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Urodynamic evaluation of women with incontinence

George Flesh, MD
Section Editor
Linda Brubaker, MD, FACOG
Deputy Editor
Kristen Eckler, MD, FACOG


Urodynamics refers to a group of tests used to assess function of the urinary tract by measuring various aspects of urine storage and evacuation (table 1). Some specific types of urodynamic testing are:

Cystometry (or cystometrogram) evaluates bladder function by measuring pressure and volume of fluid in the bladder during filling, storage, and voiding.

Uroflowmetry measures the rate of urine flow.

Urethral pressure profile tests urethral function.

Leak point pressure determines the bladder or abdominal pressure when leakage occurs due to increased abdominal pressure (Valsalva or cough) to assess urethral resistance.

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Literature review current through: Nov 2017. | This topic last updated: Mar 07, 2016.
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  1. Ouslander J, Staskin D, Raz S, et al. Clinical versus urodynamic diagnosis in an incontinent geriatric female population. J Urol 1987; 137:68.
  2. Byrne DJ, Stewart PA, Gray BK. The role of urodynamics in female urinary stress incontinence. Br J Urol 1987; 59:228.
  3. Cantor TJ, Bates CP. A comparative study of symptoms and objective urodynamic findings in 214 incontinent women. Br J Obstet Gynaecol 1980; 87:889.
  4. Summitt RL Jr, Stovall TG, Bent AE, Ostergard DR. Urinary incontinence: correlation of history and brief office evaluation with multichannel urodynamic testing. Am J Obstet Gynecol 1992; 166:1835.
  5. Weidner AC, Myers ER, Visco AG, et al. Which women with stress incontinence require urodynamic evaluation? Am J Obstet Gynecol 2001; 184:20.
  6. Jensen JK, Nielsen FR Jr, Ostergard DR. The role of patient history in the diagnosis of urinary incontinence. Obstet Gynecol 1994; 83:904.
  7. Ward RM, Hampton BS, Blume JD, et al. The impact of multichannel urodynamics upon treatment recommendations for female urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct 2008; 19:1235.
  8. Glazener CM, Lapitan MC. Urodynamic investigations for management of urinary incontinence in adults. Cochrane Database Syst Rev 2002; :CD003195.
  9. Vereecken RL. A critical view on the value of urodynamics in non-neurogenic incontinence in women. Int Urogynecol J Pelvic Floor Dysfunct 2000; 11:188.
  10. Maniam P, Goldman HB. Removal of transurethral catheter during urodynamics may unmask stress urinary incontinence. J Urol 2002; 167:2080.
  11. Lose, G, Thyssen, H. Reproducibility of cystometry and pressure-flow parameters in female patients. Neurourol Urodyn 1996; 15:302.
  12. Versi E. Discriminant analysis of urethral pressure profilometry data for the diagnosis of genuine stress incontinence. Br J Obstet Gynaecol 1990; 97:251.
  13. Karantanis E, O'Sullivan R, Moore KH. The 24-hour pad test in continent women and men: normal values and cyclical alterations. BJOG 2003; 110:567.
  14. Bombieri L, Dance DA, Rienhardt GW, et al. Urinary tract infection after urodynamic studies in women: incidence and natural history. BJU Int 1999; 83:392.
  15. Brostrom S, Jennum P, Lose G. Morbidity of urodynamic investigation in healthy women. Int Urogynecol J Pelvic Floor Dysfunct 2002; 13:182.
  16. Baker KR, Drutz HP, Barnes MD. Effectiveness of antibiotic prophylaxis in preventing bacteriuria after multichannel urodynamic investigations: a blind, randomized study in 124 female patients. Am J Obstet Gynecol 1991; 165:679.
  17. ACOG Committee on Practice Bulletins--Gynecology. ACOG practice bulletin No. 104: Antibiotic prophylaxis for gynecologic procedures. Obstet Gynecol 2009; 113:1180. Reaffirmed 2016.
  18. Sand PK, Hill RC, Ostergard DR. Supine urethroscopic and standing cystometry as screening methods for the detection of detrusor instability. Obstet Gynecol 1987; 70:57.
  19. Scotti RJ, Myers DL. A comparison of the cough stress test and single-channel cystometry with multichannel urodynamic evaluation in genuine stress incontinence. Obstet Gynecol 1993; 81:430.
  20. Abrams P, Blaivas JG, Stanton SL, et al. The standardization of terminology of lower urinary tract function recommended by the International Continence Society. Int Urogynecol J Pelvic Floor Dysfunct 1990; 1:145.
  21. Alperin M, Abrahams-Gessel S, Wakamatsu MM. Development of de novo urge incontinence in women post sling: the role of preoperative urodynamics in assessing the risk. Neurourol Urodyn 2008; 27:407.
  22. Al-Hayek S, Belal M, Abrams P. Does the patient's position influence the detection of detrusor overactivity? Neurourol Urodyn 2008; 27:279.
  23. Pollak JT, Neimark M, Connor JT, Davila GW. Air-charged and microtransducer urodynamic catheters in the evaluation of urethral function. Int Urogynecol J Pelvic Floor Dysfunct 2004; 15:124.
  24. Mayer R, Wells T, Brink C, et al. Handwashing in the cystometric evaluation of detrusor overactivity. Neurourol Urodyn 1991; 10:563.
  25. Salvatore S, Sologo M, Monti C. Can we improve diagnosis on urodynamics. Neurourol Urodyn 1998; 17:392.
  26. Barnick CG, Cardozo DL, Benness C. Use of routine videocystourethrography in the evaluation of female lower urinary tract dysfunction. Neurourol Urodyn 1989; 8:447.
  27. Artibani W. Diagnosis and significance of idiopathic overactive bladder. Urology 1997; 50:25.
  28. Porru D, Usai E. Standard and extramural ambulatory urodynamic investigation for the diagnosis of detrusor instability-correlated incontinence and micturition disorders. Neurourol Urodyn 1994; 13:237.
  29. Vereecken RL, Van Nuland T. Detrusor pressure in ambulatory versus standard urodynamics. Neurourol Urodyn 1998; 17:129.
  30. Patravali N. Ambulatory urodynamic monitoring: are we wasting our time? J Obstet Gynaecol 2007; 27:413.
  31. van Waalwijk van Doorn ES, Remmers A, Janknegt RA. Conventional and extramural ambulatory urodynamic testing of the lower urinary tract in female volunteers. J Urol 1992; 147:1319.
  32. Bhatia NN, Bradley WE, Haldeman S, Johnson BK. Continuous ambulatory urodynamic monitoring. Br J Urol 1982; 54:357.
  33. Kulseng-Hanson, S, Klevmark, B. Ambulatory urodynamic monitoring of women. Scand J Urol Nephrol 1996; 179:27.
  34. Stanton SL, Ozsoy C, Hilton P. Voiding difficulties in the female: prevalence, clinical and urodynamic review. Obstet Gynecol 1983; 61:144.
  35. Bergman A, Bhatia NN. Uroflowmetry for predicting postoperative voiding difficulties in women with stress urinary incontinence. Br J Obstet Gynaecol 1985; 92:835.
  36. Haylen BT, Ashby D, Sutherst JR, et al. Maximum and average urine flow rates in normal male and female populations--the Liverpool nomograms. Br J Urol 1989; 64:30.
  37. Nitti VW, Raz S. Obstruction following anti-incontinence procedures: diagnosis and treatment with transvaginal urethrolysis. J Urol 1994; 152:93.
  38. Defreitas GA, Zimmern PE, Lemack GE, Shariat SF. Refining diagnosis of anatomic female bladder outlet obstruction: comparison of pressure-flow study parameters in clinically obstructed women with those of normal controls. Urology 2004; 64:675.
  39. American College of Obstetricians and Gynecologists. Urinary incontinence in women. Obstet Gynecol 2005; 105:1533.
  40. Chaliha C, Digesu GA, Hutchings A, Khullar V. Changes in urethral function with bladder filling in the presence of urodynamic stress incontinence and detrusor overactivity. Am J Obstet Gynecol 2005; 192:60.
  41. Rosenzweig BA, Bhatia NN, Nelson AL. Dynamic urethral pressure profilometry pressure transmission ratio: what do the numbers really mean? Obstet Gynecol 1991; 77:586.
  42. Bowen LW, Sand PK, Ostergard DR, Franti CE. Unsuccessful Burch retropubic urethropexy: a case-controlled urodynamic study. Am J Obstet Gynecol 1989; 160:452.
  43. Koonings PP, Bergman A, Ballard CA. Low urethral pressure and stress urinary incontinence in women: risk factor for failed retropubic surgical procedure. Urology 1990; 36:245.
  44. McGuire EJ. Urodynamic findings in patients after failure of stress incontinence operations. Prog Clin Biol Res 1981; 78:351.
  45. Horbach NS, Blanco JS, Ostergard DR, et al. A suburethral sling procedure with polytetrafluoroethylene for the treatment of genuine stress incontinence in patients with low urethral closure pressure. Obstet Gynecol 1988; 71:648.
  46. Rezapour M, Falconer C, Ulmsten U. Tension-Free vaginal tape (TVT) in stress incontinent women with intrinsic sphincter deficiency (ISD)--a long-term follow-up. Int Urogynecol J Pelvic Floor Dysfunct 2001; 12 Suppl 2:S12.
  47. Appell RA. Primary slings for everyone with genuine stress incontinence? The argument for... Int Urogynecol J Pelvic Floor Dysfunct 1998; 9:249.
  48. Rud T. Urethral pressure profile in continent women from childhood to old age. Acta Obstet Gynecol Scand 1980; 59:331.
  49. Rud T. The effects of estrogens and gestagens on the urethral pressure profile in urinary continent and stress incontinent women. Acta Obstet Gynecol Scand 1980; 59:265.
  50. Sultana CJ. Urethral closure pressure and leak-point pressure in incontinent women. Obstet Gynecol 1995; 86:839.
  51. Swift SE, Ostergard DR. A comparison of stress leak-point pressure and maximal urethral closure pressure in patients with genuine stress incontinence. Obstet Gynecol 1995; 85:704.
  52. Bump RC, Elser DM, Theofrastous JP, McClish DK. Valsalva leak point pressures in women with genuine stress incontinence: reproducibility, effect of catheter caliber, and correlations with other measures of urethral resistance. Continence Program for Women Research Group. Am J Obstet Gynecol 1995; 173:551.
  53. Miklos JR, Sze EH, Karram MM. A critical appraisal of the methods of measuring leak-point pressures in women with stress incontinence. Obstet Gynecol 1995; 86:349.
  54. Haab F, Zimmern PE, Leach GE. Female stress urinary incontinence due to intrinsic sphincteric deficiency: recognition and management. J Urol 1996; 156:3.
  55. Decter RM, Harpster L. Pitfalls in determination of leak point pressure. J Urol 1992; 148:588.
  56. Stöhrer M, Goepel M, Kondo A, et al. The standardization of terminology in neurogenic lower urinary tract dysfunction: with suggestions for diagnostic procedures. International Continence Society Standardization Committee. Neurourol Urodyn 1999; 18:139.
  57. McGuire EJ, Fitzpatrick CC, Wan J, et al. Clinical assessment of urethral sphincter function. J Urol 1993; 150:1452.