Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Review Article
  • Published:

Recommendations for urodynamic assessment in the evaluation of women with stress urinary incontinence

Nature Clinical Practice Urology volume 3, pages 544–550 (2006)Cite this article

Abstract

Urinary incontinence is a common problem that is experienced by women of all ages. The overall evaluation and treatment of incontinence has increased in sophistication, both as a result of the introduction of urodynamic testing in the assessment of patients, and because there are increasing numbers of medical and surgical treatments available for incontinence. What was previously considered a personal problem for women, and which was rarely discussed, has become a more open and acceptable complaint for female patients to bring to their physicians. This Review aims to clarify when urodynamic testing is clearly indicated for patients with symptoms of stress urinary incontinence, and describes the current recommendations from three national and international governing bodies. This Review will also highlight some of the ongoing debates over the performance, interpretation, and utility of urodynamic testing, and provide references for further reading on these topics.

Key Points

  • Incontinent patients previously treated for stress urinary incontinence or prolapse, with concurrent pelvic-organ prolapse, neurologic conditions such as prior stroke or multiple sclerosis, or a history of pelvic radiation or pelvic surgery should undergo urodynamic evaluation before further treatment

  • Debate continues on the utility of urodynamic studies in patients with uncomplicated incontinence who have not undergone treatment

  • Urodynamic evaluation includes a noninvasive flow measurement, filling cystometry and a pressure–flow study

  • A good urodynamic study will reproduce the patient's symptoms; a good quality tracing with appropriate annotations will allow for a reproducible interpretation

  • The Urinary Incontinence Treatment Network has provided a multicenter protocol for urodynamic testing, and for the interpretation of guidelines and reference values for women with stress urinary incontinence

  • Debate continues on the role of urodynamic studies in prediction of surgical outcome and in patient counseling before surgery

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1: Two cystometrograms that show examples of voiding mechanisms often seen on urodynamic evaluations of women with stress urinary incontinence, and which can influence a surgical treatment decision.

Similar content being viewed by others

References

  1. Hunskaar S et al. (2005) Epidemiology of urinary (UI) and faecal (FI) incontinence and pelvic organ prolapse (POP). In Incontinence, 255–312 (Eds Abrams P et al.) Paris: Health Publications Ltd

    Google Scholar 

  2. Waetjen LE et al. (2003) Stress urinary incontinence surgery in the United States. Obstet Gynecol 101: 671–676

    PubMed  Google Scholar 

  3. Fantl JA et al. (1996) Urinary incontinence in adults: acute and chronic management. In Clinical practice guideline number 2 [Agency for Health Care Policy and Research Publication No. 96-0682]. Rockville: US Department of Health and Human Services, Public Health Service

    Google Scholar 

  4. American College of Obstetricians and Gynecologists (1995) Criteria Set #4. Washington DC: American College of Obstetricians and Gynecologists

  5. Griffiths D et al. (2005) Dynamic testing. In Incontinence, 585–674 (Eds Abrams P et al.) Paris: Health Publications Ltd

    Google Scholar 

  6. Bump RC et al. (1988) The mechanism of urinary continence in women with severe uterovaginal prolapse: results of barrier studies. Obstet Gynecol 72: 291–295

    Article  CAS  Google Scholar 

  7. Ghoniem GM et al. (1994) The value of the vaginal pack test in large cystoceles. J Urol 152: 931–934

    Article  CAS  Google Scholar 

  8. Chaikin DC et al. (2000) Predicting the need for anti-incontinence surgery in continent women undergoing repair of severe urogenital prolapse. J Urol 163: 531–534

    Article  CAS  Google Scholar 

  9. Gilleran JP et al. (2006) Reduction of moderate-to-large cystocele during urodynamic evaluation using a vaginal gauze pack: 8-year experience. BJU Int 97: 292–295

    Article  Google Scholar 

  10. Marinkovic SP and Stanton SL (2004) Incontinence and voiding difficulties associated with prolapse. J Urol 171: 1021–1028

    Article  Google Scholar 

  11. Bhatia NN (2000) Dynamics of voiding in women. Curr Opin Obstet Gynecol 12: 383–386

    Article  CAS  Google Scholar 

  12. Abrams P et al. (2002) The standardisation of terminology of lower urinary tract function: report from the Standardisation Subcommittee of the International Continence Society. Neurourol Urodyn 21: 167–178

    Article  Google Scholar 

  13. Bump RC et al. (1996) The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 175: 10–17

    Article  CAS  Google Scholar 

  14. Schafer W et al. (2002) Good urodynamic practices: uroflowmetry, filling cystometry, and pressure-flow studies. Neurourol Urodyn 21: 261–274

    Article  Google Scholar 

  15. Urinary Incontinence Treatment Network (UITN) Continence Treatment Centers [http://www.niddk.nih.gov/patient/uitn/uitn.htm] (accessed 29 August 2006)

  16. Tennstedt S (2005) Design of the stress incontinence surgical treatment efficacy trial (SISTER). Urology 66: 1213–1217

