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:

Videourodynamics — role, benefits and optimal practice

Nature Reviews Urology (2024)Cite this article

Subjects

Abstract

Videourodynamics (VUDS) is an advanced diagnostic procedure that simultaneously combines functional and anatomical evaluation of the lower urinary tract. The goal of this synchronous assessment is to promote accurate diagnosis of the aetiology responsible for patient symptoms, improving therapeutic decision-making. Overall, high-quality VUDS is advocated when other tests such as traditional urodynamics might not provide sufficient data to guide therapy, particularly in patients with complex, persistent or recurrent dysfunctions of the lower urinary tract. Additionally, VUDS is often crucial in the follow-up monitoring of many patients with these dysfunctions. A VUDS study is frequently considered a gold standard in patients with neurogenic lower urinary tract dysfunction, female bladder outlet obstruction or congenital anomalies of the lower urinary tract. Nevertheless, this specialized test should be limited to patients in whom VUDS data add value. Particularly, reliable studies comparing the effect of diagnosis with and without imaging on management outcomes are lacking, and no standardized procedures for undertaking VUDS are available. Additionally, patients should be carefully selected for VUDS evaluation, considering the increased cost and risks associated with radiological imaging. In routine practice, clinicians should balance the additional value of synchronous imaging and the enhanced diagnostic precision of VUDS against the limitations of this approach, which mainly include an uncertain effect of VUDS on final treatment outcomes.

Key points

  • Videourodynamics (VUDS) simultaneously combines functional and anatomical evaluation of the lower urinary tract.

  • The VUDS procedure is advocated when other tests might not provide sufficient data to guide therapy.

  • VUDS is often advised in patients with neurogenic lower urinary tract dysfunction, female bladder outlet obstruction or congenital anomalies of the lower urinary tract.

  • VUDS is limited by radiological imaging, increased cost and lack of standardization.

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

Access options

Buy this article

  • Purchase on SpringerLink
  • Instant access to full article PDF
Buy now

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

Fig. 1: A videourodynamics laboratory.
Fig. 2: Observations during a videourodynamics study.
Fig. 3: Neurogenic lower urinary tract dysfunction.
Fig. 4: Functional bladder outlet obstruction.
Fig. 5: Congenital genitourinary abnormalities and surgical reconstruction of the urinary tract.

Similar content being viewed by others

References

  1. Enhoerning, G., Miller, E. R. & Hinman, F. Jr. Urethral closure studied with cineroentgenography and simultaneous bladder-urethra pressure recording. Surg. Gynecol. Obstet. 118, 507–516 (1964).

    CAS  PubMed  Google Scholar 

  2. Anding, R. et al. When should video be added to conventional urodynamics in adults and is it justified by the evidence? ICI-RS 2014. Neurourol. Urodyn. 35, 324–329 (2016).

    Article  PubMed  Google Scholar 

  3. Tubaro, A. et al. in Incontinence 3rd edn Ch. 13 Committee 9 (eds Abrams, P., Cardozo, L., Khoury, S. & Wein, A.) 709–797 (International Continence Society, 2005).

  4. Tanagho, E. A., Miller, E. R., Meyers, F. H. & Corbett, R. K. Observations on the dynamics of the bladder neck. Br. J. Urol. 38, 72–84 (1966).

    Article  CAS  PubMed  Google Scholar 

  5. Oborska-Kumaszynska, D. & Wisniewska-Kubka, S. Analog and digital systems of imaging in roentgenodiagnostics. Pol. J. Radiol. 75, 73–81 (2010).

    PubMed  PubMed Central  Google Scholar 

  6. Manoliu, R. A., Grimbergen, H. A., Ouwerkerk, T. J., Ruygrok, C. T. & Vijlbrief, P. Combined dynamic studies of the bladder and urethra. Report of a method. Eur. Urol. 5, 337–342 (1979).

    Article  CAS  PubMed  Google Scholar 

  7. Bates, C. P. & Corney, C. E. Synchronous cine-pressure-flow cystography: a method of routine urodynamic investigation. Br. J. Radiol. 44, 44–50 (1971).

    Article  CAS  PubMed  Google Scholar 

  8. Whiteside, G. & Bates, P. Synchronous video pressure-flow cystourethrography. Urol. Clin. North. Am. 6, 93–102 (1979).

    Article  CAS  PubMed  Google Scholar 

  9. Palmtag, H., Boettger, F. & Rohl, L. Simultaneous cine-urographic and manoflowmetric evaluation of the neurogenic component in incontinence. Urol. Int. 30, 77–84 (1975).

    Article  CAS  PubMed  Google Scholar 

  10. Webster, G. D. & Older, R. A. Video urodynamics. Urology 16, 106–114 (1980).

    Article  CAS  PubMed  Google Scholar 

  11. Bates, C. P. Continence and incontinence. A clinical study of the dynamics of voiding and of the sphincter mechanism. Ann. R. Coll. Surg. Engl. 49, 18–35 (1971).

    CAS  PubMed  PubMed Central  Google Scholar 

  12. Marks, B. K. & Goldman, H. B. Videourodynamics: indications and technique. Urol. Clin. North. Am. 41, 383–391 (2014).

    Article  PubMed  Google Scholar 

  13. Dray, E. & Mueller, E. R. Use of urodynamic studies among certifying and recertifying urologists from 2003 to 2014. Urol. Pract. 4, 251–256 (2017).

    Article  CAS  PubMed  Google Scholar 

  14. Reynolds, W. S., Dmochowski, R. R., Lai, J., Saigal, C. & Penson, D. F. Patterns and predictors of urodynamics use in the United States. J. Urol. 189, 1791–1796 (2013).

