Video Urodynamics Research Articles

Risk Factors Predicting Upper Urinary Tract Damage in Patients With Myelodysplasia: Data Analysis of 637 Cases From A Single Center.

PurposeTo determine the risk factors predicting upper urinary tract (UUT) damage using a grading system for upper urinary tract dilation (UUTD) and a descriptive system for all urinary tract dysfunction (AUTD) in patients with myelodysplasia.MethodsSix hundred thirty-seven patients with myelodysplasia were evaluated at our center from January 2008 to November 2019. Clinical data, ultrasonography, magnetic resonance urography, and video-urodynamics (VUDS) parameters were collected. Univariate and multivariate analyses were used to determine the risk factors predicting UUT damage.ResultsThree hundred eighty-three males and 254 females were included. The average course of lower urinary tract symptoms (LUTS) was 14.08±7.07 years (range, 3–31 years). The urodynamic diagnoses of all patients were as follows: detrusor overactivity, 26.8%; detrusor underactivity, 6.44%; and acontractile detrusor, 66.72%. UUT damage was determined in 66.56% of the patients. Of the patients, 28.73 % had vesicoureteral reflux (VUR) during filling (bilateral, n=50; unilateral, n=133) on fluoroscopy during VUDS testing. Two hundred thirty-four patients had UUTD (bilateral, n=203; unilateral, n=31). The occurrence of hydronephrosis based on ultrasonography was closely related to ipsilateral VUR (P<0.05). Absent of bladder sensation, long-term course of LUTS, decreased maximum cystometric capacity (MCC) and bladder compliance (BC), and increased postvoid residual urine (PVR) were shown to be independent risk factors in logistic regression analysis.ConclusionsThis retrospective study using UUTD and AUTD systems indicated that patients with myelodysplasia have a high incidence of UUT damage. Absence of bladder sensation, long-term course of LUTS, decreased MCC and BC, and increased PVR were independent risk factors predicting UUT damage.

Endoscopic Treatment of Vesicoureteral Reflux with Macroplastique in Spinal Cord Injury Patients

Context/Objective: Vesicoureteric reflux (VUR) is a well-known complication of neurogenic lower urinary tract dysfunction. VUR results to progressive renal deterioration and eventually renal failure. Our aim was to assess the efficacy of Macroplastique bulking agent in managing VUR in spinal cord injury population and correlate the pre- and postintervention VUDS (Video-urodynamics) findings with the outcome. Design: Retrospective cohort study. Participants: Spinal cord injury patients with VUR, treated with Macroplastique, had pre- and postintervention VUDS and followed up for at least 12 months. Interventions: Macroplastique injection and video-urodynamics. Outcome Measures: The primary endpoint was the overall treatment rate of VUR at 3 months. The secondary outcomes were the overall treatment rate of VUR at 12 months, the success rate at 3 and 12 months, the need for additional treatments, and the comparison of VUDS parameters in treated versus failed cases. Results: Forty-eight patients and 62 refluxing ureteric units were studied. At 3-month follow-up, the overall treatment rate was 79.1%. The overall success rate (treated + improved) was 90.3%. There is a statistically significant difference in baseline cystometric capacity (P = 0.047), degree of reflux (P &lt; 0.01), and bladder compliance (P = 0.023) between the treated and failed cases. Conclusion: Macroplastique is effective in the management of VUR in spinal cord injury population. It is minimally invasive, quick, with low complication rates. Care should be taken to treat the parameters of the neurogenic bladder that contributes to secondary VUR development such as detrusor overactivity and poor bladder compliance.

Urinary tract imaging in infants with spina bifida: a selective approach to a baseline DMSA

