Abstract
Purpose of Review
The purpose of the review is to explore the utility of urodynamic testing and guide readers on how to choose the best between simple and complex urodynamic testing.
Recent Findings
The literature discussed includes clinical scenarios in which urodynamic testing is usually not necessary, when a simple urodynamic assessment provides sufficient clinical information and when complex testing is particularly helpful in clinical decision-making.
Summary
The evaluation of a straightforward incontinent woman usually does not require urodynamic testing when planning initial behavioral or pharmacologic therapy. The assessment of stress urinary incontinence and prolapse without incontinence can often be accomplished with simple urodynamics. Refractory or complicated urinary incontinence often necessitates complex urodynamics.
Similar content being viewed by others
References
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
Wu JM, Vaughan CP, Goode PS, Redden DT, Burgio KL, Richter HE, et al. Prevalence and trends of symptomatic pelvic floor disorders in U.S. women. Obstet Gynecol. 2014;123(1):141–8. https://doi.org/10.1097/AOG.0000000000000057.
Wu JM, Hundley AF, Fulton RG, Myers ER. Forecasting the prevalence of pelvic floor disorders in U.S. women: 2010 to 2050. Obstet Gynecol. 2009;114(6):1278–83. https://doi.org/10.1097/AOG.0b013e3181c2ce96.
•• Rosier P, Schaefer W, Lose G, Goldman HB, Guralnick M, Eustice S, et al. International continence society good urodynamic practices and terms 2016: urodynamics, uroflowmetry, cystometry, and pressure-flow study. Neurourol Urodyn. 2017;36(5):1243–60. https://doi.org/10.1002/nau.23124. The evidence-based International Continence Society standardization and terminology guidelines in order to improve urodynamic testing and reporting for patient care and scientific purposes
Yeung JY, Eschenbacher MA, Pauls RN. Pain and embarrassment associated with urodynamic testing in women. Int Urogynecol J. 2014;25(5):645–50. https://doi.org/10.1007/s00192-013-2261-1.
Yiou R, Audureau E, Loche CM, Dussaud M, Lingombet O, Binhas M. Comprehensive evaluation of embarrassment and pain associated with invasive urodynamics. Neurourol Urodyn. 2015;34(2):156–60. https://doi.org/10.1002/nau.22521.
Nager CW, Brubaker L, Litman HJ, Zyczynski HM, Varner RE, Amundsen C, et al. A randomized trial of urodynamic testing before stress-incontinence surgery. N Engl J Med. 2012;366(21):1987–97. https://doi.org/10.1056/NEJMoa1113595.
van Leijsen SA, Kluivers KB, Mol BW, Hout J, Milani AL, Roovers JP, et al. Value of urodynamics before stress urinary incontinence surgery: a randomized controlled trial. Obstet Gynecol. 2013;121(5):999–1008. https://doi.org/10.1097/AOG.0b013e31828c68e3.
Weidner AC, Myers ER, Visco AG, Cundiff GW, Bump RC. Which women with stress incontinence require urodynamic evaluation? Am J Obstet Gynecol. 2001;184(2):20–7. https://doi.org/10.1067/mob.2001.108171.
Clement KD, Lapitan MC, Omar MI, Glazener CM. Urodynamic studies for management of urinary incontinence in children and adults. Cochrane Database Syst Rev. 2013;10:CD003195. https://doi.org/10.1002/14651858.CD003195.pub3.
Suskind AM, Cox L, Clemens JQ, Oldendorf A, Stoffel JT, Malaeb B, et al. The value of urodynamics in an academic specialty referral practice. Urology. 2017;105:48–53. https://doi.org/10.1016/j.urology.2017.02.049.
Verghese TS, Middleton LJ, Daniels JP, Deeks JJ, Latthe PM. The impact of urodynamics on treatment and outcomes in women with an overactive bladder: a longitudinal prospective follow-up study. Int Urogynecol J. 2017; https://doi.org/10.1007/s00192-017-3414-4.
Gormley EA, Lightner DJ, Burgio KL, Chai TC, Clemens JQ, Culkin DJ, et al. Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU guideline. J Urol. 2012;188(6 Suppl):2455–63. https://doi.org/10.1016/j.juro.2012.09.079.
Collins CW, Winters JC, American Urological A, Society of Urodynamics Female Pelvic M, Urogenital R. AUA/SUFU adult urodynamics guideline: a clinical review. Urol Clin North Am. 2014;41(3):353–362, vii. https://doi.org/10.1016/j.ucl.2014.04.011.
Hanno PM, Burks DA, Clemens JQ, Dmochowski RR, Erickson D, Fitzgerald MP, et al. AUA guideline for the diagnosis and treatment of interstitial cystitis/bladder pain syndrome. J Urol. 2011;185(6):2162–70. https://doi.org/10.1016/j.juro.2011.03.064.
Richter HE, Albo ME, Zyczynski HM, Kenton K, Norton PA, Sirls LT, et al. Retropubic versus transobturator midurethral slings for stress incontinence. N Engl J Med. 2010;362(22):2066–76. https://doi.org/10.1056/NEJMoa0912658.
Nager CW, Sirls L, Litman HJ, Richter H, Nygaard I, Chai T, et al. Baseline urodynamic predictors of treatment failure 1 year after mid urethral sling surgery. J Urol. 2011;186(2):597–603. https://doi.org/10.1016/j.juro.2011.03.105.
Zyczynski HM, Albo ME, Goldman HB, Wai CY, Sirls LT, Brubaker L, et al. Change in overactive bladder symptoms after surgery for stress urinary incontinence in women. Obstet Gynecol. 2015;126(2):423–30. https://doi.org/10.1097/AOG.0000000000000929.
• Jelovsek JE, Hill AJ, Chagin KM, Kattan MW, Barber MD. Predicting risk of urinary incontinence and adverse events after midurethral sling surgery in women. Obstet Gynecol. 2016;127(2):330–40. https://doi.org/10.1097/AOG.0000000000001269. This is a secondary analysis of four randomized controlled trials of mid-urethral slings investigating possible predictors of developing stress and urgency urinary incontinence and adverse events 12 months after sling surgery
Brubaker L, Cundiff GW, Fine P, Nygaard I, Richter HE, Visco AG, et al. Abdominal sacrocolpopexy with Burch colposuspension to reduce urinary stress incontinence. N Engl J Med. 2006;354(15):1557–66. https://doi.org/10.1056/NEJMoa054208.
Wei JT, Nygaard I, Richter HE, Nager CW, Barber MD, Kenton K, et al. A midurethral sling to reduce incontinence after vaginal prolapse repair. N Engl J Med. 2012;366(25):2358–67. https://doi.org/10.1056/NEJMoa1111967.
Visco AG, Brubaker L, Nygaard I, Richter HE, Cundiff G, Fine P, et al. The role of preoperative urodynamic testing in stress-continent women undergoing sacrocolpopexy: the Colpopexy and Urinary Reduction Efforts (CARE) randomized surgical trial. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19(5):607–14. https://doi.org/10.1007/s00192-007-0498-2.
Nager CW, Albo ME, Fitzgerald MP, McDermott S, Wruck L, Kraus S, et al. Reference urodynamic values for stress incontinent women. Neurourol Urodyn. 2007;26(3):333–40. https://doi.org/10.1002/nau.20348.
Bo K, Frawley HC, Haylen BT, Abramov Y, Almeida FG, Berghmans B, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for the conservative and nonpharmacological management of female pelvic floor dysfunction. Int Urogynecol J. 2017;28(2):191–213. https://doi.org/10.1007/s00192-016-3123-4.
Wolf JS Jr, Bennett CJ, Dmochowski RR, Hollenbeck BK, Pearle MS, Schaeffer AJ, et al. Best practice policy statement on urologic surgery antimicrobial prophylaxis. J Urol. 2008;179(4):1379–90. https://doi.org/10.1016/j.juro.2008.01.068.
•• Norton PA, Nager CW, Brubaker L, Lemack GE, Sirls LT, Holley R, et al. The cost of preoperative urodynamics: a secondary analysis of the ValUE trial. Neurourol Urodyn. 2016;35(1):81–4. https://doi.org/10.1002/nau.22684. This is a secondary analysis from the Value of Urodynamic Evaluation (ValUE) trial, a multicenter non-inferiority randomized trial to determine whether a basic office evaluation (OE) is non-inferior in terms of SUI surgery outcomes to office evaluation with addition of urodynamic studies (UDS). This analysis calculates the cost incurred when UDS was performed as a supplement to a basic office evaluation and extrapolates the potential savings of not doing UDS in this patient population on a national basis
Funding
Dr. Swift reports an outside grant from Astellas, outside the submitted work.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
The authors declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Additional information
This article is part of the Topical Collection on Urogynecology
Rights and permissions
About this article
Cite this article
Edenfield, A.L., Swift, S.E. Urodynamic Testing: Choosing Between Simple Versus Complex. Curr Obstet Gynecol Rep 6, 269–273 (2017). https://doi.org/10.1007/s13669-017-0229-8
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13669-017-0229-8