Prospective Evaluation of Urodynamic Utility in a Subspecialty Tertiary Practice

Published:January 14, 2019DOI:


      To prospectively evaluated the utility of urodynamic evaluations (UDS) ordered in a tertiary referral center as part of a quality improvement project.


      Patients with UDS ordered by 3 subspecialty physicians were included. Physicians were surveyed when ordering UDS and at the post-UDS clinic visit to assess indications for UDS, pre- and post-UDS diagnosis, treatment plan, confidence level, and perceived helpfulness of UDS. UDS trained nurses conducting studies were surveyed on patient reported reproducibility of their symptoms and perceived difficulty of UDS.


      From April 2017 to October 2017, 127 UDS were included of which 102 met study criteria. UDS were done for neurogenic (23%) and non-neurogenic lower urinary tract symptoms (76%). The majority were conducted for incontinence evaluation (79%), or after prior lower urinary tract surgery (33%). UDS nurses reported 90% of UDS fully or partially reproduced patient symptoms. Nurses found 18% of UDS difficult due to catheter malfunctions, physical limitations, and communication abilities. Post-UDS, providers found 97% of UDS interpretable. UDS resulted in a change in treatment plan in 78% of patients. On a Likert scale, mean pre-UDS confidence level was 2.9 ± 0.8 (range 0-5). This increased to 4.1 ± 0.6 post-UDS with 76% of evaluations having a change of at least 1 point.


      UDS in a tertiary referral center result in change in patient treatment plans over three-fourths of the time with high rates of interpretability.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Urology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Bromage SJ
        • Dorkin TJ
        • Chan L
        • Tse V
        Urodynamics in the octogenarian female: is it worthwhile?.
        Int Urogynecology J. 2010; 21: 1117-1121
        • Moore KC
        • Emery SJ
        • Lucas MG
        Quality and quantity: an audit of urodynamics practice in relation to newly published National Standards.
        Neurourol Urodyn. 2011; 30: 38-42
        • Gupta A
        • Defreitas G
        • Lemack GE
        The reproducibility of urodynamic findings in healthy female volunteers: results of repeated studies in the same setting and after short-term follow-up.
        Neurourol Urodyn. 2004; 23: 311-316
        • Brostrom S
        • Jennum P
        • Lose G
        Short-term reproducibility of cystometry and pressure-flow micturition studies in healthy women.
        Neurourol Urodyn. 2002; 21: 457-460
        • Renganathan A
        • Cartwright R
        • Cardozo L
        • Robinson D
        • Srikrishna S
        Quality control in urodynamics: analysis of an international multi-center study.
        Neurourol Urodyn. 2009; 28: 380-384
        • Whiteside JL
        • Hijaz A
        • Imrey PB
        • et al.
        Reliability and agreement of urodynamics interpretations in a female pelvic medicine center.
        Obstet Gynecol. 2006; 108: 315-323
        • Zimmern P
        • Nager CW
        • Albo M
        • FitzGerald MP
        • McDermott S
        Interrater reliability of filling cystometrogram interpretation in a multicenter study.
        J Urol. 2006; 175: 2174-2177
        • Nager CW
        • Brubaker L
        • Litman HJ
        • et al.
        A randomized trial of urodynamic testing before stress-incontinence surgery.
        N Engl J Med. 2012; 366: 1987-1997
        • Zimmern P
        • Litman H
        • Nager C
        • et al.
        Pre-operative urodynamics in women with stress urinary incontinence increases physician confidence, but does not improve outcomes.
        Neurourol Urodyn. 2014; 33: 302-306
        • Sirls LT
        • Richter HE
        • Litman HJ
        • et al.
        The effect of urodynamic testing on clinical diagnosis, treatment plan and outcomes in women undergoing stress urinary incontinence surgery.
        J Urol. 2013; 189: 204-209
        • Suskind AM
        • Cox L
        • Clemens JQ
        • et al.
        The value of urodynamics in an academic specialty referral practice.
        Urology. 2017; 105: 48-53
        • Reynolds WS
        • Dmochowski RR
        • Lai J
        • Saigal C
        • Penson DF
        Patterns and predictors of urodynamics use in the United States.
        J Urol. 2013; 189: 1791-1796
        • Chughtai B
        • Hauser N
        • Anger J
        • et al.
        Trends in surgical management and pre-operative urodynamics in female medicare beneficiaries with mixed incontinence.
        Neurourol Urodyn. 2017; 36: 422-425
        • Conover MM
        • Funk MJ
        • Kinlaw AC
        • Connolly A
        • Wu JM
        Trends and patterns of urodynamic studies in U.S. women, 2000–2012.
        Obstet Gynecol. 2015; 125: 559-565
        • Nager CW
        • Brubaker L
        • Daneshgari F
        • et al.
        Design of the Value of Urodynamic Evaluation (ValUE) trial: a non-inferiority randomized trial of preoperative urodynamic investigations.
        Contemp Clin Trials. 2009; 30: 531-539
        • Rosier PFWM
        • Schaefer W
        • Lose G
        • et al.
        International Continence society good urodynamic practices and terms 2016: urodynamics, uroflowmetry, cystometry, and pressure-flow study.
        Neurourol Urodyn. 2016;
        • Abrams P
        • Cardozo L
        • Fall M
        • et al.
        The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society.
        Urology. 2003; 61: 37-49
        • Rosier PF
        The evidence for urodynamic investigation of patients with symptoms of urinary incontinence.
        F1000Prime Rep. 2013; 5
        • Yeung JY
        • Eschenbacher MA
        • Pauls RN
        Pain and embarrassment associated with urodynamic testing in women.
        Int Urogynecology J. 2014; 25: 645-650
        • Yiou R
        • Audureau E
        • Loche C-M
        • Dussaud M
        • Lingombet O
        • Binhas M
        Comprehensive evaluation of embarrassment and pain associated with invasive urodynamics.
        Neurourol Urodyn. 2015; 34: 156-160
        • Winters JC
        • Dmochowski RR
        • Goldman HB
        • et al.
        Urodynamic studies in adults: AUA/SUFU Guideline.
        J Urol. 2012; 188: 2464-2472
      1. Medicare program; payment policies under the physician fee schedule and other revisions to part B for CY 2011. 2010. Available at: Accessed June 5, 2018.

        • Nager CW
        • Albo ME
        • Fitzgerald MP
        • et al.
        A process for the development of multicenter urodynamic studies.
        Urology. 2007; 69: 63-68