Urodynamics

Urodynamics (UDS) is the dynamic study of the transport, storage, and evacuation of urine through the measurement of relevant physiological parameters. The primary clinical goal of urodynamic evaluation is to reproduce a patient's symptomatic complaints in a laboratory setting while collecting objective physiological data to provide a pathophysiological explanation for those symptoms.

Unlike most diagnostic tests, urodynamics is an interactive study — not a passive measurement. It is indicated when an accurate diagnosis is needed to direct treatment that cannot be reliably determined by history and physical examination alone: when empiric treatments have failed, when lower urinary tract disease risks causing upper tract deterioration (renal failure), or when considering invasive and irreversible surgical interventions.

Core principle. Symptoms and laboratory observations answer different questions. Low flow may reflect outlet obstruction, reduced detrusor contraction, or an unrepresentative void; pressure-flow testing helps distinguish them. A normal filling study does not exclude clinical OAB and does not establish a neurological cause. Interpret a representative, technically sound study alongside symptoms, examination and anatomy.^[4][6]

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Normal Reference Values (Quick Lookup)

Urodynamic "normal values" are reference ranges, not diagnosis buttons. Age, sex, voided volume, catheter size, position, anxiety, medications, neurologic disease, and the reason for testing all change the numbers. In one healthy-volunteer study, more than 70% of asymptomatic subjects had at least one urodynamic finding that could be labeled "pathologic," so the tracing must still be interpreted against symptoms and anatomy.^[16]

Uroflowmetry and PVR

Parameter	Useful reference	Interpretation
Voided volume	A representative, comfortably full void; ≥150 mL is commonly advised in men	A validated minimum for women is not established. Ask whether the void resembles the patient's usual void.[25]
Qmax	Healthy-women meta-analysis: pooled mean 28 mL/s (95% CI 27–30)	Marked study heterogeneity limits a universal normal range. Age, volume and testing conditions matter; even flow above 15 mL/s does not rule out obstruction.[17][18][26]
PVR	Healthy-women pooled mean 12 mL (95% CI 4–20)	A population mean is not a treatment threshold. There is no consensus cutoff for significant PVR in women; consider repeat measurements, voided volume, symptoms and consequences. Voiding efficiency = VV / (VV + PVR) × 100%.[17][25]

Filling Cystometry: Measured Healthy-Volunteer Examples

These are cohort means ± SD, not diagnostic limits. Leitner et al. studied 42 asymptomatic volunteers (20 men, 22 women); the values below are from their first seated investigation using a 7 Fr air-charged catheter and 30 mL/min filling. The small, relatively young cohort cannot define normal values for every age or testing protocol.^[16]

Measurement	Men	Women
First sensation of filling	130 ± 85 mL	75 ± 75 mL
First desire to void	215 ± 105 mL	235 ± 110 mL
Strong desire to void	435 ± 140 mL	465 ± 155 mL
Maximum cystometric capacity	500 ± 165 mL	560 ± 185 mL
Pdet at Qmax	51 ± 16 cm H₂O	29 ± 11 cm H₂O

Storage assessment	Practical interpretation
Compliance	Δvolume / ΔPdet, excluding contractions and artifacts. There is no single universally applicable normal cutoff; assess sustained detrusor pressure, capacity and the clinical risk profile.[19]
Detrusor overactivity	An involuntary detrusor contraction during filling may be phasic or terminal, with or without urgency or leakage. DO is a urodynamic observation; OAB is a clinical syndrome.[4][6]
Upper-tract risk	High storage pressures, impaired compliance, reflux and the underlying neurological disorder matter together. The historical 40 cm H₂O leak-pressure observation is not a universal safe/unsafe boundary for every patient or every pressure spike.[3][7]

Pressure-Flow Indices

Index	Interpretation	Limits
Male BOOI	Pdet@Qmax − 2(Qmax); >40 obstructed, 20–40 equivocal, <20 unobstructed	These male thresholds should not be applied to women. Female-specific methods exist, but there is no universally accepted female diagnostic threshold.[21][23][25]
BCI / ICS detrusor contraction index	Pdet@Qmax + 5(Qmax); traditional categories: >150 strong, 100–150 normal, <100 weak	The 2023 ICS standard calls this the detrusor contraction index. A low value alone does not establish detrusor underactivity; consider contraction duration, outlet resistance, emptying and whether the void was representative.[20][23]

Quality-Control Pressures

Position	Pves / Pabd baseline	Pdet baseline	Meaning
Supine	5–20 cm H₂O	−5 to +5 cm H₂O	Cough should produce similar synchronous rises in Pves and Pabd, leaving Pdet approximately unchanged.[2]
Sitting	15–40 cm H₂O	−5 to +5 cm H₂O	Pves and Pabd should rise together with abdominal events; Pdet should not drift.
Standing	30–50 cm H₂O	−5 to +5 cm H₂O	A non-zeroed, drifting, or dampened channel can fabricate pathology.

Read the tracing before classifying it: check pressure transmission, identify artifacts, confirm symptom reproduction, then assess storage, outlet resistance and emptying together.

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Components of Urodynamic Testing

The ICS standard urodynamic protocol comprises clinical history with symptom scores, physical examination, 3-day voiding diary, uroflowmetry with post-void residual (PVR), and cystometry with pressure-flow study.^[2]

1. Uroflowmetry (Non-invasive)

A non-invasive measurement of urine flow rate over time during spontaneous voiding.

• Normal pattern: Smooth, bell-shaped arc with rapid rise to peak and symmetric descent
• Plateau or prolonged low flow: May suggest outlet resistance, but is not diagnostic
• Intermittent flow: May reflect abdominal straining, intermittent outlet relaxation, reduced contraction or test inhibition

Illustrative free-flow curvesOriginal schematic · v2026-09-11 · Clinical review pending

A smooth bell-shaped example reaches about 25 mL/s; a lower plateau reaches about 8 mL/s and lasts longer. Both are invented shapes. Low flow is nonspecific and cannot distinguish obstruction from weak detrusor contraction alone. The 15 mL/s line is a reference, not a diagnostic cutoff; voided volume and context matter. (Original WARWIKI schematic; see the figure source record and review limits.)

Limitation: Cannot distinguish between bladder outlet obstruction and detrusor underactivity — both produce low flow. Invasive pressure studies are required for differentiation.

Combined with PVR (by ultrasound or catheterization), uroflowmetry screens for voiding dysfunction and guides the need for further testing.

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2. Cystometry

Graphic depiction of bladder and abdominal pressure relative to infused volume during filling, storage, and voiding. The multichannel cystometrogram uses:

• Pves — intravesical pressure (from bladder catheter)
• Pabd — intra-abdominal pressure (from rectal or vaginal catheter)
• Pdet — detrusor pressure (calculated: Pves − Pabd)

Zeroing and reference: For external, fluid-filled systems, zero to atmospheric pressure with the transducers at the pubic symphysis. Follow the system-specific setup for other catheter technologies.^[2][4]

Normal baseline pressures by position:

Position	Pves / Pabd (cm H₂O)	Pdet (cm H₂O)
Supine	5–20	−5 to +5
Sitting	15–40	−5 to +5
Standing	30–50	−5 to +5

Filling phase assessments:

• Sensation: First Sensation of Filling (FSF), First Desire to Void (FDV), Strong Desire to Void (SDV)
• Compliance: ΔVolume ÷ ΔPdet (normal: large volume change with minimal pressure rise)
• Detrusor overactivity: Involuntary phasic or terminal contractions during filling
• Cystometric capacity: Bladder volume at the end of filling; record why filling stopped. Reconcile infused volume, leakage, diuresis, voided volume and PVR rather than assigning a diagnosis from capacity alone.

Illustrative filling cystometrogramOriginal schematic · v2026-09-11 · Clinical review pending

Pdet is Pves minus Pabd. The example cough raises vesical and abdominal pressures together; a later phasic detrusor rise is not matched by abdominal pressure. FSF, FDV and SDV mark reported filling sensations. All curves and milestone volumes are invented teaching examples, not patient observations or normal-reference thresholds. Measurement artifacts must be excluded clinically. (Original WARWIKI schematic; see the figure source record and review limits.)

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3. Pressure-Flow Study (Voiding Phase)

Simultaneous measurement of detrusor pressure and flow rate during voiding.

Key parameters:

• Qmax — Maximum flow rate; interpret with voided volume and detrusor pressure
• Pdet at Qmax — Detrusor pressure at the moment of maximum flow
• Opening detrusor pressure — Pdet when flow begins; check pressure–flow synchronization
• Delay before flow — Record the time from permission to void to flow onset and whether the patient experienced inhibition

Nomograms for obstruction grading in men:

• Abrams-Griffiths nomogram: Classifies as obstructed, equivocal, or unobstructed based on Pdet@Qmax vs. Qmax
• ICS bladder outlet obstruction index (BOOI): BOOI = Pdet@Qmax − 2(Qmax); >40 = obstructed; 20–40 = equivocal; <20 = unobstructed in men. The Schäfer nomogram is a separate obstruction-grading system.^[21]
• Bladder contractility index (BCI): BCI = Pdet@Qmax + 5(Qmax); assesses detrusor contractile strength

Male pressure-flow classificationOriginal schematic · v2026-09-11 · Clinical review pending

The male ICS / Abrams-Griffiths pressure-flow nomogram plots detrusor pressure at maximum flow (Pdet@Qmax) against maximum flow rate (Qmax). BOOI = Pdet@Qmax − 2 × Qmax: above 40 is obstructed, 20–40 inclusive is equivocal, and below 20 is unobstructed. These thresholds are not a female BOO classification, and low pressure with low flow does not by itself establish detrusor underactivity. Dots are hypothetical examples, not study observations. (Original WARWIKI schematic; source: ICS adult male terminology, section 5.12.)^[21]

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4. Videourodynamics (VUDS)

Combines multichannel pressure-flow studies with simultaneous fluoroscopic imaging of the bladder and urethra.

Additional information provided:

• Anatomical localization of bladder outlet obstruction (bladder neck vs. sphincter level vs. urethra)
• Visualization of vesicoureteral reflux (VUR) during filling
• Morphology of the bladder (trabeculation, diverticula)
• Urethral anatomy during voiding

Indications for VUDS over standard UDS:

• Selected neurogenic lower urinary tract dysfunction when simultaneous anatomy, reflux or outlet localization adds information to pressure testing
• Complex posterior urethral pathology
• Evaluation after failed surgery
• Suspected vesicoureteral reflux

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5. Urethral Function Tests

Urethral pressure profile (UPP) and Valsalva/cough leak point pressure (VLPP/CLPP):

• Assess outlet resistance and sphincteric competence
• Demonstrate considerable test-retest variation and overlap between normal and pathological measurements
• VLPP correlates weakly with incontinence severity and does not reliably predict surgical outcomes
• No reliable cutoff predicts continence surgery failure^[1]

Clinical utility: Limited as standalone tests; most useful in context of full multichannel study.

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6. Electromyography (EMG)

Measures neuromuscular activity of pelvic floor musculature and urethral sphincter during filling and voiding.

Role: Support assessment of outlet coordination, including suspected detrusor-sphincter dyssynergia (DSD) in an appropriate neurological setting. Surface patches are commonly used but record a broader pelvic-floor signal and are susceptible to movement, straining and contact artifacts. Increased patch activity alone does not prove DSD; correlate it with pressures, flow and, when needed, fluoroscopy.^[4][16]

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The "9 Cs" Framework for UDS Interpretation

A systematic approach to reviewing a urodynamic study:

C	Parameter	What You're Assessing
Contractions	Detrusor overactivity	Involuntary phasic or terminal detrusor contractions during filling
Compliance	Bladder wall viscoelasticity	ΔV/ΔPdet; interpret sustained detrusor pressure with capacity and neurological/upper-tract risk
Continence	Sphincteric competence	Leak with cough/Valsalva in absence of detrusor contraction = SUI
Capacity	Cystometric capacity	Volume at end of filling and reason for stopping; pain, urgency, leakage and compliance may contribute
Sensation	Sensory thresholds	FSF, FDV, SDV and their relationship to usual symptoms; sensation reports are not a standalone neurological diagnosis
Contractility	Detrusor strength	Contraction pressure, duration, flow and emptying; indices alone do not diagnose underactivity
Coordination	DSD assessment	Interpret EMG with flow, pressure, neurological context and artifacts
Complete Emptying	Post-void residual	Elevated PVR after voiding = incomplete emptying
Clinical Obstruction	BOO grading	BOOI, Abrams-Griffiths, Schäfer nomogram

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Classic Urodynamic Signatures

Bladder Outlet Obstruction (BOO)

Hallmark: High Pdet in the presence of low Qmax.