There is no general agreement among paediatric urologists on how infants with spina bifida (SB) should be investigated after birth. Recently the EUA/ESPU guidelines have been published recommending a baseline DMSA scan in the first year of life and a Voiding Cystourethrogram (VCUG) or Videourodynamic (VUD) between the second and third month of life. The aim of this study was to evaluate the outcome of renal investigations in the first year of life in infants with SB to verify if an early DMSA scan is indicated in the management of this group of patients. All renal imaging, Renal and Bladder Ultrasound (RBUS), VCUGs, VUDs and DMSA were reviewed by two independent assessors to evaluate outcome. Seventy patients with spina bifida (40 girls) were enrolled between June 2015 and February 2020. An early VUD detected vesico-ureteral reflux (VUR) in 8/49 (16%) of patients. An early VUD also gave additional information on detrusor under or over activity, bladder trabeculation, end filling detrusor pressure (EFDP) and sphincteric incompetence. DMSA scan detected renal scarring in 4/68 (6%) patients. Three of these 4 patients had significant history of febrile UTIs while the fourth patient had grade 2 left sided VUR. The initial assessment of a newborn with myelodysplasia includes a Renal and Bladder Ultrasound during birth hospitalization. This study confirms the recently published EUA/ESPU guidelines on the management of neurogenic bladder in children and adolescents, which recommend a VUD or VCUG & Cystomanometry with Electromyogram (CMG) (if VUD not available) in the first 6-12 weeks of life. A selective approach to DMSA scan only in infants with SB who either had a febrile UTI or vesico-ureteric reflux would not have missed any scarring or dysplasia and would have saved 58 unnecessary nuclear scans.

Urodynamic Studies for the Diagnosis of Lower Urinary Tract Symptoms: Experience in BSMMU

Objectives: The aim of urodynamic testing is to obtain objective information regarding urinary bladder storage and voiding function. This investigation provides information of the underlying causes depending on the individual situation and findings. Materials and Methods: This Retrospective study of the UDS was conducted at Urology department of Bangabandhu Sheikh Mujib Medical University, Dhaka from January 2012 to April 2017. A total of 403 cases of urodynamic studies done. Patient age range was 10-85 years. Female Patient was only 41 and post operative cases was only six. Bladder dairy, Ultrasonography of Kidney, ureter, bladder with maximum cystometric capacity (MCC)and post void residue (PVR), Urine culture were done for most of the patient. Patient with indwelling catheter was remove and clean intermittent catheterization was demonstrated. There was no patient with pace maker or valve replacement. We didn’t use routine prophylactic antibiotics, Patients was advice to contact to UDS room physically or over telephone if they feel fever, retention, and other complications. Urodynamic tests include uroflowmetry, postvoid residual measurement, cystometric test, leak point pressure measurement, pressure flow study, and few cases with electromyography. Results: Among them most cases are equivocal and obstructive cases are ranked second about 68 cases (16.87 These were Benign Prostatic Hyperplasia (BPH), stricture urethra, atonic bladder, and dysfunctional voiding. Only five patients had urinary tract infections (1.2%) with rise of temperature but only two had cultural positive and treated with sensitive antibiotics. Organism were streptococcus aureus and pseudomonus. One female and one male patient develop retention and relived by continuous catheterisation and after 7 days removed catheter. Conclusions: Urodynamics could help most diagnosis of LUTSs in most of the cases. We are not yet in using video urodynamics instead urethrocystoscopy may help in assessing the urethra and bladder neck. Bangladesh Journal of Urology, Vol. 21, No. 1, January 2018 p.8-13

1087 - Patient factors affect radiation exposure during video urodynamics

1087 - Patient factors affect radiation exposure during video urodynamics

PD06-06 CLINICIAN FACTORS AFFECT EXPOSURE TO RADIATION DURING VIDEO URODYNAMICS

INTRODUCTION AND OBJECTIVE:Video urodynamics (VUDS) enables delineation of site and cause of bladder outlet obstruction and/or incontinence as well as additional findings such as vesico-ureteric re...

Radiation exposure during videourodynamic testing: Is dose reduction possible using a standardized protocol?

To evaluate the impact of a protocol for standardized image capture during video urodynamics (VUD) on radiation exposure. Secondly, to categorize radiation exposure by condition warranting VUD and to identify clinical variables that correlate with increased radiation exposure. One hundred fifty patients underwent VUD using our standardized protocol. All images were taken using low dose and pulsed settings. Four images are captured: one scout image, one filling image, one voiding image, and one post-void image. If the patient is unable to void with the catheter in place, the catheter is removed and a second image is taken during an attempt at unintubated flow. If vesicoureteral reflux (VUR) is identified, an alternate protocol is entered to document parameters. The mean radiation exposure measured in dose area product (DAP), fluoroscopy time, and number of images were noted and compared with previously published fluoroscopy data collected at our institution before protocol implementation. The mean fluoroscopy exposure after the implementation of our protocol was 273.5 mGy/cm2 taking 5.2 images in 4.5 seconds. Protocol implementation leads to a 51.2% reduction in radiation exposure calculated by mean DAP (P < .0001) and a 96.5% reduction in fluoroscopy time (P < .0001). The presence of VUR, fluoroscopy time, and body mass index (BMI) > 25 were associated with higher radiation exposure (P < .0001). Implementation and adherence to a standardized protocol for fluoroscopy led to a reduction in radiation exposure fluoroscopy time. The presence of VUR, fluoroscopy time, and BMI > 25 were associated with higher radiation exposure.

