Understanding and Redefining the Role of Urodynamics in Pelvic Floor Disorders
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RECONSTRUCTED BLADDER FUNCTION & DYSFUNCTION (M KAUFMAN, SECTION EDITOR)
Understanding and Redefining the Role of Urodynamics in Pelvic Floor Disorders Stephanie Gleicher 1 & Natasha Ginzburg 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review The goal of this study is to review current literature regarding the role of urodynamic studies (UDS) in evaluation of non-neurogenic patients with pelvic floor disorders of stress urinary incontinence (SUI), pelvic organ prolapse (POP), voiding dysfunction, and interstitial cystitis/bladder pain syndrome (IC/BPS). Recent Findings Rates of pre-operative UDS have decreased among women with SUI. Guidelines suggest UDS is not required for index SUI patients opting for surgical treatments. Non-index SUI patients are candidates for UDS testing if such objective information will better clarify symptomology or guide management decisions. Women undergoing POP repair should be evaluated for occult SUI via physical exam or UDS. Women with high grade POP may have associated LUTS which may impact outcomes. UDS can assist in developing adjunct treatments or guiding surgical repair. UDS should be considered in women with voiding dysfunction who fail empiric treatments. Summary UDS should be used judiciously, but may offer invaluable insights for symptom etiology and guide management for women with various pelvic floor disorders. Keywords Urodynamics . Stress urinary incontinence . Pelvic organ prolapse . Voiding dysfunction . Bladder outlet obstruction . Detrusor underactivity
Introduction Urodynamic evaluation (UDS) is commonly used to elicit objective and clinically meaningful information regarding bladder function, urethral integrity, and pelvic floor dynamics. The information obtained has the potential to guide patient counseling and management decisions. Prior to conducting UDS, it is critical that a clear and concise clinical question is established, and that the study is conducted in a standard and thoughtful manner. While the utility of UDS has been questioned in certain scenarios [1], evidence suggests that results can impact management decisions especially for nonThis article is part of the Topical Collection on Reconstructed Bladder Function & Dysfunction * Natasha Ginzburg [email protected] Stephanie Gleicher [email protected] 1
Department of Urology, SUNY Upstate Medical University, Syracuse, NY 13210, USA
index female patients without underlying neurologic disorders [2]. The aim of this review is to discuss the evolving role of UDS evaluation in an array of pelvic floor disorders, including SUI, pelvic organ prolapse POP, voiding dysfunction, and IC/ BPS.
General UDS Optimization Basic UDS encompasses a variety of clinical examinations to better understand bladder dynamics during storage and emptying, including cystometry and pressure flow studies. The International Continence Society (ICS) recommends that basic UDS equipment includes the ability to measure detrusor pressure in real time via measuring intravesical and
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