• BOOI >40 = obstructed; 20–40 = equivocal (men)
• May also see high bladder capacity, detrusor overactivity (secondary to obstruction), reduced compliance
• Etiology may be clarified by examination, endoscopy and/or VUDS: benign prostatic enlargement (most common in older men), urethral stricture, bladder neck contracture, dysfunctional voiding
• BOO in females: less common; urethral stenosis, prior anti-incontinence surgery, or pelvic organ prolapse

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Detrusor Overactivity (DO)

Involuntary phasic or terminal detrusor contractions during filling, with or without associated urgency or incontinence.

• Idiopathic DO: No identified neurological cause
• Neurogenic DO (NDO): Associated with known neurological condition (suprasacral spinal cord injury, multiple sclerosis, Parkinson's, stroke)

NDO in spinal cord injury is clinically critical: high-amplitude contractions + DSD + reduced compliance = significant upper tract risk.

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Low Bladder Compliance

A sustained rise in Pdet relative to added volume, after excluding detrusor contractions, rectal artifacts and technical problems. Reduced compliance may have several causes; the tracing alone does not establish histological fibrosis.

Where the 40 cm H₂O reference comes from. McGuire et al. followed 42 patients with myelodysplasia. Of 22 whose intravesical pressure at leakage exceeded 40 cm H₂O, 15 had reflux and 18 had ureteral dilatation; among 20 at or below 40, none had reflux and two had dilatation. This influential association supports attention to pressure-related risk, but it does not validate a universal cutoff for all adults, every transient pressure rise, or isolated Pves without abdominal-pressure context.^[3]

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Detrusor Underactivity (DUA)

A detrusor contraction of reduced strength or duration, resulting in prolonged voiding, incomplete emptying, or inability to void.

• A low contraction index supports assessment but is not sufficient for diagnosis
• Low-pressure/low-flow voiding may reflect reduced contraction or situational inhibition. BOO and reduced contraction can coexist; do not treat them as mutually exclusive
• Clinically important before offering surgical outlet reduction procedures in men

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Detrusor-External Sphincter Dyssynergia (DSD)

Involuntary contraction of the external urethral sphincter coinciding with a detrusor contraction during voiding. Characteristic of suprasacral spinal cord lesions.

Consequences:

• Functional outlet obstruction → high voiding pressures
• Upper tract risk (hydronephrosis, VUR, renal failure)
• Autonomic dysreflexia in cervical/high thoracic injuries

Assess with pressure-flow findings, sphincter activity and, where useful, fluoroscopic outlet behavior. Exclude surface-EMG artifacts and distinguish neurogenic DSD from non-neurogenic dysfunctional voiding.

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Stress Urinary Incontinence (SUI)

Involuntary leakage of urine during filling cystometry associated with increased abdominal pressure (cough, Valsalva, heel drop) in the absence of a detrusor contraction.

On the tracing: Pves and Pabd rise simultaneously → Pdet is unchanged → leakage occurs via the urethra.

Document the provocation and whether a detrusor contraction accompanies leakage. UDS can help when the mechanism is uncertain, but is not routinely required when uncomplicated SUI is clearly demonstrated clinically.

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Fowler's Syndrome

A syndrome of otherwise unexplained, often painless urinary retention in women, associated with abnormal urethral sphincter needle-EMG findings. Fowler's original studies described complex repetitive discharges and decelerating bursts. Specialist evaluation must exclude anatomical, medication-related and neurological causes. EMG findings require clinical correlation, and sacral neuromodulation is an option for selected refractory functional retention rather than a guaranteed response.^[30][31]

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Technical Standards and Quality Control

Per ICS Good Urodynamic Practices 2016–2018:^[2][4]

• Liquid-filled catheters connected to pressure transducers positioned at the level of the pubic symphysis with atmospheric pressure as zero reference
• Quality of recording must be monitored throughout the study — not just reviewed at the end
• Provocations (cough tests, positional changes, running water) should reproduce the patient's specific symptoms
• Artifacts must be identified and not allowed to confound interpretation: rectal contractions (false Pdet drops), catheter movement artifacts ("knock" artifacts), signal dampening
• Equipment must be calibrated per manufacturer specifications

Reporting: Identify flow onset, Qmax and its simultaneous Pdet on synchronized traces. The 2023 ICS pressure-flow standards refine analysis and reporting of outlet resistance, contraction and voiding efficiency; arbitrary A–D letters are not a universal tracing convention.^[22][23]

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Clinical Indications and Guidelines

When UDS Should NOT Be Routinely Performed

Uncomplicated stress urinary incontinence (SUI) in women:

The VALUE trial (630 women) found office evaluation non-inferior to office evaluation plus UDS for one-year surgical outcomes in uncomplicated, demonstrable SUI. AUA/SUFU allows omission in the index patient, which can include stress-predominant mixed incontinence when SUI is clearly demonstrated; mixed symptoms alone do not invariably mandate testing.^[5][24]

OAB — initial evaluation: AUA/SUFU advises against routine UDS initially. Testing can be useful when diagnostic uncertainty or inadequate response raises a question that will change management; a normal tracing does not rule out OAB.^[6]

Low-risk NLUTD — initial evaluation: Routine UDS is not advised after appropriate risk classification. In contrast, SCI, MS, transverse myelitis and spinal dysraphism belong in the initial unknown-risk pathway, requiring further assessment; absence of voiding symptoms does not automatically make MS low risk.^[7]

When UDS Can Add Value

Scenario	Decision to resolve
Unclear incontinence type, significant emptying symptoms, recurrent SUI, or complex prolapse	Whether findings would change treatment selection or counseling; consider the individual phenotype and planned intervention.[8][24][25]
Selected men considering outlet surgery	Is obstruction present, is contraction reduced, and was non-invasive assessment sufficient? Routine testing of every man is not supported.[27]
Unknown-risk NLUTD	Establish storage/voiding risk alongside renal function and upper-tract assessment.[7]
Established moderate/high-risk NLUTD	Repeat testing for relevant clinical change or to assess treatment and risk; the interval depends on the risk profile, not a universal annual UDS rule.[7]
Refractory symptoms or major reconstructive decisions	Resolve diagnostic uncertainty, quantify unsafe storage or evaluate emptying when the result can change an invasive treatment plan.[6][25]

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Evidence on UDS and Outcomes

High-Impact Randomized Evidence

Study	Population and finding	Clinical meaning
VALUE (2012)	630 women with uncomplicated demonstrable SUI. Success: 76.9% with UDS vs 77.2% with office evaluation alone; the trial met its non-inferiority criterion.[5]	Routine preoperative UDS can be omitted in this selected setting.
FUTURE (2025)	1,099 women with refractory OAB or urgency-predominant mixed incontinence being considered for invasive treatment. At 15 months, patient-reported success was 117/496 (23.6%) after UDS plus comprehensive clinical assessment vs 114/503 (22.7%) after clinical assessment alone; adjusted OR 1.12 (95% CI 0.73–1.74).[28]	The superiority trial did not demonstrate added benefit from routine UDS. This is not proof of equivalence or a reason to omit testing for a separate neurogenic, obstructive or diagnostic question.
UPSTREAM five-year follow-up (2025)	From 820 randomized men with bothersome LUTS considering further treatment, IPSS difference was 0.41 points (95% CI −1.10 to 1.93), with no detected difference in surgery (OR 0.96, 95% CI 0.71–1.28). Questionnaires were returned by only about half of each arm; routine data were available for 801/820.[27][29]	The results do not support adding UDS routinely for every man. Five-year non-inferiority was not established because of uncertainty around the symptom estimate; selective testing remains appropriate.

The earlier 2020 meta-analysis of seven female-incontinence RCTs (1,149 participants) and the 2013 Cochrane review also found no clear improvement in continence outcomes from routine UDS. These reviews include overlapping older trial evidence and should not be counted as independent new studies. Changes in management or physician confidence do not by themselves establish patient benefit.^[9][10]

Impact on Physician Confidence

Despite limited outcome improvement in uncomplicated cases, UDS influences clinical thinking. In a prospective tertiary referral study (n=102), UDS resulted in a management change in 78% of patients, with mean physician confidence increasing from 2.9 to 4.1 (on a 0–5 scale).^[11]

Predictive Value

Preoperative DO or voiding abnormalities can inform counseling, but their predictive performance is inconsistent. An association with postoperative symptoms does not demonstrate that routinely testing and changing treatment improves outcomes.^[8][25]

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Complications and Tolerability

Catheterization can cause discomfort, dysuria, bacteriuria, symptomatic infection or retention. Incidence depends on the population and outcome definition. In the older 119-patient study, the 4.8% retention figure applied to the 63 men, not all participants; all affected men had significant BOO. The 154-patient questionnaire study found average pain 2.27/10 and embarrassment 2.59/10, with most willing to repeat testing.^[12][13]