Ambulatory urodynamics in clinical practice: A single centre experience.

To assess the additional value of ambulatory urodynamics (AUDS) monitoring in the management of patients with unexplained lower urinary tract symptoms. A retrospective review of the urodynamic data at a tertiary referral center between January 2006 and December 2018. During this period 12,123 urodynamic studies were conducted; 430 patients were arranged to have AUDS monitoring because their symptoms were not reproduced with either standard or video urodynamics (UDS). A total of 391 patients were included, (360 females, 31 males). Symptoms were reproduced in 74% of cases. The most common AUDS finding was detrusor overactivity with or without incontinence, followed by urodynamic stress incontinence. In 75.7% of the patients, the additional information from AUDS resulted in a change to patient management. Additional UDS findings were made in the majority of patients who underwent AUDS. This helped in setting a new treatment plan for the bothersome urinary findings. AUDS monitoring is a useful additional diagnostic tool and can help to guide patient management where symptoms are not explained by standard or video UDS.

The incidence and outcomes of urodynamic stress urinary incontinence in female patients with urethral diverticulum

To assess the incidence and management of urodynamic stress urinary incontinence (USUI) in women undergoing transvaginal excision of a urethral diverticulum (UD) at our institution. A prospective database, capturing patients undergoing urethral diverticulectomy over a 9-year period (May 2007 to August 2016), was reviewed focusing on USUI and subsequent management. One hundred patients underwent UD excision (with modified Martius labial fat-pad flap interposition). Preoperative magnetic resonance imaging data, available in 90 patients, demonstrated that 80% had complex diverticula. Complete urodynamic data were available for 93 patients. Preoperatively, 27 patients (29%) had USUI of which 16 patients resolved with either UD excision alone (n = 8) or 3 months of pelvic floor muscle therapy (PFMT) (n = 8). All 11 with persistent postoperative USUI had video urodynamics (VUDs) confirming Blaivas type 3 USUI. Six patients had a rectus fascial pubovaginal sling (RFPVS) with success in five (83.3%) while five had a mid-urethral obturator tape (MUT-O) with 100% success. Sixteen patients developed de novo stress urinary incontinence (SUI) postoperatively, with resolution after PFMT in 12 (75%). VUDS identified USUI (Blaivas type 3) in two (of the remaining four) patients, managed successfully with MUT-O (n = 1) and RFPVS (n = 1). Preoperative USUI is present in 29% with UD. Postoperatively, 35.5% (n = 33) have pre-existing (19) or de novo (14) SUI, of which 60.6% (n = 20) resolves after 12 months of conservative management. Surgery for USUI is required in 13 (13.9%), with cure in 92.3%. This supports our practice to excise UD primarily and delay USUI surgery, therefore, avoiding overtreatment for the majority.

Can we replace the catheter when evaluating urinary residuals?

To test the different formulae to calculate the bladder volume using ultrasound; the accuracy of patients hearing/feeling "bubbles" at the end of urodynamics testing as a measure of being empty; and how good we are at estimating PVR using X-ray at the end of video urodynamics testing. This was a prospective cohort study. Using Sonosite 180 plus, bladder volumes were calculated as, height × width × depth × proportionality constant (0.52, 0.625, 0.65, and 0.7) Patients were asked whether the patient heard or felt "bubbles" at the end of the investigation. Each patient was fluoroscopically screened and the clinician estimated the volume and compared with single-use catheter volume. A total of 85 patients were assessed. All four formulae were significantly correlated. The PC, 0.52, correlated best (r = 0.938, P < 0.001) with no significant difference with the actual volumes ( P = 0.275). The "bubbles test" had a positive predictive value of 93%. A video postvoid residual (PVR) estimation significantly correlated with catheterised bladder volume ( r = 0.842, P < 0.001). There was no significant difference between the estimated and actual bladder volumes ( P = 0.579). This study showed that although all four formulae correlated significantly, the PC of 0.52 was the only formula without a significant difference from the actual volume. More work is needed to produce patient individualised PC. Our clinicians were able to accurately estimate the PVR on X-ray. This study has identified the best formula to accurately estimate bladder volume and that video estimation along with the "bubbles" test can avoid unnecessary intervention.

Gel-Infused Translabial Ultrasound in the Evaluation of Female Urethral Stricture.

The aims of this study were to describe our technique of gel-infused translabial ultrasound (GITLUS) to assess the female urethra for stricture and to highlight its utility when compared with other diagnostic techniques. Consecutive patients presenting with prior diagnosis and/or suspicion for female urethral stricture underwent evaluation with uroflowmetry, postvoid residual, video urodynamics, and cystoscopy at the surgeon's discretion. All patients underwent GITLUS; 8-MHz curvilinear and 6-MHz linear high-frequency transducers were used to image the urethra from meatus to bladder neck while instilling 20 mL of lidocaine jelly to distend the urethra. Stricture location, length, caliber, and presence of periurethral fibrosis were assessed. Two healthy volunteers underwent GITLUS to serve as a comparison. Eight patients with suspected stricture underwent GITLUS. In all cases, GITLUS identified and characterized stricture and demonstrated periurethral fibrosis. Two healthy volunteers underwent GITLUS, which demonstrated a patent urethra and no evidence of fibrosis. Cystoscopy and video urodynamics on patients with stricture did not perform as well at identifying and fully assessing strictures. Six patients underwent definitive surgical repair, and GITLUS findings were confirmed. One patient had a postoperative GITLUS demonstrating resolution of the stricture and periurethral fibrosis. Gel-infused translabial ultrasound is a novel and accurate technique that in this small series appeared to identify and further characterize female urethral stricture in cases where it was utilized. Further research is needed to determine its role in preoperative planning and in providing a definitive diagnosis of stricture when other studies are equivocal.

SENS-U: validation of a wearable ultrasonic bladder monitor in children during urodynamic studies

Urinary incontinence is a common problem in school-age children. Because many children remain unaware of a full-bladder sensation, the SENS-U™ Bladder Sensor was developed. The SENS-U is a small, wearable ultrasound sensor, which is positioned on the lower abdomen using a skin-friendly adhesive. The sensor continuously estimates the bladder filling status and informs the user when it is time to go to the toilet. In this study, the clinical performance of the SENS-U is evaluated in children during (video) urodynamics. In this study, 30 children (6-12 years) were included who were scheduled for a (video) urodynamic study. During urodynamics, the SENS-U determined the average anterior-posterior (A-P) bladder dimension (every 30s) to estimate the filling status. The correlation between the average A-P bladder dimension and the infused volume is analyzed by Spearman's correlation. Thirty patients (boys/girls: 15/15; mean age: 7.9±1.4 years) were included, in whom the SENS-U detected the full bladder before voiding in 90% of the patients (27/30). In the other patients, the bladder was outside the detection area due to either erroneous sensor placement (n=1) or an (relative) obese abdomen in the upright position (n=2). There was a strong correlation (median rs =0.94) between the average A-P bladder dimension and the infused volume. The detectable maximum bladder volume ranged between 71 and 463ml. The SENS-U is able to detect a full bladder with a success rate of 90%. When excluding erroneous data due to sensor misplacement or an (relative) obese abdomen, the detection rate may even be higher. Future research will focus on investigating the effect of theSENS-U in incontinence training.

Predicting and Modifying Risk for Development of Renal Failure in Boys with Posterior Urethral Valves.

The purpose of this review is to bring the reader up to date on the current risk factors for the development of renal deterioration in the boys with posterior urethral valves (PUV) and approaches to modify this risk. Renal bladder ultrasound (RBUS) is routinely performed in boys with PUV and recent advancements allow imaging processing that can more accurately quantify renal parenchyma and correlate this with risk for renal loss. Refinement of urine studies may improve our ability to stratify patients into renal loss categories. Use of videourodynamics (VUDS) allows refined assessment of the valve bladder to identify those who might benefit from secondary procedures and/or the addition of targeted pharmacotherapy to improve bladder emptying or dangerous storage pressures. All boys with a history of PUV are at a significant long-term risk of renal deterioration. The literature suggests that several technical advances have improved our ability to predict this risk, although there needs to be further refinement and validation before widespread use. Utilization of close follow-up, VUDS, pharmacotherapy, and bladder drainage provide the best methods to improve care to this group of patients and if more studies confirm their utility, adoption of these as part of standard of care protocols may be warranted.

Macroplastique and Botox are superior to Macroplastique alone in the management of neurogenic vesicoureteric reflux in spinal cord injury population with presumed healthy bladders

Context/ObjectiveVesico-ureteric reflux(VUR) is a known complication of neuropathic bladder in spinal cord injury(SCI) population. Bulking agents such as Macroplastique are new minimally-invasive treatment option for VUR with good results. The aim of this study is to assess the efficacy of Macroplastique alone or in combination with Botox(BTX-A), in managing VUR in SCI population with presumed healthy bladders and correlate the pre-and post-injection urodynamic findings with the outcome.DesignRetrospective comparative study.ParticipantsSCI patients with VUR and presumed health bladders (normo-compliant, low filling pressures), treated with macroplastique alone or in combination with BTX-A, who had pre and post-intervention Video-urodynamics (VUDS) and followed up for at least 12 months.InterventionsMacroplastique and BTX-A injections, VUDS.Outcome measuresThe primary end point was the overall treatment rate of VUR at 3 months and the secondary outcomes were the success rate (treated + improved) and the comparison of urodynamic parameters (pre-and post-injection).ResultsWe studied 34 intervention-naïve SCI patients. 19 had only Macroplastique (Group 1) and 15 had Macroplastique and BTX-A (Group 2). The overall treatment rate was 65.4% for group 1 and 88.9% for group 2 (P = 0.029). The overall success rate (treated + improved) was 80.8% and 94.4% respectively (P = 0.123). The comparison of follow up VUDS parameters showed a statistically significant rise in the detrusor pressure of group 1 (34.04cmH2O vs.19.2cmH2O, P = 0.008) and a drop in compliance (19.8mls/cmH2O vs.26.3mls/cmH2O, P = 0.018) as compared to baseline.ConclusionThe combination of BTX-A and Macroplastique is more effective that Macroplastique alone in the management of secondary VUR in SCI patients with presumed healthy bladders.

A Case Study in Video Urodynamics: A Unique Lesson Learned

A Case Study in Video Urodynamics: A Unique Lesson Learned

Impact of posterior urethral diameter/external urethral sphincter diameter as a new tool to predict detrusor pressure in the voiding phase.

We measured posterior urethra diameter (PUD) and external urethral sphincter diameter (EUSD), which can also be measured by voiding cystourethrography (VCUG) and investigated the relationship between PUD/EUSD and detrusor pressure (Pdet) during voiding by videourodynamics (VUDS). Sixty-three children, who were 3years old or less and underwent VUDS, were enrolled in the present study. We measured PUD and EUSD in addition to detrusor pressure at the time of the widest EUS during voiding (Pdet-voiding) by VUDS, and PUD/EUSD was investigated compared to Pdet-voiding. Seventy-eight VUDS were performed in 63 patients, and the median age at VUDS was 10.2months. These studies revealed a significant correlation between PUD/EUSD and Pdet-voiding (r=0.641, p<0.001). However, a significant correlation was not observed between PUD/EUSD and age (r=0.180). We defined Pdet-voiding of more than 80cmH2O as a high voiding pressure, and a PUD/EUSD of 2.4 was a good predictor for the cutoff value for high voiding pressure. Pdet-voiding was significantly higher in children with a PUD/EUSD of≥2.4 (p<0.001). In 19 children who had neurological diseases, a significant correlation was found between PUD/EUSD and Pdet-voiding (r=0.842, p<0.001), and a PUD/EUSD of 2.4 was a useful cutoff value for high voiding pressure. PUD/EUSD is a valuable tool to predict high voiding pressure in pediatric patients. A PUD/EUSD of≥2.4 in VCUG indicates the need to perform more invasive tests, such as VUDS, in pediatric patients aged 3 and under with neuropathic diseases.

Characterization of Bladder and Pelvic Floor Dysfunction in Women With Chronic Pelvic Pain