    Article  Google Scholar 

  17. Zimmern PE et al. (2006) Interrater reliability of filling cystometrogram interpretation in a multicenter study. J Urol 175: 2174–2177

    Article  CAS  Google Scholar 

  18. Nager C et al. (2003) Urodynamic challenges posed by a multicenter study of surgery for female stress urinary incontinence. Society of Female Urology and Urodynamics Spring Meeting, Chicago

  19. Zimmern P et al. (2004) Urodynamic inter-rater reliability between local and central physician reviewers for the filling cystometrogram in SISTER (Stress Incontinence Surgical Treatment Efficacy Trial) [abstract #19]. Neurourol Urodyn 23: a419–a420

    Google Scholar 

  20. Nager C et al. (2005) Non-invasive uroflowmetry and filling cystometry values in a large cohort of women undergoing surgery for pure or predominant stress urinary incontinence [abstract # 79]. Neurourol Urodyn 24: a526–a527

    Google Scholar 

  21. Nager CW et al. Reference urodynamic values for stress incontinent women. Neurourol Urodyn, in press

  22. Okorocha I et al. (2002) Female urodynamics and lower urinary tract infection. BJU Int 89: 863–867

    Article  CAS  Google Scholar 

  23. Brostrom S et al. (2002) Morbidity of urodynamic investigation in healthy women. Int Urogynecol J Pelvic Floor Dysfunct 13: 182–184

    Article  Google Scholar 

  24. Yokoyama T et al. (2005) Tolerability and morbidity of urodynamic testing: a questionnaire-based study. Urology 66: 74–76

    Article  Google Scholar 

  25. Weber AM and Walters MD (2000) Cost-effectiveness of urodynamic testing before surgery for women with pelvic organ prolapse and stress urinary incontinence. Am J Obstet Gynecol 183: 1338–1346

    Article  CAS  Google Scholar 

  26. Weber AM et al. (2002) The cost-effectiveness of preoperative testing (basic office assessment vs. urodynamics) for stress urinary incontinence in women. BJU Int 89: 356–363

    Article  CAS  Google Scholar 

  27. Hijaz K et al. (2005) Impact of urodynamic studies and validated symptom and quality of life questionnaires on the clinical diagnosis and treatment recommendations of female urologists for women with female pelvic floor disorders [abstract #1312]. J Urol 173: a356

    Article  Google Scholar 

  28. Jarvis GJ et al. (1980) An assessment of urodynamic examination in incontinent women. Br J Obstet Gynaecol 87: 893–896

    Article  CAS  Google Scholar 

  29. Swithinbank LV et al. (1999) Role of ambulatory urodynamic monitoring in clinical urological practice. Neurourol Urodyn 18: 215–222

    Article  CAS  Google Scholar 

  30. Lockhart JL et al. (1984) Anti-incontinence surgery in women with detrusor instability. Neurourol Urodyn 3: 201–207

    Article  Google Scholar 

  31. Pow-Sang JM et al. (1986) Female urinary incontinence: preoperative selection, surgical complications and results. J Urol 136: 831–833

    Article  CAS  Google Scholar 

  32. Jorgensen L et al. (1987) Vaginal repair in female motor urge incontinence. Eur Urol 13: 382–385

    Article  CAS  Google Scholar 

  33. McGuire EJ and Sarvastano JA (1985) Stress incontinence and detrusor instability/urge incontinence. Neurourol Urodyn 4: 313–316

    Article  Google Scholar 

  34. Romanzi LJ et al. (2001) Involuntary detrusor contractions: correlation of urodynamic data to clinical categories. Neurourol Urodyn 20: 249–257

    Article  CAS  Google Scholar 

  35. Bhatia NN and Bergman A (1986) The use of preoperative uroflowmetry and simultaneous urethrocystometry for predicting risk of prolonged postoperative bladder drainage. Urology 28: 440–445

    Article  CAS  Google Scholar 

  36. Sze EHM et al. (1996) Voiding after Burch colposuspension and effects of concomitant pelvic surgery: correlation with preoperative voiding mechanism. Obstet Gynecol 88: 564–597

    Article  CAS  Google Scholar 

  37. Miller EA et al. (2003) Preoperative urodynamic evaluation may predict voiding dysfunction in women undergoing pubovaginal sling. J Urol 169: 2234–2237

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Assistant Professor in the Department of Urology, University of Iowa, Iowa City, IA, USA

    Elizabeth B Takacs

  2. Professor of Urology at the Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA

    Philippe E Zimmern

Authors
  1. Elizabeth B Takacs
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Philippe E Zimmern
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Philippe E Zimmern.

Ethics declarations

Competing interests

The authors declare no competing financial interests.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Takacs, E., Zimmern, P. Recommendations for urodynamic assessment in the evaluation of women with stress urinary incontinence. Nat Rev Urol 3, 544–550 (2006). https://doi.org/10.1038/ncpuro0605

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ncpuro0605

This article is cited by

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing