Urodynamic Studies: Types and Indications

  • Benjamin M. BruckerEmail author
  • Victor W. Nitti


Urodynamics (UDS) consist of a number of studies, which individually or collectively provide information about the function of the lower urinary tract. It is critical to understand how UDS can be practically used in the evaluation of patients with specific symptoms or conditions. Furthermore it is important to understand terminology, methods, and means of interpretation of the varied tests that comprise these studies. This chapter provides a brief overview of urodynamic studies including post void residual, uroflowmetry, pelvic floor electromyography, cystometry pressure-flow UDS, urethral pressure profilometry, and videourodynamics. We then dive into the indications for various aspects of the UDS studies focusing on how these tests are used in aspects of urinary incontinence, neurogenic lower urinary tract dysfunction, lower urinary tract symptoms, and other urologic conditions.


Stress Urinary Incontinence Lower Urinary Tract Symptom Lower Urinary Tract Detrusor Overactivity Bladder Outlet Obstruction 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Davis DM. The hydrodynamics of the upper urinary tract (urodynamics). Ann Surg. 1954;140:839 [Lippincott, Williams, and Wilkins].PubMedCentralPubMedCrossRefGoogle Scholar
  2. 2.
    Brown ET, Krlin RM, Winters JC. Urodynamics: examining the current role of UDS testing. What is the role of urodynamic testing in light of recent AUA urodynamics and overactive bladder guidelines and the VALUE study? Curr Urol Rep. 2013;14:403–8.PubMedCrossRefGoogle Scholar
  3. 3.
    Abrams P, Blaivas JG, Stanton S, Andersen JT. ICS standardisation of terminology of lower urinary tract function. Scand J Urol Nephrol. 1988;114:5–19.Google Scholar
  4. 4.
    Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, et al. The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn. 2002;21:167–78.PubMedCrossRefGoogle Scholar
  5. 5.
    Winters JC, Dmochowski RR, Goldman HB, Herndon CDA, Kobashi KC, Kraus SR, et al. Urodynamic studies in adults: AUA/SUFU guideline. J Urol. 2012;188:2464–72.PubMedCrossRefGoogle Scholar
  6. 6.
    Nitti VW, Combs AJ. Urodynamics: when, why and how. In: Nitti VW, editor. Practical urodynamics. Philadelphia: W.B. Saunders; 1998. p. 15–25.Google Scholar
  7. 7.
    Schäfer W, Abrams P, Liao L, Mattiasson A, Pesce F, Spangberg A, et al. Good urodynamic practices: uroflowmetry, filling cystometry, and pressure-flow studies. Neurourol Urodyn. 2002;21:261–74.PubMedCrossRefGoogle Scholar
  8. 8.
    Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn. 2010;29:4–20.PubMedGoogle Scholar
  9. 9.
    Haylen BT, Lee J. The accuracy of post-void residual measurement in women. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19:603–6.PubMedCrossRefGoogle Scholar
  10. 10.
    Park YH, Ku JH, Oh S-J. Accuracy of post-void residual urine volume measurement using a portable ultrasound bladder scanner with real-time pre-scan imaging. Neurourol Urodyn. 2011;30(3):335–8.PubMedCrossRefGoogle Scholar
  11. 11.
    Boone TB, Kim YH. Uroflowmetry. In: Nitti VW, editor. Practical urodynamics. Philadephia: W B Saunders; 1998. p. 28–37.Google Scholar
  12. 12.
    Drach GW, Layton TN, Binard WJ. Male peak urinary flow rate: relationships to volume voided and age. J Urol. 1979;122:210–4.PubMedGoogle Scholar
  13. 13.
    Gray M. Traces: making sense of urodynamics testing—part 2: uroflowmetry. Urol Nurs. 2010;30:321–6.PubMedGoogle Scholar
  14. 14.
    Chan C-K, Yip SK-H, Wu IPH, Li M-L, Chan N-H. Evaluation of the clinical value of a simple flowmeter in the management of male lower urinary tract symptoms. BJU Int. 2012;109:1690–6.PubMedCrossRefGoogle Scholar
  15. 15.
    Abrams P, Blaivas JG, Stanton SL, Andersen DJT. The standardization of terminology of lower urinary tract function recommended by the international continence society. Int Urogynecol J Pelvic Floor Dysfunct. 1990;1:45–58 [Springer].CrossRefGoogle Scholar
  16. 16.
    Brucker BM, Fong E, Shah S, Kelly C, Rosenblum N, Nitti VW. Urodynamic differences between dysfunctional voiding and primary bladder neck obstruction in women. Urology. 2012;80:55–60.PubMedCrossRefGoogle Scholar
  17. 17.