Infection prevention: Screen for suspected symptomatic UTI and defer elective testing when present. The 2012 Cochrane review (nine trials, 973 participants) found reduced bacteriuria but uncertain symptomatic-UTI benefit (RR 0.73, 95% CI 0.52–1.03). EAU recommends no antibiotic prophylaxis for UDS; the SUFU 2017 policy instead recommends prophylaxis for defined risk groups, including NLUTD, elevated PVR, immunosuppression, age >70, asymptomatic bacteriuria, or catheter/device use. A history of recurrent UTI alone was not an indication under that SUFU policy. Apply the relevant local protocol with this guideline difference in view.^[14][32][33]

Autonomic dysreflexia: Monitor hemodynamics in susceptible NLUTD patients during UDS. If dysreflexia occurs, stop the study, drain the bladder and continue monitoring; persistent dysreflexia requires pharmacological management and/or escalation of care.^[7]

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Ambulatory Urodynamic Monitoring (AUM)

AUM uses physiological anterograde filling (natural diuresis) and longer observation periods compared to traditional retrograde-fill laboratory UDS.^[15]

Indications: Unexplained urinary symptoms with non-diagnostic standard UDS; suspected DO not captured in brief laboratory study.

Limitations: Retrograde calibration more difficult; longer duration; requires patient cooperation.

Telemetric AUM (TAUM): Wireless systems differ in the signals they record. The FDA-cleared Glean system records bladder pressure during natural filling; its April 2026 abdominal-sensor addition permits multichannel pressure recording and calculation of detrusor pressure. The cleared setting is a clinic, and uroflow volume is not continuous intravesical volume measurement. Clearance and small feasibility studies do not establish superior clinical outcomes or replacement of every conventional UDS component. See the Glean device hub for current hardware and evidence limitations.^[34]

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Summary of Guideline Recommendations

Setting	Practical recommendation
Clearly demonstrated index SUI	Routine preoperative UDS may be omitted; assess non-index features individually.[24]
Initial uncomplicated OAB	Do not perform routine UDS.[6]
Refractory OAB	FUTURE does not support testing everyone before invasive treatment; retain testing for a specific decision or diagnostic uncertainty.[6][28]
Male LUTS	Use selectively when the result can change management, rather than routinely before all outlet surgery.[26][27]
NLUTD	Initial unknown-risk assessment includes multichannel UDS; low-risk patients do not need routine initial UDS. Subsequent testing depends on risk and clinical change.[7]
Technical performance	Apply ICS good-practice recommendations and the 2023 pressure-flow standards.[4][22][23]

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References

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2. Drake MJ, Doumouchtsis SK, Hashim H, Gammie A. "Fundamentals of Urodynamic Practice, Based on International Continence Society Good Urodynamic Practices Recommendations." Neurourol Urodyn. 2018;37(S6):S50–S60. [doi:10.1002/nau.23773]

3. McGuire EJ, Woodside JR, Borden TA, Weiss RM. "Prognostic value of urodynamic testing in myelodysplastic patients." J Urol. 1981;126(2):205–209. [PMID: 7196460]

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5. Nager CW, Brubaker L, Litman HJ, et al. "A Randomized Trial of Urodynamic Testing before Stress-Incontinence Surgery." N Engl J Med. 2012;366(21):1987–1997. [doi:10.1056/NEJMoa1113595]

6. Cameron AP, Chung DE, Dielubanza EJ, et al. "The AUA/SUFU Guideline on the Diagnosis and Treatment of Idiopathic Overactive Bladder." J Urol. 2024;212(1):11–20. [doi:10.1097/JU.0000000000003985]

7. Ginsberg DA, Boone TB, Cameron AP, et al. "The AUA/SUFU Guideline on Adult Neurogenic Lower Urinary Tract Dysfunction: Diagnosis and Evaluation." J Urol. 2021;206(5):1097–1105. [doi:10.1097/JU.0000000000002235]

8. Ruffolo AF, Tsiapakidou S, Daykan Y, et al. "European Urogynaecological Association Position Statement: The Role of Urodynamics in Stress Urinary Incontinence Evaluation and Treatment Decision." Eur J Obstet Gynecol Reprod Biol. 2024;297:176–181. [doi:10.1016/j.ejogrb.2024.04.024]

9. Lor KY, Soupashi M, Abdel-Fattah M, Mostafa A. "Does Pre-Operative Urodynamics Lead to Better Outcomes in Management of Urinary Incontinence in Women? A Linked Systematic Review and Meta-Analysis." Eur J Obstet Gynecol Reprod Biol. 2020;244:141–153. [doi:10.1016/j.ejogrb.2019.11.013]