    Article  PubMed  Google Scholar 

  15. Rosier, P. et al. International Continence Society Good Urodynamic Practices and Terms 2016: urodynamics, uroflowmetry, cystometry, and pressure-flow study. Neurourol. Urodyn. 36, 1243–1260 (2017).

    Article  PubMed  Google Scholar 

  16. Winters, J. C. et al. Urodynamic studies in adults: AUA/SUFU guideline. J. Urol. 188, 2464–2472 (2012).

    Article  PubMed  Google Scholar 

  17. Wyndaele, M. & Rosier, P. Basics of videourodynamics for adult patients with lower urinary tract dysfunction. Neurourol. Urodyn. 37, S61–S66 (2018).

    Article  PubMed  Google Scholar 

  18. Artibani, W. & Cerruto, M. A. The role of imaging in urinary incontinence. BJU Int. 95, 699–703 (2005).

    Article  PubMed  Google Scholar 

  19. Jiang, Y. H., Chen, S. F. & Kuo, H. C. Role of videourodynamic study in precision diagnosis and treatment for lower urinary tract dysfunction. Ci Ji Yi Xue Za Zhi 32, 121–130 (2020).

    PubMed  Google Scholar 

  20. Anding, R. et al. When should video and EMG be added to urodynamics in children with lower urinary tract dysfunction and is this justified by the evidence? ICI-RS 2014. Neurourol. Urodyn. 35, 331–335 (2016).

    Article  PubMed  Google Scholar 

  21. European Association of Urology. Guidelines: Neuro-urology. EAU uroweb.org/guidelines/neuro-urology (2024).

  22. European Association of Urology. Guidelines: Non-neurogenic female LUTS. EAU uroweb.org/guidelines/non-neurogenic-female-luts (2024).

  23. European Association of Urology. Guidelines: Management of non-neurogenic male LUTS. EAU uroweb.org/guidelines/management-of-non-neurogenic-male-luts (2024).

  24. Lin, P. J. Technical advances of interventional fluoroscopy and flat panel image receptor. Health Phys. 95, 650–657 (2008).

    Article  CAS  PubMed  Google Scholar 

  25. Gray, M. Traces: making sense of urodynamics testing – part 12: videourodynamics testing. Urol. Nurs. 32, 193–202 (2012).

    Article  PubMed  Google Scholar 

  26. Vañó, E. et al. ICRP publication 113. Education and training in radiological protection for diagnostic and interventional procedures. Ann. ICRP 39, 7–68 (2009).

    Article  PubMed  Google Scholar 

  27. ACR Committee on Drugs and Contrast Media. ACR manual on contrast media. American College of Radiology www.acr.org/-/media/ACR/Files/Clinical-Resources/Contrast_Media.pdf (2023).

  28. McAlister, W. H. & Griffith, R. C. Cystographic contrast media: clinical and experimental studies. AJR Am. J. Roentgenol. 141, 997–1001 (1983).

    Article  CAS  PubMed  Google Scholar 

  29. Marks, B., Vasavada, S. & Goldman, H. B. 2282 contrast concentration does not alter fluoro-urodynamic interpretation. J. Urol. 189, e936–e936 (2013).

    Article  Google Scholar 

  30. Gehrich, A. P., Hill, M. J., McWilliams, G. D., Larsen, W. & McCartin, T. Comparison of urodynamic volume measurements using room and body temperature saline: a double-blinded randomized crossover study design. Female Pelvic Med. Reconstr. Surg. 18, 170–174 (2012).

    Article  PubMed  Google Scholar 

  31. Stroh, D. A. et al. A proposal for a standardized nomenclature of the C-arm movements. J. Am. Acad. Orthop. Surg. Glob. Res Rev. 4, e20.00008 (2020).

    PubMed  PubMed Central  Google Scholar 

  32. Mills, T., Winter, D., Keith, S. & Fletcher, D. WE-E-211-01: medical physics in federal and state governments. Med. Phys. 39, 3955 (2012).

    Article  CAS  PubMed  Google Scholar 

  33. Killewich, L. A. & Singleton, T. A. Governmental regulations and radiation exposure. J. Vasc. Surg. 53, 44S–46S (2011).

    Article  PubMed  Google Scholar 

  34. Hirshfeld, J. W. Jr. et al. ACCF/AHA/HRS/SCAI clinical competence statement on physician knowledge to optimize patient safety and image quality in fluoroscopically guided invasive cardiovascular procedures: a report of the American College of Cardiology Foundation/American Heart Association/American College of Physicians Task Force on Clinical Competence and Training. Circulation 111, 511–532 (2005).

    Article  PubMed  Google Scholar 

  35. Brucker, B. M. et al. Radiation exposure during videourodynamics: establishing risk factors. Low. Urin. Tract. Symptoms 10, 181–185 (2018).

    Article  CAS  PubMed  Google Scholar 

  36. Galloway, N. T., Mekras, J. A., Helms, M. & Webster, G. D. An objective score to predict upper tract deterioration in myelodysplasia. J. Urol. 145, 535–537 (1991).

    Article  CAS  PubMed  Google Scholar 

  37. Lee, C. L., Wunderle, K., Vasavada, S. P. & Goldman, H. B. Reduction of radiation during fluoroscopic urodynamics: analysis of quality assurance protocol limiting fluoroscopic images during fluoroscopic urodynamic studies. Urology 78, 540–543 (2011).

    Article  PubMed  Google Scholar 

  38. Hoffman, D. et al. Radiation exposure during videourodynamic testing: Is dose reduction possible using a standardized protocol? Neurourol. Urodyn. 39, 715–720 (2020).

    Article  PubMed  Google Scholar 

  39. Lagopoulos, V. & Gigi, E. Anaphylactic and anaphylactoid reactions during the perioperative period. Hippokratia 15, 138–140 (2011).

    CAS  PubMed  PubMed Central  Google Scholar 

  40. Cartwright, R., Cardozo, L. & Durling, R. A retrospective review of a series of videourodynamic procedures, with respect to the risk of anaphylactoid reactions. Neurourol. Urodyn. 27, 559 (2008).

    Article  PubMed  Google Scholar 

  41. Chaikin, D. C., Groutz, A. & Blaivas, J. G. Predicting the need for anti-incontinence surgery in continent women undergoing repair of severe urogenital prolapse. J. Urol. 163, 531–534 (2000).

    Article  CAS  PubMed  Google Scholar 

  42. Corcos, J. & Przydacz, M. Consultation in Neurourology: A Practical Evidence-Based Guide 49–65 (Springer, 2018).

  43. Danforth, T. L. & Ginsberg, D. A. Neurogenic lower urinary tract dysfunction: how, when, and with which patients do we use urodynamics? Urol. Clin. North. Am. 41, 445–452 (2014).

    Article  PubMed  Google Scholar 

  44. European Association of Urology. Guidelines: Paediatric urology. EAU uroweb.org/guidelines/paediatric-urology (2024).

  45. Gajewski, J. B. et al. An International Continence Society (ICS) report on the terminology for adult neurogenic lower urinary tract dysfunction (ANLUTD). Neurourol. Urodyn. 37, 1152–1161 (2018).

    Article  PubMed  Google Scholar 

  46. Corcos, J. & Przydacz, M. Consultation in Neurourology: A Practical Evidence-Based Guide 17–36 (Springer, 2018).

  47. Panicker, J. N., Fowler, C. J. & Kessler, T. M. Lower urinary tract dysfunction in the neurological patient: clinical assessment and management. Lancet Neurol. 14, 720–732 (2015).

    Article  PubMed  Google Scholar 

  48. Wang, Z., Deng, H., Li, X. & Liao, L. The video-urodynamic and electrophysiological characteristics in patients with traumatic spinal cord injury. Int. Neurourol. J. 25, 327–336 (2021).

    Article  PubMed  PubMed Central  Google Scholar 

  49. Agrawal, M. & Joshi, M. Urodynamic patterns after traumatic spinal cord injury. J. Spinal Cord. Med. 38, 128–133 (2015).

    Article  PubMed  PubMed Central  Google Scholar 

  50. Weld, K. J. & Dmochowski, R. R. Association of level of injury and bladder behavior in patients with post-traumatic spinal cord injury. Urology 55, 490–494 (2000).

    Article  CAS  PubMed  Google Scholar 

  51. Ginsberg, D. A. et al. The AUA/SUFU guideline on adult neurogenic lower urinary tract dysfunction: diagnosis and evaluation. J. Urol. 206, 1097–1105 (2021).

    Article  PubMed  Google Scholar 

  52. Przydacz, M., Chlosta, P. & Corcos, J. Recommendations for urological follow-up of patients with neurogenic bladder secondary to spinal cord injury. Int. Urol. Nephrol. 50, 1005–1016 (2018).

    Article  PubMed  Google Scholar 

  53. Veenboer, P. W. et al. Cross-sectional study of determinants of upper and lower urinary tract outcomes in adults with spinal dysraphism – new recommendations for urodynamic followup guidelines? J. Urol. 192, 477–482 (2014).

    Article  PubMed  Google Scholar 

  54. Perrin, A. & Corcos, J. The utility of urodynamic studies in neuro-urological patients. Biomedicines 11, 1134 (2023).

    Article  PubMed  PubMed Central  Google Scholar 

  55. Corcos, J. & Przydacz, M. Consultation in Neurourology: A Practical Evidence-Based Guide 115–148 (Springer, 2018).

  56. De, E. J. et al. Diagnostic discordance of electromyography (EMG) versus voiding cystourethrogram (VCUG) for detrusor-external sphincter dyssynergy (DESD). Neurourol. Urodyn. 24, 616–621 (2005).

    Article  PubMed  Google Scholar 

  57. Spettel, S., Kalorin, C. & De, E. Combined diagnostic modalities improve detection of detrusor external sphincter dyssynergia. ISRN Obstet. Gynecol. 2011, 323421 (2011).

    Article  PubMed  PubMed Central  Google Scholar 

  58. Harris, C., Smith, P. P. & Gousse, A. E. in Rapid and practical interpretation of urodynamics (eds Rovner, E. S. & Koski, M. E.) 251–262 (Springer, 2015).

  59. Castro-Diaz, D. & Taracena Lafuente, J. M. Detrusor-sphincter dyssynergia. Int. J. Clin. Pract. 60, 17–21 (2006).

    Article  Google Scholar 

  60. Perkash, I. Use of contact laser crystal tip firing Nd:YAG to relieve urinary outflow obstruction in male neurogenic bladder patients. J. Clin. Laser Med. Surg. 16, 33–38 (1998).

    Article  CAS  PubMed  Google Scholar 

  61. Williams, D. R. & Litvan, I. Parkinsonian syndromes. Continuum 19, 1189–1212 (2013).

    PubMed  PubMed Central  Google Scholar 

  62. Pavlakis, A. J., Siroky, M. B., Goldstein, I. & Krane, R. J. Neurourologic findings in Parkinson’s disease. J. Urol. 129, 80–83 (1983).

    Article  CAS  PubMed  Google Scholar 

  63. Stocchi, F. et al. Urodynamic and neurophysiological evaluation in Parkinson’s disease and multiple system atrophy. J. Neurol. Neurosurg. Psychiatry 62, 507–511 (1997).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  64. Sakakibara, R., Hattori, T., Uchiyama, T. & Yamanishi, T. Videourodynamic and sphincter motor unit potential analyses in Parkinson’s disease and multiple system atrophy. J. Neurol. Neurosurg. Psychiatry 71, 600–606 (2001).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  65. Blaivas, J. G., Sinha, H. P., Zayed, A. A. & Labib, K. B. Detrusor-external sphincter dyssynergia: a detailed electromyographic study. J. Urol. 125, 545–548 (1981).

    Article  CAS  PubMed  Google Scholar 

  66. National Clinical Guideline Centre. Urinary Incontinence in Neurological Disease: Management of Lower Urinary Tract Dysfunction in Neurological Disease Clinical Guideline 148 (National Clinical Guideline Centre, 2012).

  67. Alloussi, S. H. et al. Videourodynamic changes of botulinum toxin A in patients with neurogenic bladder dysfunction (NBD) and idiopathic detrusor overactivity (IDO) refractory to drug treatment. World J. Urol. 30, 367–373 (2012).

    Article  CAS  PubMed  Google Scholar 

  68. Sekido, N. et al. Clinical guidelines for the diagnosis and treatment of lower urinary tract dysfunction in patients with spinal cord injury. Int. J. Urol. 27, 276–288 (2020).

    Article  PubMed  Google Scholar 

  69. Corcos, J. & Przydacz, M. Consultation in Neurourology: A Practical Evidence-Based Guide 243–253 (Springer, 2018).

  70. Abrams, P. et al. The standardisation of terminology of lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Neurourol. Urodyn. 21, 167–178 (2002).

    Article  PubMed  Google Scholar 

  71. Brucker, B. M. et al. Comparison of urodynamic findings in women with anatomical versus functional bladder outlet obstruction. Female Pelvic Med. Reconstr. Surg. 19, 46–50 (2013).

    Article  PubMed  Google Scholar 

  72. Malde, S. et al. Systematic review of the performance of noninvasive tests in diagnosing bladder outlet obstruction in men with lower urinary tract symptoms. Eur. Urol. 71, 391–402 (2017).

    Article  PubMed  Google Scholar 

  73. Pang, K. H. et al. Diagnostic tests for female bladder outlet obstruction: a systematic review from the European Association of Urology non-neurogenic female LUTS guidelines panel. Eur. Urol. Focus. 8, 1015–1030 (2022).

    Article  PubMed  Google Scholar 

  74. Aponte, M. M. et al. Urodynamics for clinically suspected obstruction after anti-incontinence surgery in women. J. Urol. 190, 598–602 (2013).

    Article  PubMed  Google Scholar 

  75. Nitti, V. W., Tu, L. M. & Gitlin, J. Diagnosing bladder outlet obstruction in women. J. Urol. 161, 1535–1540 (1999).

    Article  CAS  PubMed  Google Scholar 

  76. Blaivas, J. G. & Groutz, A. Bladder outlet obstruction nomogram for women with lower urinary tract symptomatology. Neurourol. Urodyn. 19, 553–564 (2000).

    Article  CAS  PubMed  Google Scholar 

  77. Groutz, A., Blaivas, J. G. & Chaikin, D. C. Bladder outlet obstruction in women: definition and characteristics. Neurourol. Urodyn. 19, 213–220 (2000).

    Article  CAS  PubMed  Google Scholar 

  78. Carlson, K. V., Fiske, J. & Nitti, V. W. Value of routine evaluation of the voiding phase when performing urodynamic testing in women with lower urinary tract symptoms. J. Urol. 164, 1614–1618 (2000).

    Article  CAS  PubMed  Google Scholar 

  79. Hsiao, S. M., Lin, H. H. & Kuo, H. C. Videourodynamic studies of women with voiding dysfunction. Sci. Rep. 7, 6845 (2017).

    Article  PubMed  PubMed Central  Google Scholar 

  80. Nitti, V. W. Primary bladder neck obstruction in men and women. Rev. Urol. 7, S12–S17 (2005).

    PubMed  PubMed Central  Google Scholar 

  81. Hickling, D., Aponte, M. & Nitti, V. Evaluation and management of outlet obstruction in women without anatomical abnormalities on physical exam or cystoscopy. Curr. Urol. Rep. 13, 356–362 (2012).

    Article  PubMed  Google Scholar 

  82. Osman, N. I. & Chapple, C. R. Fowler’s syndrome – a cause of unexplained urinary retention in young women? Nat. Rev. Urol. 11, 87–98 (2014).

    Article  PubMed  Google Scholar 

  83. Swinn, M. J., Wiseman, O. J., Lowe, E. & Fowler, C. J. The cause and natural history of isolated urinary retention in young women. J. Urol. 167, 151–156 (2002).

    Article  PubMed  Google Scholar 

  84. Moore, T. Bladder-neck obstruction in women. Proc. R. Soc. Med. 46, 558–564 (1953).

    CAS  PubMed  PubMed Central  Google Scholar 

  85. Andrich, D. E., Rickards, D., Landon, D. N., Fowler, C. J. & Mundy, A. R. Structural assessment of the urethral sphincter in women with urinary retention. J. Urol. 173, 1246–1251 (2005).

    Article  CAS  PubMed  Google Scholar 

  86. de Groat, W. C. et al. Neural control of the urethra. Scand. J. Urol. Nephrol. 35(207), 35–43 (2001).

    Article  Google Scholar 

  87. Dasgupta, R., Critchley, H. D., Dolan, R. J. & Fowler, C. J. Changes in brain activity following sacral neuromodulation for urinary retention. J. Urol. 174, 2268–2272 (2005).

    Article  PubMed  Google Scholar 

  88. DasGupta, R. & Fowler, C. J. Urodynamic study of women in urinary retention treated with sacral neuromodulation. J. Urol. 171, 1161–1164 (2004).

    Article  PubMed  Google Scholar 

  89. Fowler, C. J. et al. Abnormal electromyographic activity of the urethral sphincter, voiding dysfunction, and polycystic ovaries: a new syndrome? BMJ 297, 1436–1438 (1988).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  90. Haylen, B. T. et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol. Urodyn. 29, 4–20 (2010).

    Article  PubMed  Google Scholar 

  91. Carlson, K. V., Rome, S. & Nitti, V. W. Dysfunctional voiding in women. J. Urol. 165, 143–147 (2001).

    Article  CAS  PubMed  Google Scholar 

  92. Fan, Y. H., Lin, A. T., Wu, H. M., Hong, C. J. & Chen, K. K. Psychological profile of female patients with dysfunctional voiding. Urology 71, 625–629 (2008).

    Article  PubMed  Google Scholar 

  93. Pannek, J., Einig, E. M. & Einig, W. Clinical management of bladder dysfunction caused by sexual abuse. Urol. Int. 82, 420–425 (2009).

    Article  PubMed  Google Scholar 

  94. Jiang, Y. H., Lee, C. L., Chen, S. F. & Kuo, H. C. Therapeutic effects of urethral sphincter botulinum toxin A injection on dysfunctional voiding with different videourodynamic characteristics in non-neurogenic women. Toxins 13, 362 (2021).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  95. Brucker, B. M. et al. Urodynamic differences between dysfunctional voiding and primary bladder neck obstruction in women. Urology 80, 55–60 (2012).

    Article  PubMed  Google Scholar 

  96. Groutz, A., Blaivas, J. G., Pies, C. & Sassone, A. M. Learned voiding dysfunction (non-neurogenic, neurogenic bladder) among adults. Neurourol. Urodyn. 20, 259–268 (2001).

    Article  CAS  PubMed  Google Scholar 

  97. Deindl, F. M., Vodusek, D. B., Bischoff, C., Hofmann, R. & Hartung, R. Dysfunctional voiding in women: which muscles are responsible? Br. J. Urol. 82, 814–819 (1998).

    Article  CAS  PubMed  Google Scholar 

  98. Chow, P. M., Hsiao, S. M. & Kuo, H. C. Obstructive patterns in videourodynamic studies predict responses of female dysfunctional voiding treated with or without urethral botulinum toxin injection: a long-term follow-up study. Int. Urogynecol. J. 31, 2557–2564 (2020).

    Article  PubMed  Google Scholar 

  99. Jiang, Y. H., Wang, C. C. & Kuo, H. C. OnabotulinumtoxinA urethral sphincter injection as treatment for non-neurogenic voiding dysfunction – a randomized, double-blind, placebo-controlled study. Sci. Rep. 6, 38905 (2016).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  100. Kaplan, S. A., Te, A. E. & Jacobs, B. Z. Urodynamic evidence of vesical neck obstruction in men with misdiagnosed chronic nonbacterial prostatitis and the therapeutic role of endoscopic incision of the bladder neck. J. Urol. 152, 2063–2065 (1994).

    Article  CAS  PubMed  Google Scholar 

  101. Kaplan, S. A. et al. Etiology of voiding dysfunction in men less than 50 years of age. Urology 47, 836–839 (1996).

    Article  CAS  PubMed  Google Scholar 

  102. Nitti, V. W., Lefkowitz, G., Ficazzola, M. & Dixon, C. M. Lower urinary tract symptoms in young men: videourodynamic findings and correlation with noninvasive measures. J. Urol. 168, 135–138 (2002).

    Article  PubMed  Google Scholar 

  103. European Association of Urology. Guidelines: Chronic pelvic pain. EAU uroweb.org/guidelines/chronic-pelvic-pain (2024).

  104. Gupta, N. K., Gaur, S. & Pal, D. K. Role of videourodynamics in the identification of causes of lower urinary tract symptoms and low uroflow in young men. Urol. Ann. 14, 332–335 (2022).

    Article  PubMed  PubMed Central  Google Scholar 

  105. Singh, G. et al. Urodynamics in the evaluation of lower urinary tract symptoms in young adult men: a systematic review. Indian. J. Urol. 39, 97–106 (2023).

    Article  PubMed  PubMed Central  Google Scholar 

  106. Schurch, B., Schmid, D. M., Karsenty, G. & Reitz, A. Can neurologic examination predict type of detrusor sphincter-dyssynergia in patients with spinal cord injury? Urology 65, 243–246 (2005).

    Article  PubMed  Google Scholar 

  107. Bellucci, C. H. et al. Acute spinal cord injury – do ambulatory patients need urodynamic investigations? J. Urol. 189, 1369–1373 (2013).

    Article  PubMed  Google Scholar 

  108. Gross, O., Leitner, L., Rasenack, M., Schubert, M. & Kessler, T. M. Detrusor sphincter dyssynergia: can a more specific definition distinguish between patients with and without an underlying neurological disorder? Spinal Cord. 59, 1026–1033 (2021).

    Article  PubMed  PubMed Central  Google Scholar 

  109. Berte, N. et al. Long-term renal outcome in infants with congenital lower urinary tract obstruction. Prog. Urol. 28, 596–602 (2018).

    Article  CAS  PubMed  Google Scholar 

  110. Malin, G., Tonks, A. M., Morris, R. K., Gardosi, J. & Kilby, M. D. Congenital lower urinary tract obstruction: a population-based epidemiological study. BJOG 119, 1455–1464 (2012).

    Article  CAS  PubMed  Google Scholar 

  111. Ruano, R., Dunn, T., Braun, M. C., Angelo, J. R. & Safdar, A. Lower urinary tract obstruction: fetal intervention based on prenatal staging. Pediatr. Nephrol. 32, 1871–1878 (2017).

    Article  PubMed  Google Scholar 

  112. Johnson, M. P. et al. Natural history of fetal lower urinary tract obstruction with normal amniotic fluid volume at initial diagnosis. Fetal Diagnosis Ther. 44, 10–17 (2018).

    Article  Google Scholar 

  113. Concodora, C. W., Reddy, P. P. & VanderBrink, B. A. The role of video urodynamics in the management of the valve bladder. Curr. Urol. Rep. 18, 24 (2017).

    Article  PubMed  Google Scholar 

  114. Peters, C. A. et al. The urodynamic consequences of posterior urethral valves. J. Urol. 144, 122–126 (1990).

    Article  CAS  PubMed  Google Scholar 

  115. Jaureguizar, E., Lopez-Pereira, P. & Martinez-Urrutia, M. J. The valve bladder: etiology and outcome. Curr. Urol. Rep. 3, 115–120 (2002).

    Article  PubMed  Google Scholar 

  116. Holmdahl, G., Sillén, U., Hanson, E., Hermansson, G. & Hjälmås, K. Bladder dysfunction in boys with posterior urethral valves before and after puberty. J. Urol. 155, 694–698 (1996).

    Article  CAS  PubMed  Google Scholar 

  117. Hennus, P. M., van der Heijden, G. J., Bosch, J. L., de Jong, T. P. & de Kort, L. M. A systematic review on renal and bladder dysfunction after endoscopic treatment of infravesical obstruction in boys. PLoS ONE 7, e44663 (2012).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  118. Androulakakis, P. A., Karamanolakis, D. K., Tsahouridis, G., Stefanidis, A. A. & Palaeodimos, I. Myogenic bladder decompensation in boys with a history of posterior urethral valves is caused by secondary bladder neck obstruction? BJU Int. 96, 140–143 (2005).

    Article  PubMed  Google Scholar 

  119. Tubaro A. et al. in Incontinence 5th edn Ch. 7 Committee 7 (eds Abrams, P., Cardozo, L., Khoury, S. & Wein, A.) 507–622 (International Continence Society, 2013).

  120. Engel, J. D. & Schaeffer, A. J. Evaluation of and antimicrobial therapy for recurrent urinary tract infections in women. Urol. Clin. North. Am. 25, 685–701 (1998).

    Article  CAS  PubMed  Google Scholar 

  121. Finer, G. & Landau, D. Pathogenesis of urinary tract infections with normal female anatomy. Lancet Infect. Dis. 4, 631–635 (2004).

    Article  PubMed  Google Scholar 

  122. Foxman, B. Epidemiology of urinary tract infections: incidence, morbidity, and economic costs. Am. J. Med. 113, 5S–13S (2002).

    Article  PubMed  Google Scholar 

  123. Carlson, K. J. & Mulley, A. G. Management of acute dysuria. A decision-analysis model of alternative strategies. Ann. Intern. Med. 102, 244–249 (1985).

    Article  CAS  PubMed  Google Scholar 

  124. Hijazi, S. & Leitsmann, C. Clinical significance of video-urodynamic in female recurrent urinary tract infections. Int. J. Womens Health 8, 31–34 (2016).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  125. Lee, P. J. & Kuo, H. C. High incidence of lower urinary tract dysfunction in women with recurrent urinary tract infections. Low. Urin. Tract. Symptoms 12, 33–40 (2020).

    Article  PubMed  Google Scholar 

  126. van de Merwe, J. P. et al. Diagnostic criteria, classification, and nomenclature for painful bladder syndrome/interstitial cystitis: an ESSIC proposal. Eur. Urol. 53, 60–67 (2008).

    Article  PubMed  Google Scholar 

  127. Hanno, P. M., Erickson, D., Moldwin, R., Faraday, M. M. & American Urological Association Diagnosis and treatment of interstitial cystitis/bladder pain syndrome: AUA guideline amendment. J. Urol. 193, 1545–1553 (2015).

    Article  PubMed  Google Scholar 

  128. Kuo, H. C. Urodynamic study and potassium sensitivity test for women with frequency-urgency syndrome and interstitial cystitis. Urol. Int. 71, 61–65 (2003).

    Article  PubMed  Google Scholar 

  129. Sastry, D. N., Hunter, K. M. & Whitmore, K. E. Urodynamic testing and interstitial cystitis/painful bladder syndrome. Int. Urogynecol. J. 21, 157–161 (2010).

    Article  PubMed  Google Scholar 

  130. Kuo, Y. C. & Kuo, H. C. Videourodynamic characteristics of interstitial cystitis/bladder pain syndrome – the role of bladder outlet dysfunction in the pathophysiology. Neurourol. Urodyn. 37, 1971–1977 (2018).

    Article  CAS  PubMed  Google Scholar 

  131. Cameron, A. P. & Gajewski, J. B. Bladder outlet obstruction in painful bladder syndrome/interstitial cystitis. Neurourol. Urodyn. 28, 944–948 (2009).

    Article  PubMed  Google Scholar 

  132. Yu, W. R., Chang, W. C. & Kuo, H. C. Clinical presentation, videourodynamic characteristics, and treatment outcome in men with interstitial cystitis-like lower urinary tract symptoms. Int. Urol. Nephrol. 54, 2157–2165 (2022).

    Article  PubMed  Google Scholar 

  133. Yu, W. R., Chang, W. C. & Kuo, H. C. Voiding dysfunctions in patients with non-Hunner’s ulcer interstitial cystitis/bladder pain syndrome do not affect long-term treatment outcome. Int. J. Clin. Pract. 75, e14372 (2021).

    Article  PubMed  Google Scholar 

  134. Webster, J. R. Combined video/pressure/flow cystourethrography in female patients with voiding disturbances. Urology 5, 209–215 (1975).

