Urodynamics: Indications, Technique, and Fluoroscopy

Abstract

Symptom of urinary incontinence is the presentation of several abnormalities in the function of lower urinary tract (LUT) and the etiologies are varied. Similarly, pelvic organ prolapse (POP) can give rise to various LUT symptoms most commonly urgency and difficulty in voiding, and it can mask stress urinary incontinence. The initial management of mild/moderate incontinence and small degree of POP is conservative, incorporating pelvic floor muscle training, behavioural modification and medications. Urodynamics (UDS), in broad sense, is required during initial evaluation in the form of bladder diary (urolog) and measurement of postvoid urinary volume with or without uroflowmetry. Invasive multichannel UDS is required when the initial treatment fails and more insight is required into pathophysiological basis of the symptomatology. The armamentarium of multichannel UDS includes cystometry, pressure-flow study, urethral pressure profilometry with or without electromyography, and fluoroscopic surveillance (video-UDS). The best study would be decided by the physician based on the urodynamic question(s). The interpretation of urodynamic investigation is best done in real-time during the investigation or immediately after it; therefore, the treating physician/team member should be directly involved in the study. Indications of various urodynamic tests, current armamentarium of multichannel UDS, its strength and limitations in current understanding are discussed in the chapter.