Urodynamics in Female Urology

Urodynamics in female urology are often indicated when empiric or conservative treatment does not improve lower urinary tract symptoms. Based on the expected underlying lower urinary tract dysfunction, the urodynamic evaluation is designed by the clinician to reproduce a patient's symptoms and to identify underlying pathophysiological mechanisms, as well as to analyse other functions of the lower urinary tract which may be relevant for planning further (invasive) treatment. In this review, we describe the available urodynamic tests, the normal findings, and the evidence for the role of urodynamics, and on the specific measurements and parameters used to evaluate female lower urinary tract symptoms. In women with a suspected storage dysfunction, filling cystometry allows identification of detrusor overactivity or reduced bladder compliance as possible underlying causation of overactive bladder. Most women with stress incontinence have other storage and/or voiding symptoms and urodynamics should always be performed prior to invasive treatment. In the minority with pure stress urinary incontinence, urodynamic observations can guide the type of surgery chosen, but this has not yet been shown to change treatment outcome. Voiding dysfunction in women has recently received more research attention and various urodynamic parameters are being evaluated on their ability to distinguish detrusor underactivity from bladder outlet obstruction in pressure-flow studies. Video-urodynamics can provide a useful addition when anatomical information is needed in complex patients (eg, prior surgery or neurogenic patients). Finally, ambulatory urodynamics can be used when symptoms cannot be reproduced or explained by conventional urodynamics. Urodynamics provide important diagnostic confirmation of lower urinary tract dysfunction in women after empiric and/or conservative treatment for symptoms. Correct methodology and interpretation of the urodynamic evaluation allows identification of underlying pathophysiological mechanisms prior to advancing to invasive treatment.