Role Of Urodynamics Research Articles

What is the role of urodynamics when undergoing prostatic surgery? Is there still a significant role for pressure flow studies based on the UPSTREAM study?

What is the role of urodynamics when undergoing prostatic surgery? Is there still a significant role for pressure flow studies based on the UPSTREAM study?

Persistence of lower urinary tract symptoms in post- menopausal women after mid-urethral sling: the role of urodynamics in patient counselling

Persistence of lower urinary tract symptoms in post- menopausal women after mid-urethral sling: the role of urodynamics in patient counselling

A0847 - The role of urodynamics in the evaluation of lower urinary tract symptoms after postoperative radiotherapy

A0847 - The role of urodynamics in the evaluation of lower urinary tract symptoms after postoperative radiotherapy

IUGA report on reporting urodynamics in women.

Urodynamics (UDS) is the current gold standard investigation for explaining pathology in lower urinary tract dysfunction. The role of UDS is to answer a urodynamic question based on reproducing the patient's symptoms. Despite the introduction of several standardization documents on terminology and methodology for performing UDS and the standard of equipment required, there remains no standardization on how to report and therefore how to interpret UDS findings. The lack of guidance in this specific area may undermine the value of this extremely important tool in the patient evaluation. The aim of this article is to propose a standardized proforma and checklist for the reporting of UDS studies; the main text discusses the rationale for the proforma. This document underwent four rounds of review by the working group and external review by Andrew Gammie. Between each round the document was re-circulated for comment and the comments collated and then reviewed for adoption or rejection based on consensus prior to the document going for further external review. The comments of the external review were then collated and again circulated for consideration prior to adoption based on consensus and the paper put out to review by an IUGA committee public consultation prior to being submitted for publication. This article sets out the rationale for a standardized proforma for reporting female UDS. This document gives a standardized approach to reporting of UDS. The importance of this is based on UDS being part of a process and not an isolated event. Standardized reporting, like the WHO checklist, gives a framework to ensure that the test has been ordered appropriately and that the final report refers to the indication rather than merely the observations. As such, a standardized report has a better chance of being interpreted appropriately for the woman's symptoms.

Role of urodynamics in male patients of high-anorectal malformations: a prospective study.

Association of spinal or vertebral anomalies and the iatrogenic denervation during surgical correction of anorectal malformation patients especially in boys can lead to neurogenic bladder inthese subset of patients. The paucity of literature with regard to urodynamic studies focusing exclusively in male children with high-anorectal malformations (HARM) lead us to analyze the urodynamic changes. The objective was to study urodynamic profile in male patients who have undergone surgery for anorectal malformation. Male high-anorectal malformation patients who had completed all the stages of repair were prospective studied. Following the basic work up, all patients based on the urodynamics were categorized into 2 groups as safe or unsafe bladders. Unsafe bladder was defined as detrusor pressure > 40cm (high detrusor pressure) or pressure variability of 15cm of water (detrusor overactivity) or significant post-void residue. MRI was limited to patients with only abnormal urodynamics to rule out spinal causes of neurogenic bladder and due to financial constraints, it could not be offered to all patients. 41 HARM meet the exclusion criteria. All patients were asymptomatic with none having history of urinary tract infections. Ultrasound showed bladder wall thickening in 31.7% patients. UDS revealed reduction in bladder capacity and compliance was noted in 31.7% and 30% patients, respectively. Elevated detrusor pressures (> 40cm of water) were noted in 10% (4/41), detrusor overactivity with concomitant elevated detrusor pressures in 19.5% (8/41) and normal UDS in 70% (29/41). 13 patients (31.7%) had abnormal cystometric parameters with 12(30%) having unsafe bladders. MRI confirmed sacral agenesis in 1 patient with unsafe bladder. Urodynamics can demonstrate occult neurovesical dysfunction in patients with HARM. This would help in early renal protective therapy and prevent the burden of long-term sequelae of neurovesical dysfunction in HARM patients.

The Role of Urodynamics in the Pre-transplant Evaluation of Renal Transplant.

The goal of this study is to delineate the role of advanced urologic evaluation with urodynamics prior to renal transplantation. We seek to report on its indications, possible findings, and subsequent treatment pathways. This body of literature is largely comprised of retrospective, single-site studies. Patient selection for urodynamics can be determined based on patient history and voiding symptoms. Many of these renal transplant patients have urodynamic abnormalities such as decreased bladder capacity and compliance. Appropriate treatment of these abnormalities allows for average rates of graft survival. Urodynamic evaluation is not needed in every renal transplant recipient. However, in patients with oliguria or bladder dysfunction, urodynamics can often reveal significant pathology. The well-selected patient with lower urinary tract symptoms may also benefit from urodynamic evaluation. Treatment options are widely variable, from observation to reconstructive surgery, and should be based on the patient and urodynamic findings.

