Comprehensive urodynamics: Being devoted to clinical urologic practice

Abstract

As a combined electrophysiological system for evaluating the lower urinary tract (LUT), comprehensive urodynamics (UDS) aims at duplicating patient’s micturition process, either normal or abnormal, and further seeking for possible causative origin, either neurogenic or non-neurogenic, in order to guide treatment. Through thorough analysis, some so-called cut-off values, for example, bladder outlet obstruction (BOO) degree or dyssynergic degree between the detrusor and sphincter, could be gained; however, in most cases, their qualitative description, such as stress urinary incontinence, idiopathic detrusor underactivity (DUA), detrusor overactivity (IDO), low compliance, and idiopathic sphincter overactivity (ISO), is more preferable and important. In aged neurologically intact male patients with symptoms of the LUT (LUTS) including benign prostatic hyperplasia, a combined UDS system, which coupled BOO with compliance, was constructed. The patients may be categorized into one of the seven subgroups, including equivocal or mild BOO with sphincter synergia with or without IDO (pattern A), equivocal or mild BOO with ISO (B), classic BOO with sphincter synergia (C) or ISO (D), BOO with only low compliance (E), BOO with both DUA and low compliance (F), and potential BOO with DUA (G). This new system can be used to optimize diagnosis and treatment according to a derived guideline diagram.

Keywords: Detrusor overactivity; Electromyography; Sphincter overactivity; Stress urinary incontinence; Urodynamics; Urology

Core tip: Scant progress during the last 2 decades and poor prognostic value of urodynamics (UDS) for benign prostatic hyperplasia interventional therapy may come from some technological problems, here we mean the underestimation of the role of electromyogram and some shortcomings of the UDS technology. Based on individualized UDS evaluation of more than 9000 cases, some so-called cut-off values, for example, degrees of bladder outlet obstruction and dyssynergia between the detrusor and sphincter, could be gained; however, in most cases, their qualitative description, such as stress urinary incontinence, idiopathic detrusor underactivity, detrusor overactivity, low compliance, and idiopathic sphincter overactivity, is more preferable and important.