless continuous wave near infrared spectroscopy. Biomed Spectrosc Imag. 2012;1:205–22.

    Google Scholar 

  19. Molavi B, Shadgan B, Macnab AJ, Dumont GA. Noninvasive optical monitoring of bladder filling to capacity using a wireless near infrared spectroscopy device. IEEE Trans Biomed Circuits Syst. 2014;8:325–33.

    PubMed  Google Scholar 

  20. Shin SC, Moon J, Kye S, Lee K, Lee YS, Kang HG. Continuous bladder volume monitoring system for wearable applications. Conf Proc IEEE Eng Med Biol Soc. 2017:4435–8.

  21. Gill BC, Fletter PC, Zaszczurynski PJ, Perlin A, Yachia D, Damaser MS. Feasibility of fluid volume conductance to assess bladder volume. Neurourol Urodyn. 2008;27:525–31.

    PubMed  Google Scholar 

  22. Goode PS, Locher JL, Bryant RL, Roth DL, Burgio KL. Measurement of postvoid residual urine with portable transabdominal bladder ultrasound scanner and urethral catheterization. Int Urogynecol J Pelvic Floor Dysfunct. 2000;11(5):296–300.

    CAS  PubMed  Google Scholar 

  23. van Leuteren PG, Klijn AJ, de Jong TPVM, Dik P. SENS-U: validation of a wearable ultrasonic bladder monitor in children during urodynamic studies. J Pediatr Urol. 2018;14:569.e1–6.

    Google Scholar 

  24. Kristiansen NK, Djurhuus JC, Nygaard H. Design and evaluation of an ultrasound-based bladder volume monitor. Med Biol Eng Comput. 2004;42:762–9.

    CAS  PubMed  Google Scholar 

  25. Park YH, Ku JH, Oh SJ. Accuracy of post-void residual urine volume measurement using a portable ultrasound bladder scanner with real-time pre-scan imaging. Neurourol Urodyn. 2011;30:335–8.

    PubMed  Google Scholar 

  26. Schlebusch T, Nienke S, Leonhardt S, Walter M. Bladder volume estimation from electrical impedance tomography. Physiol Meas. 2014;35:1813–23.

    CAS  PubMed  Google Scholar 

  27. • Cantu H, Sharaf A, Bevan W, Hassine A, Hasim H. Ambulatory urodynamics in clinical practice: a single centre experience. Neurourol Urodyn. 2019;38(8):2077–82 A retrospective review including 391 patients who underwent AUM following nondiagnostic UDS with 74% symptom reproduction, which changed clinical management in 75.7% of these patients.

    PubMed  Google Scholar 

  28. Lu YT, Jakobsen LK, Djurhuus JC, Bjerrum SN, Wen JG, Olsen LH. What is a representative voiding pattern in children with lower urinary tract symptoms? Lack of consistent findings in ambulatory and conventional urodynamic tests. J Pediatr Urol. 2016;12:154.e1–7.

    CAS  Google Scholar 

  29. Martens FM, van Kuppevelt HJ, Beekman JA, Heijnen IC, D’Hauwers KW, Heesakkers JP. No primary role of ambulatory urodynamics for the management of spinal cord injury patients compared to conventional urodynamics. Neurourol Urodyn. 2010;29:1380–6.

    CAS  PubMed  Google Scholar 

  30. Rantell A, Lu Y, Averbeck MA, Badawi JK, Rademakers K, Tarcan T, et al. What is the utility of urodynamics, including ambulatory, and 24 h monitoring, in predicting upper urinary tract damage in neurourological patients and other lower urinary tract dysfunction? ICI-RS 2017. Neurourol Urodyn. 2018;37:S25–31.

    PubMed  Google Scholar 

  31. Rodrigues P, Hering F, Cieli E, D’Imperio M, Campagnari JC. Can we state stable bladder? How many repetitions should we do for an appropriate demonstration of involuntary detrusor contraction? Urol Int. 2015;95:86–91.

    PubMed  Google Scholar 

  32. • Wille S, Schumacher P, Paas J, Tenholte D, Eminaga O, et al. Catheterless long-term ambulatory urodynamic measurement using a novel three-device system. PLoS One. 2014;9(5):e96280 In-depth discussion on applications and design of a telemetric AUM device.

    PubMed  PubMed Central  Google Scholar 

  33. Bakula M, Soebadi A, De Ridder D, Puers R. The bladder pill: developments toward bladder pressure measurement in wake mini-pigs. Procedia Eng. 2016;168:193–6.

    Google Scholar 

  34. Basu AS, Majerus S, Ferry L, Makovey I, Zhu H, Damaser MS. Is submucosal bladder pressure monitoring feasible? Proc Inst Mech Eng H. 2019;233:100–13.

    PubMed  Google Scholar 

  35. Majerus S, Makovey I, Zhu H, Ko W, Damaser MS. Wireless implantable pressure monitor for conditional bladder neuromodulation. IEEE Biomed Circuits Syst Conf (BioCAS). 2015;2015:204–8.

    Google Scholar 

  36. Lee HY, Choi B, Kim S, Kim SJ, Bae WJ, Kim SW. Sensitivity-enhanced pressure sensor for wireless bladder pressure monitoring. IEEE Sensors J. 2016;16:4715–24.

    Google Scholar 

  37. Kim A, Powell CR, Ziaie B. An implantable pressure sensing system with electromechanical interrogation scheme. IEEE Trans Biomed Eng. 2014;61:2209–17.

    PubMed  Google Scholar 

  38. Lee SS, Kim A, Chitnis R, Powel C, Ziaie B. A modular embedded system design for implantable wireless bladder pressure sensing. In 7th Int Conf Microtechnol Med Biol, Marina Del Rey, CA. (2013).

  39. Wang CC, Huang CC, Liou JS, Ciou YJ, Huang IY, Li CP, et al. A mini-invasive long-term bladder urine pressure measurement ASIC and system. IEEE Trans Biomed Circuits Syst. 2008;2:44–9.

    Google Scholar 

  40. Siwapornsathain E, Lal A, Binard JA. A telemetry and sensor platform for ambulatory urodynamics. Proc 2nd Ann Int IEEE-EMBS Special Topic Conf Microtechnol Med Biol. 2002:283–7. https://doi.org/10.1109/MMB.2002.1002331.

  41. Melgaard J, Rijkhoff NJM. Detecting the onset of urinary bladder contractions using an implantable pressure sensor. IEEE Trans Neural Syst Rehabil Eng. 2011;19:700–8.

    CAS  PubMed  Google Scholar 

  42. Majerus S, Fletter PC, Ferry EK, Zhu H, Gustafson KJ, Damaser MS. Suburothelial bladder contraction detection with implanted pressure sensor. PLoS One. 2017;12(1):e0168375.

    PubMed  PubMed Central  Google Scholar 

  43. Tan R, McClure T, Lin CK, Jea D, Dabiri F, Massey T, et al. Development of a fully implantable wireless pressure monitoring system. Biomed Microdevices. 2009;11(1):259–64.

    PubMed  Google Scholar 

  44. Clausen I, Tvedt LGW, Hellandsvik A, Rognlien DKW, Glott T. An in vivo MEMS sensor system for percutaneous measurement of urinary bladder. Conf Proc IEEE Eng Med Biol Soc. 2017:1857–60.

  45. Karam R, Bourbeau D, Majerus S, Makovey I, Goldman HB, et al. Real-time classification of bladder events for effective diagnosis and treatment of urinary incontinence. IEEE Trans Biomed Eng. 2016;63(4):721–9.

    PubMed  Google Scholar 

  46. Brown JS, McNaughton KS, Wyman JF, Burgio KL, Harkaway R, et al. Measurement characteristics of a voiding diary for use by men and women with overactive bladder. Urology. 2003;61(4):802–9.

    PubMed  Google Scholar 

  47. Jimenez-Cidre MA, Lopez-Fando L, Esteban-Fuertes M, Prieto-Chaparro L, Llorens-Martinez FJ, Salinas-Casado J, et al. The 3-day bladder diary is a feasible, reliable and valid tool to evaluate the lower urinary tract symptoms in women. Neurourol Urodyn. 2015;34(2):128–32.

    PubMed  Google Scholar 

  48. Cameron AP, Wiseman JB, Smith AR, Merion RM, Gillespie BW, Bradley CS, et al. Are three-day voiding diaries feasible and reliable? Results from the symptoms of lower urinary tract dysfunction research network (LURN) cohort. Neurourol Urodyn. 2019;38(8):2185–93.

    PubMed  Google Scholar 

  49. Drossaerts J, Rademakers KLJ, Rahnama’I SM, Marcelissen T, Van Kerrebroeck P, van Koeveringe G. The value of ambulatory Urodynamics in the evaluation of treatment effect of sacral Neuromodulation. Urol Int. 2019;102(3):299–305.

    PubMed  PubMed Central  Google Scholar 

  50. Dalmose AL, Rijkhoff NJ, Kirkeby HJ, Nohr M, Sinkjae T, Djurhuus JC. Conditional stimulation of the dorsal penile/clitoral nerve may increase cystometric capacity in patients with spinal cord injury. Neurourol Urodyn. 2003;22(2):130–7.

    CAS  PubMed  Google Scholar 

  51. Collinger JL, Foldes S, Bruns TM, Wodlinger B, Gaunt R, Weber DJ. Neuroprosthetic technology for individuals with spinal cord injury. J Spinal Cord Med. 2013;36(4):258–72.

    PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Cleveland Clinic, Glickman Urological & Kidney Institute, Cleveland, OH, USA

    Neil J. Kocher, Margot S. Damaser & Bradley C. Gill

  2. Advanced Platform Technology Center, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, USA

    Margot S. Damaser

  3. Department of Biomedical Engineering, Cleveland Clinic, Lerner Research Institute, Cleveland, OH, USA

    Margot S. Damaser

  4. Division of Urology, Surgical Service, Louis Stokes Cleveland Veterans Affairs Medical Center, 9500 Euclid Ave, Cleveland, OH, 44195, USA

    Bradley C. Gill

Authors
  1. Neil J. Kocher
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Margot S. Damaser
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bradley C. Gill
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bradley C. Gill.

Ethics declarations

Conflict of Interest

As a result of ongoing research and development, Dr. Damaser reports conflicts of interest that include nonfinancial support from the Hologic, Inc. and the Parker-Hannifin, Inc., as well as an issued patent for an Implantable Pressure Sensor with pending patents on Systems and Methods for Estimating a Volume of a Hollow Organ and a Sensing Device for Ambulatory Urodynamics Having a Pressure Sensitive Housing. No other authors report any relevant financial conflicts of interest.

Human and Animal Rights

The research presented in this article is comprised of a literature review and does not involve the use of live human or animal subjects. However, any studies cited that were performed by the authors and involved human or animal subjects were performed in accordance with all applicable ethical standards, including the Helsinki declaration and its amendments, institutional / national research committee standards, and international/national/institutional guidelines.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Female Urology

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Kocher, N.J., Damaser, M.S. & Gill, B.C. Advances in Ambulatory Urodynamics. Curr Urol Rep 21, 41 (2020). https://doi.org/10.1007/s11934-020-00989-w

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11934-020-00989-w

Keywords

  • Ambulatory urodynamic monitoring
  • Urodynamics
  • Telemetric
  • Wireless sensor
  • Bladder pressure
  • Urinary incontinence