Objective: The purpose of this study was to elucidate the link between voiding dysfunction and lower urinary tract symptoms (LUTSs) associated with chronic pelvic pain (CPP). Study Design: Retrospective cohort study. Background: Although a gynecologic etiology is the most common cause of pelvic pain, there exists a population of patients for which these diagnoses have been ruled out, which extremely limits their diagnostic and therapeutic options. Methods and Measures: A total of 105 consecutive female patients who underwent video urodynamics for evaluation of CPP between January 2010 and December 2015 participated in the study. Following urodynamics, patients with LUTSs and associated CPP were divided into 3 urodynamic diagnostic categories post hoc and compared with standard questionnaires and urodynamic findings across each group. Results: Mean age of the cohort was 53 ± 16.60 years, and mean body mass index was 26.05 ± 5.45 kg/m2. Of the 105 patients, 50 patients were found to have detrusor overactivity, 41 patients had detrusor underactivity, and 14 patients were found to have dysfunctional voiding. The patients with detrusor overactivity had lower bladder capacity, as well as earlier desires to void, compared with the other groups. A total of 79% of patients with dysfunctional voiding and 7.4% of patients with detrusor underactivity had discordant electromyogram activity. Conclusions: In addition, preliminary data show that many of the patients may have underlying pelvic floor muscle dysfunction leading to their LUTS. Given the discordant therapy for LUTS versus CPP, this study presents the preliminary work to demonstrate muscular skeletal dysfunction associated with LUTS.

Clinical Outcome of Augmentation Enterocystoplasty for Patients with Ketamine-induced Cystitis

Background: Ketamine abuse has become a global phenomenon in recent years. Ketamineinduced cystitis (KC) is a new clinical syndrome which can result in severely inflamed bladder and intractable bladder pain. Currently there is no guideline for managing patients with KC. Objectives: To analyze the clinical outcome of patients with KC managed with augmentation enterocystoplasty (AE). Study Design: Retrospective interventional study. Setting: A tertiary teaching hospital, Hualien Tzu Chi Hospital. Methods: We retrospectively collected and analyzed the medical records and videourodynamic (VUD) test results of 26 patients who underwent AE as treatment for refractory KC during the period 2009 – 2014. All of these patients abused ketamine with nasal snorting, at least 3 grams per dose, twice per week for 6 months. Data from VUD studies performed before AE and 3 – 6 months after surgery that were analyzed in this study included cystometric bladder capacity (CBC), post-void residual (PVR) urine volume, maximum urinary flow rate (Qmax), voided volume, and bladder compliance. A self-report questionnaire was used to assess patient satisfaction with AE. Results: Patients included 14 women and 12 men aged 20 – 43 years (mean age, 28.5 years) with an average duration of ketamine abuse of 4.7 years (range, 1 – 10 years). All patients had contracted bladder, 9 had hydronephrosis, and 10 had vesicoureteral reflux (VUR). There was significant improvement in CBC (52.7 ± 29.7 v 327 ± 69.4 mL, P &lt; 0.0001), Qmax (6.94 ± 4.32 v 13.7 ± 4.96 mL/s, P &lt; 0.0001), PVR (8.08 ± 19.2 v 82.6 ± 91.5 mL, P &lt; 0.0001), voided volume (44.1 ± 28.3 v 250.7 ± 133.4 mL, P &lt; 0.0001), and bladder compliance (11.1 ± 11.9 v 54 ± 43, P &lt; 0.0001) after AE. Hydronephrosis resolved in 7 patients after AE and VUR resolved in all patients who underwent AE with ureteral reimplantation. All patients who stopped using ketamine were free of bladder pain postoperatively. However, 10 patients who reused ketamine had recurrent bladder pain and recurrent urinary tract infection. Limitations: Small number of patients limits scope of study. Conclusions: AE is effective at treating KC-induced bladder pain and restoring normal lower urinary tract function. However, absolute cessation of ketamine is the key to success in KC treatment. Key words: Ketamine-induced cystitis, augmentation enterocystoplasty, bladder pain, contracted bladder, inflammation, surgery

4: Video urodynamics for the evaluation of complex urinary symptoms

4: Video urodynamics for the evaluation of complex urinary symptoms

The Role of Video Urodynamics in the Management of the Valve Bladder.

The purpose of this review is to bring the reader up-to-date on the current use of video urodynamics (VUDS) in the evaluation and management of the valve bladder. Findings show that multiple studies on valve bladder have utilized VUDS in some aspect of their research. VUDS is increasingly used in instances when vesicoureteral reflux, changing or inconsistent urodynamic studies, and bladder neck obstruction are a component of valve bladder. VUDS has also been used in pre-operative evaluation of patients with end-stage renal disease receiving a kidney transplant. Currently, there are no prospective studies looking at the use of VUDS and outcomes directly related to its use in patient assessment. The literature demonstrates that VUDS plays an integral role in the management of patients with valve bladder; however, additional research is required to better define the proper circumstances for its use.