    Barrett DM. Disposable (infant) surface electrocardiogram electrodes in urodynamics: a simultaneous comparative study of electrodes. J Urol. 1980;124:663–5.PubMedGoogle Scholar
  18. 18.
    Sakakibara R, Fowler CJ, Hattori T, Hussain IF, Swinn MJ, Uchiyama T, et al. Pressure-flow study as an evaluating method of neurogenic urethral relaxation failure. J Auton Nerv Syst. 2000;80(1–2):85–8.PubMedCrossRefGoogle Scholar
  19. 19.
    Wein A, Barrett D. Etiologic possibilities for increased pelvic floor electromyography activity during cystometry. J Urol. 1982;127(5):949–52.PubMedGoogle Scholar
  20. 20.
    Gleason DM, Bottaccini MR, Reilly RJ. Comparison of cystometrograms and urethral profiles with gas and water media. Urology. 1977;9(2):155–60.PubMedCrossRefGoogle Scholar
  21. 21.
    Gleason D, Reilly B. Gas cystometry. Urol Clin North Am. 1979;6(1):85–8.PubMedGoogle Scholar
  22. 22.
    Godec CJ, Cass AS. Rapid and slow-fill gas cystometry. Influence on bladder capacity and diagnosis of hyperreflexic bladder. Urology. 1979;13(1):109–10.PubMedCrossRefGoogle Scholar
  23. 23.
    Sorensen S, Gregersen H, Sorensen SM. Long term reproducibility of urodynamic investigations in healthy fertile females. Scand J Urol Nephrol Suppl. 1988;114:35–41.PubMedGoogle Scholar
  24. 24.
    van Waalwijk van Doorn ES, Remmers A, Janknegt RA. Conventional and extramural ambulatory urodynamic testing of the lower urinary tract in female volunteers. J Urol. 1992;147:1319–26.Google Scholar
  25. 25.
    Hosker G. Urodynamics. In: Hillard T, Purdie D, editors. The yearbook of obstetrics and gynaecology. London: RCOG Press; 2004. p. 233–54.Google Scholar
  26. 26.
    Stohrer M, Goepel M, Kondo A, et al. The standardization of terminology in neurogenic lower urinary tract dysfunction with suggestions for diagnostic procedures. Neurourol Urodynn. 1999;18:139–58.CrossRefGoogle Scholar
  27. 27.
    McGuire EJ, Woodside JR, Borden TA, Weiss RM. Prognostic value of urodynamic testing in myeloplastic children. J Urol. 1981;126:205–9.PubMedGoogle Scholar
  28. 28.
    McGuire EJ, Fitzpatrick CC, Wan J, et al. Clinical assessment of urethral sphincter function. J Urol. 1993;150:1452–4.PubMedGoogle Scholar
  29. 29.
    Zimmern P, Nager CW, Albo M, FitzGerald MP, McDermott S. Interrater reliability of filling cystometrogram interpretation in a multicenter study. J Urol. 2006;175:2174–7.PubMedCrossRefGoogle Scholar
  30. 30.
    Nitti VW. Pressure flow urodynamic studies: the gold standard for diagnosing bladder outlet obstruction. Rev Urol. 2005;7 Suppl 6:S14.PubMedCentralPubMedGoogle Scholar
  31. 31.
    Gleason DM, Lattimer JK. The pressure-flow study: a method for measuring bladder neck resistance. J Urol. 1962;87:844–52.PubMedGoogle Scholar
  32. 32.
    Abrams PH, Griffiths DJ. The assessment of prostatic obstruction from urodynamic measurements and from residual urine. Br J Urol. 1979;51:129–34.PubMedCrossRefGoogle Scholar
  33. 33.
    Abrams P. Bladder outlet obstruction index, bladder contractility index and bladder voiding efficiency: three simple indices to define bladder voiding function. BJU Int. 1999;84(1):14–5.PubMedCrossRefGoogle Scholar
  34. 34.
    Chassagne S, Bernier PA, Haab F, et al. Proposed cutoff values to define bladder outlet obstruction in women. Urology. 1998;51:408–11.PubMedCrossRefGoogle Scholar
  35. 35.
    Nitti VW, Tu LM, Gitlin J. Diagnosing bladder outlet obstruction in women. J Urol. 1999;161(5):1535–40.PubMedCrossRefGoogle Scholar
  36. 36.
    Blaivas JG, Groutz A. Bladder outlet obstruction nomogram for women with lower urinary tract symptomatology. Neurourol Urodyn. 2000;19:553–64.PubMedCrossRefGoogle Scholar
  37. 37.
    Defreitas GA, Zimmern PE, Lemack GE, Shariat SF. Refining diagnosis of anatomic female bladder outlet obstruction: comparison of pressure-flow study parameters in clinically obstructed women with those of normal controls. Urology. 2004;64:675–9.PubMedCrossRefGoogle Scholar
  38. 38.
    Akikwala TV, Fleischman N, Nitti VW. Comparison of diagnostic criteria for female bladder outlet obstruction. J Urol. 2006;176:2093–7.PubMedCrossRefGoogle Scholar
  39. 39.
    Brown M, Wickham JEA. The urethral pressure profile. Br J Urol. 1969;41:211–7.PubMedCrossRefGoogle Scholar
  40. 40.
    Lose G, Griffiths D, Hosker G, et al. Standardisation of urethral pressure measurement: report from the Standardisation Sub-Committee of the International Continence Society. Neurourol Urodyn. 2002;21:258–60.PubMedCrossRefGoogle Scholar
  41. 41.
    Tanagho EA, Miller ER, Meyers FH, Corbett RK. Observations on the dynamics of the bladder neck. Br J Urol. 1966;38:72–84.PubMedCrossRefGoogle Scholar
  42. 42.
    Bates CP, Whiteside CG, Turner-Warwick R. Synchronous cine/pressure/flow/cysto-urethrography with special reference to stress and urge incontinence. Br J Urol. 1970;42:714–23.PubMedCrossRefGoogle Scholar
  43. 43.
    Webster GD, Older RA. Video urodynamics. Urology. 1980;16(1):106–14.PubMedCrossRefGoogle Scholar
  44. 44.
    Mayo ME, Chapman WH, Shurtleff DB. Bladder function in children with meningomyelocele: comparison of cine-fluoroscopy and urodynamics. J Urol. 1979;121(4):458–61.PubMedGoogle Scholar
  45. 45.
    Kuo HC. Videourodynamic characteristics and lower urinary tract symptoms of female bladder outlet obstruction. Urology. 2005;66(5):1005–9.PubMedCrossRefGoogle Scholar
  46. 46.
    McGuire EJ, Woodside JR. Diagnostic advantages of fluoroscopic monitoring during urodynamic evaluation. J Urol. 1981;125(6):830–4.PubMedGoogle Scholar
  47. 47.
    Porru D, Madeddu G, Campus G, Montisci I, Scarpa RM, Usai E. Evaluation of morbidity of multi-channel pressure-flow studies. Neurourol Urodyn. 1999;18:647–52.PubMedCrossRefGoogle Scholar
  48. 48.
    Zhang X, Li G, Wei X, Mo X, Hu L, Zha Y, et al. Resistive index of prostate capsular arteries: a newly identified parameter to diagnose and assess bladder outlet obstruction in patients with benign prostatic hyperplasia. J Urol. 2012;188:881–7.PubMedCrossRefGoogle Scholar
  49. 49.
    Sahai A, Seth J, Van der Aa F, Panicker J, De Ridder D, Dasgupta P. Current state of the art in non-invasive urodynamics. Curr Bladder Dysfunct Rep. 2013;8:83–91.CrossRefGoogle Scholar
  50. 50.
    Huang T, Qi J, Yu YJ, Xu D, Jiao Y, Kang J, et al. Predictive value of resistive index, detrusor wall thickness and ultrasound estimated bladder weight regarding the outcome after transurethral prostatectomy for patients with lower urinary tract symptoms suggestive of benign prostatic obstruction. Int J Urol. 2012;19:343–50.PubMedCrossRefGoogle Scholar
  51. 51.
    Han DH, Lee HW, Sung HH, Lee HN, Lee Y-S, Lee K-S. The diagnostic efficacy of 3-dimensional ultrasound estimated bladder weight corrected for body surface area as an alternative nonurodynamic parameter of bladder outlet obstruction. J Urol. 2011;185:964–9.PubMedCrossRefGoogle Scholar
  52. 52.
    Macnab AJ, Stothers L. Near-infrared spectroscopy: validation of bladder-outlet obstruction assessment using non-invasive parameters. Can J Urol. 2008;15:4241–8.PubMedGoogle Scholar
  53. 53.
    Nitti VW. Urodynamic and videourodynamic evaluation of the lower urinary tract. In: Wein A, Kavoussi L, Novick A, Partin A, Peters C, editors. Campbell Walsh urology. 10th ed. Philadelphia: Elsevier Saunders; 2011. p. 1847–70.Google Scholar
  54. 54.
    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.PubMedCentralPubMedCrossRefGoogle Scholar
  55. 55.
    Nitti VW, Lefkowitz G, Ficazzola M, Dixon CM. Lower urinary tract symptoms in young men: videourodynamic findings and correlation with non-invasive measures. J Urol. 2002;168:135–8.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Department of UrologyNew York University Langone Medical CenterNew YorkUSA

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