Urodynamic Studies in Adults

Publication Date: December 1, 2012

Stress Urinary Incontinence (SUI)/Prolapse

Clinicians who are making the diagnosis of urodynamic stress incontinence should assess urethral function. (Recommendation, C)
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Surgeons considering invasive therapy in patients with SUI should assess PVR urine volume. (Clinical Principle / Expert Opinion, )
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Clinicians may perform multichannel UDS in patients with both symptoms and physical findings of SUI who are considering invasive, potentially morbid, or irreversible treatments. (Option, C)
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Clinicians should perform repeat stress testing with the urethral catheter removed in patients suspected of having SUI who do not demonstrate this finding with the catheter in place during urodynamic testing. (Recommendation, C)
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In women with high-grade POP but without the symptom of SUI, clinicians should perform stress testing with reduction of the prolapse. Multichannel UDS with prolapse reduction may be used to assess for occult stress incontinence and detrusor dysfunction in these women with associated LUTS. (Option, C)
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Overactive Bladder (OAB), Urgency Urinary Incontinence, Mixed Incontinence

Clinicians may perform multichannel filling cystometry when it is important to determine if altered compliance, detrusor overactivity (DO), or other urodynamic abnormalities are present (or not) in patients with urgency incontinence in whom invasive, potentially morbid, or irreversible treatments are considered. (Option, C)
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Clinicians may perform PFS in patients with urgency incontinence after bladder outlet procedures to evaluate for BOO. (Clinical Principle / Expert Opinion, )
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Clinicians should counsel patients with urgency incontinence and mixed incontinence that the absence of DO on a single urodynamic study does not exclude it as a causative agent for their symptoms. (Clinical Principle / Expert Opinion, )
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Neurogenic Bladder

Clinicians should perform PVR assessment, either as part of complete urodynamic study or separately, during the initial urological evaluation of patients with relevant neurological conditions (e.g., spinal cord injury, myelomeningocele) and as part of ongoing follow-up when appropriate. (Standard, B)
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Clinicians should perform a complex CMG during initial urological evaluation of patients with relevant neurological conditions with or without symptoms and as part of ongoing follow-up when appropriate. In patients with other neurologic diseases, physicians may consider CMG as an option in the urological evaluation of patients with LUTS. (Recommendation, C)
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Clinicians should perform pressure flow analysis in patients with relevant neurologic disease with or without symptoms or in patients with other neurologic disease and elevated PVR or urinary symptoms. (Recommendation, C)
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When available, clinicians may perform fluoroscopy at the time of urodynamics (VUDS) in patients with relevant neurologic disease at risk for NGB or in patients with other neurologic disease and elevated PVR or urinary symptoms. (Recommendation, C)
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Clinicians should perform EMG in combination with CMG with or without PFS in patients with relevant neurologic disease at risk for NGB or in patients with other neurologic disease and elevated PVR or urinary symptoms. (Recommendation, C)
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Lower Urinary Tract Symptoms

Clinicians may perform PVR in patients with LUTS as a safety measure to rule out significant urinary retention both initially and during follow-up. (Clinical Principle / Expert Opinion, )
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Uroflow may be used by clinicians in the initial and ongoing evaluation of male patients with LUTS that suggest an abnormality of voiding/ emptying. (Recommendation, C)
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Clinicians may perform multi-channel filling cystometry when it is important to determine if DO or other abnormalities of bladder filling/urine storage are present in patients with LUTS, particularly when invasive, potentially morbid, or irreversible treatments are considered. (Clinical Principle / Expert Opinion, )
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Clinicians should perform PFS in men when it is important to determine if urodynamic obstruction is present in men with LUTS, particularly when invasive, potentially morbid, or irreversible treatments are considered. (Standard, B)
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Clinicians may perform PFS in women when it is important to determine if obstruction is present. (Recommendation, C)
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Clinicians may perform VUDS in properly selected patients to localize the level of obstruction, particularly for diagnosing primary bladder neck obstruction (PBNO). (Clinical Principle / Expert Opinion, )
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Recommendation Grading

Disclaimer

Overview

Title

Urodynamic Studies in Adults

Authoring Organizations

Publication Month/Year

December 1, 2012

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

Assist clinicians in the appropriate selection of urodynamic tests, following an evaluation and symptom characterization.

Inclusion Criteria

Female, Male, Adult

Health Care Settings

Ambulatory, Outpatient

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Counseling, Diagnosis, Management

Diseases/Conditions (MeSH)

D014563 - Urodynamics, D059411 - Lower Urinary Tract Symptoms

Keywords

Urinary Incontinence, urodynamics, lower urinary tract symptoms, pelvic organ prolapse