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11. Malik RD, Hess DS, Carmel ME, Lemack GE, Zimmern PE. "Prospective Evaluation of Urodynamic Utility in a Subspecialty Tertiary Practice." Urology. 2019;126:59–64. [doi:10.1016/j.urology.2019.01.004]

12. Klingler HC, Madersbacher S, Djavan B, et al. "Morbidity of the Evaluation of the Lower Urinary Tract With Transurethral Multichannel Pressure-Flow Studies." J Urol. 1998;159(1):191–194. [doi:10.1016/S0022-5347(01)64054-0]

13. Yokoyama T, Nozaki K, Nose H, et al. "Tolerability and Morbidity of Urodynamic Testing: A Questionnaire-Based Study." Urology. 2005;66(1):74–76. [doi:10.1016/j.urology.2005.01.027]

14. Foon R, Toozs-Hobson P, Latthe P. "Prophylactic Antibiotics to Reduce the Risk of Urinary Tract Infections After Urodynamic Studies." Cochrane Database Syst Rev. 2012;10:CD008224. [doi:10.1002/14651858.CD008224.pub2]

15. Abelson B, Majerus S, Sun D, et al. "Ambulatory Urodynamic Monitoring: State of the Art and Future Directions." Nat Rev Urol. 2019;16(5):291–301. doi:10.1038/s41585-019-0175-5.

16. Leitner L, Walter M, Sammer U, Knüpfer SC, Mehnert U, Kessler TM. "Urodynamic Investigation: A Valid Tool to Define Normal Lower Urinary Tract Function?" PLoS One. 2016;11(10):e0163847. [doi:10.1371/journal.pone.0163847]

17. Wyman JF, Zhou J, Yvette LaCoursiere D, et al. "Normative Noninvasive Bladder Function Measurements in Healthy Women: A Systematic Review and Meta-Analysis." Neurourol Urodyn. 2020;39(2):507–522. [doi:10.1002/nau.24265]

18. Girman CJ, Panser LA, Chute CG, et al. "Natural History of Prostatism: Urinary Flow Rates in a Community-Based Study." J Urol. 1993;150(3):887–892. [doi:10.1016/s0022-5347(17)35640-9]

19. Wyndaele JJ, Gammie A, Bruschini H, et al. "Bladder Compliance What Does It Represent: Can We Measure It, and Is It Clinically Relevant?" Neurourol Urodyn. 2011;30(5):714–722. [doi:10.1002/nau.21129]

20. Rosier PF, Kirschner-Hermanns R, Svihra J, Homma Y, Wein AJ. "ICS Teaching Module: Analysis of Voiding, Pressure Flow Analysis (Basic Module)." Neurourol Urodyn. 2016;35(1):36–38. [doi:10.1002/nau.22660]

21. D'Ancona C, Haylen B, Oelke M, et al. "The International Continence Society (ICS) Report on the Terminology for Adult Male Lower Urinary Tract and Pelvic Floor Symptoms and Dysfunction." Neurourol Urodyn. 2019;38(2):433–477. [doi:10.1002/nau.23897]

22. Rosier PFWM, et al. "ICS-SUFU standard: Theory, terms, and recommendations for pressure-flow studies performance, analysis, and reporting. Part 1." Neurourol Urodyn. 2023;42:1590–1602. doi:10.1002/nau.25192.

23. Rosier PFWM, et al. "ICS-SUFU standard: Theory, terms, and recommendations for pressure-flow studies performance, analysis, and reporting. Part 2." Neurourol Urodyn. 2023;42:1603–1627. doi:10.1002/nau.25187.

24. AUA/SUFU. "Surgical Treatment of Female Stress Urinary Incontinence (SUI): Guideline (2023)." J Urol. 2023. doi:10.1097/JU.0000000000003435. Guideline.

25. EAU. Non-neurogenic Female LUTS Guidelines, 2026. Diagnosis.

26. EAU. Management of Non-neurogenic Male LUTS Guidelines, 2026. Diagnostic evaluation.

27. Clout M, et al. "Urodynamics Tests for the Diagnosis and Management of Male Bladder Outlet Obstruction: Long-term Follow-up of the UPSTREAM Non-inferiority Randomised Controlled Trial." Eur Urol Focus. 2025;11:618–624. doi:10.1016/j.euf.2025.02.004.

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