    Article  CAS  PubMed  Google Scholar 

  135. Faubion, S. S., Shuster, L. T. & Bharucha, A. E. Recognition and management of nonrelaxing pelvic floor dysfunction. Mayo Clin. Proc. 87, 187–193 (2012).

    Article  PubMed  PubMed Central  Google Scholar 

  136. Yu, W. R., Jiang, Y. H., Jhang, J. F. & Kuo, H. C. Use of urinary biomarkers in discriminating interstitial cystitis/bladder pain syndrome from male lower urinary tract dysfunctions. Int. J. Mol. Sci. 24, 12055 (2023).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  137. Jhang, J. F. & Kuo, H. C. Pathomechanism of interstitial cystitis/bladder pain syndrome and mapping the heterogeneity of disease. Int. Neurourol. J. 20, S95–S104 (2016).

    Article  PubMed  PubMed Central  Google Scholar 

  138. Watanabe, T., Rivas, D. A. & Chancellor, M. B. Urodynamics of spinal cord injury. Urol. Clin. North. Am. 23, 459–473 (1996).

    Article  CAS  PubMed  Google Scholar 

  139. Shan, S. et al. Video-urodynamics efficacy of sacral neuromodulation for neurogenic bladder guided by three-dimensional imaging CT and C-arm fluoroscopy: a single-center prospective study. Sci. Rep. 12, 16306 (2022).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  140. Lee, C. L. et al. Therapeutic outcome of active management in male patients with detrusor underactivity based on clinical diagnosis and videourodynamic classification. Sci. Rep. 12, 362 (2022).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  141. Jiang, Y. H., Lee, C. L., Jhang, J. F. & Kuo, H. C. Current pharmacological and surgical treatment of underactive bladder. Ci Ji Yi Xue Za Zhi 29, 187–191 (2017).

    PubMed  Google Scholar 

  142. Ansari, S. H. & Mahdy, A. E. Are video-urodynamics superior to traditional urodynamic studies in changing treatment decision with urinary symptoms? Arab. J. Urol. 17, 160–165 (2019).

    Article  PubMed  PubMed Central  Google Scholar 

  143. Osman, N. I., Li Marzi, V., Cornu, J. N. & Drake, M. J. Evaluation and classification of stress urinary incontinence: current concepts and future directions. Eur. Urol. Focus. 2, 238–244 (2016).

    Article  PubMed  Google Scholar 

  144. Withington, J., Hirji, S. & Sahai, A. The changing face of urinary continence surgery in England: a perspective from the Hospital Episode Statistics database. BJU Int. 114, 268–277 (2014).

    Article  PubMed  Google Scholar 

  145. Zacchè, M. M., Giarenis, I., Thiagamoorthy, G., Robinson, D. & Cardozo, L. Is there a link between preoperative fluoroscopic cough stress testing and synthetic midurethral tape outcome? Eur. J. Obstet. Gynecol. Reprod. Biol. 193, 61–64 (2015).

    Article  PubMed  Google Scholar 

  146. Kalejaiye, O., Vij, M. & Drake, M. J. Classification of stress urinary incontinence. World J. Urol. 33, 1215–1220 (2015).

    Article  PubMed  Google Scholar 

  147. Scarpero, H. M., Padmanabhan, P., Xue, X. & Nitti, V. W. Patient perception of videourodynamic testing: a questionnaire based study. J. Urol. 173, 555–559 (2005).

    Article  PubMed  Google Scholar 

  148. Giarenis, I. et al. Radiation exposure during videourodynamics in women. Int. Urogynecol. J. 24, 1547–1551 (2013).

    Article  PubMed  Google Scholar 

  149. Hsi, R. S. et al. Effective and organ specific radiation doses from videourodynamics in children. J. Urol. 190, 1364–1369 (2013).

    Article  PubMed  PubMed Central  Google Scholar 

  150. Smuck, M., Zheng, P., Chong, T., Kao, M. C. & Geisser, M. E. Duration of fluoroscopic-guided spine interventions and radiation exposure is increased in overweight patients. PM R 5, 291–296 (2013).

    Article  PubMed  Google Scholar 

  151. Georges, J. L. et al. Reduction of radiation delivered to patients undergoing invasive coronary procedures. Effect of a programme for dose reduction based on radiation-protection training. Arch. Cardiovasc. Dis. 102, 821–827 (2009).

    Article  PubMed  Google Scholar 

  152. Smith, D. L. et al. Radiation exposure during continuous and pulsed fluoroscopy. J. Endourol. 27, 384–388 (2013).

    Article  PubMed  Google Scholar 

  153. Bartal, G., Vano, E., Paulo, G. & Miller, D. L. Management of patient and staff radiation dose in interventional radiology: current concepts. Cardiovasc. Interv. Radiol. 37, 289–298 (2014).

    Article  Google Scholar 

  154. Dudley, A. G. et al. Interrater reliability in pediatric urodynamic tracings: a pilot study. J. Urol. 197, 865–870 (2017).

    Article  PubMed  Google Scholar 

  155. Dudley, A. G. et al. Interrater reliability in interpretation of neuropathic pediatric urodynamic tracings: an expanded multicenter study. J. Urol. 199, 1337–1343 (2018).

    Article  PubMed  Google Scholar 

  156. Glancz, L. J., Cartwright, R. & Cardozo, L. Inter- and intra-rater reliability of fluoroscopic cough stress testing. J. Obstet. Gynaecol. 30, 492–495 (2010).

    Article  CAS  PubMed  Google Scholar 

  157. Miller, B. D., Tallman, C. T., Boone, T. B. & Khavari, R. Low interrater reliability of videourodynamic diagnosis of detrusor external sphincter dyssynergia. Female Pelvic Med. Reconstr. Surg. 27, 297–299 (2021).

    Article  PubMed  PubMed Central  Google Scholar 

  158. Scatliff, J. H. & Morris, P. J. From Roentgen to magnetic resonance imaging: the history of medical imaging. N. C. Med. J. 75, 111–113 (2014).

    PubMed  Google Scholar 

  159. Ozawa, H., Igarashi, T., Uematsu, K., Watanabe, T. & Kumon, H. The future of urodynamics: non-invasive ultrasound videourodynamics. Int. J. Urol. 17, 241–249 (2010).

    Article  PubMed  Google Scholar 

  160. Nose, H. et al. Accuracy of two noninvasive methods of diagnosing bladder outlet obstruction using ultrasonography: intravesical prostatic protrusion and velocity-flow video urodynamics. Urology 65, 493–497 (2005).

    Article  PubMed  Google Scholar 

  161. Ding, Y. Y. et al. Reliability of color Doppler ultrasound urodynamics in the evaluation of bladder outlet obstruction. Urology 56, 967–971 (2000).

    Article  CAS  PubMed  Google Scholar 

  162. Roic, A. C., Milosevic, D., Turudić, D. & Roic, G. An innovative diagnostic procedure in children: videourodynamics with contrast-enhanced voiding urosonography. J. Ultrasound 26, 583–587 (2023).

    Article  PubMed  Google Scholar 

  163. Tufano, A. et al. The value of contrast-enhanced ultrasound (CEUS) in differentiating testicular masses: a systematic review and meta-analysis. Appl. Sci. 11, 8990 (2021).

    Article  CAS  Google Scholar 

  164. Cvitkovic-Roic, A., Turudic, D., Milosevic, D., Palcic, I. & Roic, G. Contrast-enhanced voiding urosonography in the diagnosis of intrarenal reflux. J. Ultrasound 25, 89–95 (2022).

    Article  PubMed  Google Scholar 

  165. Kljucevsek, D., Battelino, N., Tomazic, M. & Kersnik Levart, T. A comparison of echo-enhanced voiding urosonography with X-ray voiding cystourethrography in the first year of life. Acta Paediatr. 101, e235–e239 (2012).

    Article  PubMed  Google Scholar 

  166. Darge, K. Voiding urosonography with ultrasound contrast agents for the diagnosis of vesicoureteric reflux in children. I. Procedure. Pediatr. Radiol. 38, 40–53 (2008).

    Article  PubMed  Google Scholar 

  167. Papadopoulou, F. et al. Harmonic voiding urosonography with a second-generation contrast agent for the diagnosis of vesicoureteral reflux. Pediatr. Radiol. 39, 239–244 (2009).

    Article  PubMed  Google Scholar 

  168. IBM Data and AI Team. AI versus machine learning versus deep learning versus neural networks: what’s the difference? IBM www.ibm.com/blog/ai-vs-machine-learning-vs-deep-learning-vs-neural-networks/ (2023).

  169. Weaver, J. K. et al. Deep learning of videourodynamics to classify bladder dysfunction severity in patients with spina bifida. J. Urol. 209, 994–1003 (2023).

    Article  PubMed  Google Scholar 

  170. Hobbs, K. T. et al. Machine learning for urodynamic detection of detrusor overactivity. Urology 159, 247–254 (2022).

    Article  PubMed  Google Scholar 

  171. Wang, H. S. et al. Pattern recognition algorithm to identify detrusor overactivity on urodynamics. Neurourol. Urodyn. 40, 428–434 (2021).

    Article  PubMed  Google Scholar 

  172. Blair, B. et al. Reduced fluoroscopy protocol for percutaneous nephrostolithotomy: feasibility, outcomes and effects on fluoroscopy time. J. Urol. 190, 2112–2116 (2013).

    Article  PubMed  Google Scholar 

  173. Ecclestone, H. et al. Does videourodynamic classification depend on patient positioning in patients with stress urinary incontinence? Neurourol. Urodyn. 37, 2257–2262 (2018).

    Article  PubMed  Google Scholar 

  174. Amelink, A., Kok, D. J., Sterenborg, H. J. & Scheepe, J. R. In vivo measurement of bladder wall oxygen saturation using optical spectroscopy. J. Biophotonics 4, 715–720 (2011).

    Article  PubMed  Google Scholar 

  175. Sturm, R. M. et al. Ultrasound shear wave elastography: a novel method to evaluate bladder pressure. J. Urol. 198, 422–429 (2017).

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

M.P. is a scholar supported by the Polish National Agency for Academic Exchange (grant BPN/WAL/2022/1/00013), an official academic agency of the Government of Poland.

Author information

Authors and Affiliations

  1. Department of Urology, Jagiellonian University Medical College, Krakow, Poland

    Mikolaj Przydacz

  2. Glickman Urological Institute, Cleveland Clinic, Cleveland, OH, USA

    Mikolaj Przydacz & Howard B. Goldman

Authors
  1. Mikolaj Przydacz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Howard B. Goldman
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Both authors researched data for the article. Both authors contributed substantially to discussion of the content. M.P. wrote the article. Both authors reviewed and/or edited the manuscript before submission.

Corresponding author

Correspondence to Mikolaj Przydacz.

Ethics declarations

Competing interests

H.B.G. is on the advisory boards of Laborie and BrightUro. M.P. declares no competing interests.

Peer review

Peer review information

Nature Reviews Urology thanks Karyn Eilber, Hann-Chorng Kuo and the other, anonymous, reviewer(s) for their contribution to the peer review of this work.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Related links

Online etymology dictionary: https://www.etymonline.com

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Przydacz, M., Goldman, H.B. Videourodynamics — role, benefits and optimal practice. Nat Rev Urol (2024). https://doi.org/10.1038/s41585-024-00923-6

Download citation

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1038/s41585-024-00923-6

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