Do we understand voiding dysfunction in women? Current understanding and future perspectives: ICI-RS 2017.

Urinary retention in women is poorly understood, compared to the equivalent condition in men, and was the subject of a dedicated session organized at the International Consultation on Incontinence Research Society (ICI-RS) in Bristol, United Kingdom, 2017. The current understanding of the pathophysiological correlates of idiopathic voiding dysfunction in women, the role of urodynamics, neurophysiology, and non-invasive tests in characterizing functional bladder outlet obstruction due to a non-relaxing urethral sphincter, and poorly defined diagnosis of detrusor underactivity were reviewed. Putative factors underlying the pathogenesis of urinary retention following urinary tract infections were discussed. Further research is required to explore the association between bladder wall inflammation and alterations in detrusor contractile functions. The complex interrelationship between urinary retention and psychological co-morbidities and sexual trauma were explored, and the overlap between these and psychological co-morbidities and functional neurological problems with functional urological problems were recognized. Understanding the mechanism of action of sacral neuromodulation, often a successful treatment for urinary retention, would provide insight into the underlying factors that may be responsible for urinary retention. Specifically, there is a need to understand the role of the endogenous enkephalinergic system in the pathogenesis of urinary retention and to identify predictors of successful treatment with sacral neuromodulation. Based on current understanding and potential directions of research in the future, an algorithm for the evaluation of women with voiding dysfunction was proposed. In the future, recommendations for research should lead to a better understanding of urinary retention in women and its treatment.

The role of urodynamics in the surgical management of benign prostatic obstruction

Benign prostatic obstruction (BPO) is a common cause of lower urinary tract symptoms (LUTS) in elderly men. However, such symptoms are often caused by primary detrusor overactivity or underactivity. Surgical management where BPO is absent or merely incidental has a lower chance of success, and exposes the patient to the potential complications of surgery. This review discusses the diagnostic challenges facing this common presentation. Most evidence comes from small, historical prospective cohort studies. A Cochrane review found only two studies that met the prespecified inclusion criteria. It concluded that urodynamics changed decision-making regarding surgery for LUTS but it was not possible to determine whether this impacted upon outcome. A systematic review of several noninvasive alternatives to urodynamics could not recommend any of them over urodynamic pressure-flow study assessment. Further research is currently in progress, the 'UPSTREAM' study, which is a randomized, multicentre trial. Men are randomized to undergo investigation with clinical evaluation and uroflowmetry, or to additionally receive urodynamics. The primary aim is to determine the impact of urodynamics on the assessment pathway. Assessment of BPO involves determining whether it has a contributory role in individual patients. This is a crucial factor in outcome, as surgery can give poor results if the symptoms are principally caused by detrusor dysfunction (overactivity or underactivity). Urodynamics can help determine this if undertaken to a suitable standard. Further research will identify the precise role of this test modality.

Urodynamics in the Pediatric Patient: When to Order, How to Interpret

The goal of this review is to elucidate the role of urodynamics in the assessment and management of lower urinary tract (LUT) dysfunction in children. Many children with LUT dysfunction will improve with an explanation of bladder and bowel function, advice on fluid intake and bathroom schedules, and treatment of constipation. Among those who fail to respond, urodynamics may be useful in guidance. There are four types of urodynamic studies: non-invasive urodynamics, uroflow, invasive urodynamics, and videourodynamics. This review outlines the information that can be obtained from these studies. Biofeedback is a non-invasive urodynamic technique which involves the visualization of LUT function to teach the child control over these muscles particularly the pelvic floor muscle. In the absence of success, other options are available for LUT management. Patterns of non-invasive urodynamics can be helpful in diagnosing and planning care for children with LUT dysfunction particularly if the pattern is consistent with history and home bladder diaries. Many diagnoses respond to pelvic floor exercises taught by biofeedback. Constipation plays a large role in LUT dysfunction and may respond to diet, medication, and biofeedback. More invasive testing and treatment is available for the few who do not respond.

Role of urodynamics in management of urethral diverticulum in females

BackgroundFew studies have focused on the urodynamic findings of urethral diverticula (UD). We characterized the symptoms and urodynamic findings in women with UD. MethodsA retrospective review of all women in a single center having surgical treatment for symptomatic UD between May 2004 and September 2014 was done. Lower urinary tract symptoms were evaluated with International Prostate Symptom Score and Overactive Bladder Symptom Score questionnaires. All patients underwent magnetic resonance imaging and videourodynamic study (VUDS) prior to surgery, and postoperative evaluation with VUDS. ResultsA total of 20 female patients were enrolled into the study. 12 (60%) UD patients presented with symptoms of stress urinary incontinence (SUI). However, there were merely 3 (15%) patients diagnosed as urodynamic SUI. 15 (75%) patients exhibited low catheter-free uroflow. Detrusor overactivity was demonstrated in 4 (20%) patients. Bladder outlet obstruction (BOO) was diagnosed in 8 (40%) cases. Postoperative VUDS revealed persistent BOO in 50% of patients with preoperative BOO. Of these, residual diverticulum was noted by VUDS in one patient. ConclusionFor UD patients with urinary incontinence or voiding dysfunction, VUDS is helpful in accurately characterizing these symptoms.

Urodynamic Evaluation Following Bladder Reconstruction

Bladder reconstruction for storage or emptying failure involves augmenting the size of the native bladder or replacing it with a bladder substitute. The properties of the reconstructed bladder should resemble closely those of the “ideal” native bladder: high capacity and compliance, absence of detrusor overactivity, outlet competence, and ease of regular emptying. As in evaluations of the native bladder, urodynamics may assist in providing useful information regarding the status of the reconstruction. Available data indicate that enterocystoplasty, orthotopic neobladders, and continent catheterizable reservoirs all approach the “ideal” criteria in long-term follow-up. On the other hand, the role of urodynamics in troubleshooting the failed augment is still not well defined. While ambulatory urodynamics may one day yield valuable information, its utility remains in question.

Role of urodynamics in stress urinary incontinence: A critical appraisal.

Introduction:Role of urodynamics prior to surgery of stress urinary incontinence (SUI) is under constant debate. Demonstration of the presence of detrusor overactivity is the only aspect that has been emphasized in the literature so far. We believe that there are number of other factors which may influence the evaluation and in turn the choice of surgical management and prediction of outcome of treatment. They are as follows: (1) Presence of voiding inefficiency, (2) asymptomatic detrusor overactivity, (3) and severity of SUI. These features may complicate the precise evaluation of patients of SUI. The main objective of this study is to analyze the dynamics of leakage and voiding using urodynamics. This study also aims at correlating these findings with clinical information.Materials and Methods:One hundred consecutive cases referred to our center for preoperative evaluation of SUI were recruited in the study prospectively. All patients were interrogated using International Consultation on Incontinence Questionnaire. All patients underwent complete urodynamic evaluation including uroflowmetry, filling cystometry, leak point pressure measurement, and pressure flow studies, according to Good Urodynamic Practice guidelines. Patients’ symptoms were correlated with urodynamic findings, with special emphasis on the presence of detrusor overactivity, severity of SUI, voiding efficiency, and presence of bladder outlet obstruction. Clinical information and urodynamic findings were correlated using Chi-square test.Results:There is a statistically significant correlation between the presence of symptoms of urge urinary incontinence and urodynamic findings of detrusor overactivity at P < 0.05. There is a statistically significant correlation between the symptoms of urge incontinence (in addition to SUI) and urodynamic findings of intrinsic sphincter deficiency at P < 0.05. Fifteen of 51 patients who did not have associated storage symptoms were found to have some degree of detrusor overactivity on urodynamic evaluation. There was no statistically significant correlation between asymptomatic cases of urge incontinence and incidental finding of detrusor overactivity at P < 0.05. There is no statistically significant correlation between the urodynamic findings of symptoms of voiding dysfunction and urodynamic findings, suggestive of the same value at P < 0.05.Conclusions:Urodynamic study in SUI has a potential of giving much more information than demonstration of Detrusor Overactivity alone. The predominant symptom of urge urinary incontinence can predictably diagnose detrusor overactivity in these cases. However, the incidence of asymptomatic detrusor overactivity remains as high as 15% and may have implication in postoperative results. This study clearly shows that there is a definite incidence of significant voiding dysfunction, which cannot be reliably evaluated without properly conducted pressure flow study. This factor may govern the choice of correct treatment which also predicts the outcome more reliably. Preoperative urodynamic study thus adds a dimension of precision to evaluation of the patients of SUI and may also influence technique and outcome measures in this group of patients.

Urodynamics useless before surgery for female stress urinary incontinence: Are you sure? Results from a multicenter single nation database.

The role of urodynamics (UDS) before surgery for stress urinary incontinence (SUI) remains a debated issue in female urology as well as in urogynaecology and it has been recently questioned on the basis of data coming from selected population of patients defined as "uncomplicated." The aim of this study was to investigate the percentage of "uncomplicated" patients undergoing urodynamic evaluations in six referral Italian centers. The secondary aim was to assess the prevalence of women, for whom the urodynamic evaluation could add new information to the pre-urodynamic picture and in how many cases these findings had a significant impact on patient management. The data of women who underwent urodynamic evaluation prior to surgery for stress urinary incontinence between 2008 and 2013 were retrospectively analyzed. According to the definition of the Value of Urodynamic Evaluation (ValUE) trial criteria, patients presenting with SUI were classified as "uncomplicated" or "complicated." Urodynamic observations were then compared with pre-urodynamic data. Overall, 2,053 female patients were considered. Only 740/2,053 (36.0%) patients were defined "uncomplicated" according to the definition used in the ValUE trial. The urodynamic observations were not consistent with the pre-urodynamic diagnosis in 1,276 out of 2,053 patients (62.2%). Voiding dysfunctions were urodynamically diagnosed in 394 patients (19.2%). Planned surgery was cancelled or modified in 304 patients (19.2%), due to urodynamic findings. "Uncomplicated" patients represent a minority among female SUI patients evaluated before surgery. In "complicated" patients, the role of urodynamic has not been challenged yet and UDS seems still mandatory. Neurourol. Urodynam. 35:809-812, 2016. © 2015 Wiley Periodicals, Inc.

Role of Urodynamics in the Evaluation of Elderly Voiding Dysfunction

Voiding dysfunction is a common condition in the elderly that can affect both men and women. Due to the age-associated changes in the lower urinary tract, voiding dysfunction in the elderly is usually complex and multifactorial, necessitating more objective testing sometimes. In this chapter, we will focus on the role of urodynamics in the setting of voiding dysfunction in the elderly. The term voiding dysfunction will be used to refer both to storage and obstructive lower urinary tract symptoms.

Lower urinary tract dysfunction in pelvic gynecologic cancer: the role of urodynamics.

The exact incidence of lower urinary tract dysfunction is not known and its pathogenesis is not completely understood. Advances in urodynamic assessment and widespread availability of a standardized technique have facilitated its exploration prior to and subsequent to the surgical management of patients with gynecologic pelvic cancer. We performed a PubMed and Medline literature search using the following keywords: bladder dysfunction, urinary dysfunction, and urodynamics and all these terms in combination with radical hysterectomy in order to analyze the role of urodynamics in patients with pelvic gynecologic cancer in the preoperative as well as in the early and late postoperative settings.

Role of Urodynamics in the Evaluation of Urinary Incontinence and Prolapse

Urodynamics are functional tests of the bladder that are commonly requested for the evaluation of urinary incontinence and prolapse. As a diagnostic test that also can provide prognostic information, urodynamics should be requested when there is a specific question that needs to be answered. This chapter will review the literature that pertains to the common reasons for requesting urodynamics before stress urinary incontinence surgery and review recent randomized trials on urodynamic testing before stress incontinence surgery. In addition, the chapter will compare the predictive ability of urodynamic prolapse reduction stress testing with office-based prolapse reduction stress testing for detecting postoperative stress urinary incontinence in women without symptoms of stress urinary incontinence undergoing prolapse surgery.

Urological implications of pelvic trauma

Urological implications of pelvic trauma

When Are Urodynamics Indicated in Patients with Stress Urinary Incontinence?

Despite technical and procedural advances in urodynamics over the past decade, the role of urodynamics in women with stress urinary incontinence (SUI) remains controversial. Many of these advancements have been the result of multicentric studies in the United States, such as the UITN and PFDN, which will be highlighted in this article. It appears to be the consensus that urodynamics may not be needed in pure stress incontinence. Urodynamics can be valuable in unmasking stress urinary incontinence in prolapse, although its impact on the ultimate management of occult incontinence remains debated. This article reviews the indications for urodynamic testing in women with SUI but will exclude more complex conditions such as mixed or recurrent incontinence which are outside the scope of this review.

How Do Urodynamics Findings Influence the Treatment of the Typical Patient With Overactive Bladder?

Overactive bladder (OAB) is a clinical symptom complex whose hallmark is the symptom of urinary urgency, usually accompanied by frequency and nocturia, with or without urgency incontinence. Historically, urodynamics (UDS) evaluation has not been recommended in the initial evaluation of OAB, since it is defined primarily by clinical symptoms. As the pathophysiology of the OAB complex has become more clearly elucidated from recent studies, the role of UDS has again become a topic of discussion as a tool that can provide objective data to reflect these new findings. The utility of UDS in the diagnosis and treatment of OAB is still evolving, but in certain clinical scenarios, especially when empiric treatment has failed, it can provide definitive information that can identify associated pathologies and/or alter the treatment course. Herein, we will discuss the current literature regarding use of UDS in OAB patients and offer our own opinions as to its use.

Male lower urinary tract symptoms: The role of urodynamics

Male lower urinary tract symptoms: The role of urodynamics