Urodynamic Evaluation for Female Urinary Incontinence

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Abstract
The diagnosis and management of urinary incontinence and voiding dysfunction in females is often challenging. Patient history and physical examination are poor indicators of the underlying etiology. Female incontinence results from a variety of diseases and disorders. A recent meta-analysis of 19 articles found the symptom of stress incontinence was 91% sensitive, but only 51% specific in diagnosing genuine stress incontinence.1 Assessing urethral hypermobility using the cotton swab test is also suboptimal.2 Most experts agree that testing beyond the basic office visit is required to confirm the clinical diagnosis of urinary incontinence, but the indications, timing, and type of testing are unresolved. Testing modalities ranging from a simple stress test to complex multichannel urodynamics with fluoroscopy are described. Urodynamic testing in evaluating female urinary incontinence is controversial. Changes in testing technology and the understanding of incontinence pathophysiology have resulted in new information with little consensus as to its clinical applicability. It becomes increasingly difficult for the practicing physician to decide which tests are necessary to evaluate lower urinary tract dysfunction. The primary goals of urodynamic testing are objective documentation of urine leakage, reproduction of the patient's symptoms, correlation of symptoms with urodynamic parameters, determination of the etiology of urinary leakage, and prediction and evaluation of response to medical and surgical therapies. Unfortunately, few data exist to prove that urodynamics accomplishes these goals. Nevertheless, urodynamic testing is accepted as crucial in the evaluation of female incontinence. This chapter reviews basic urodynamic testing, the technique, clinical uses, and the role of the subspecialist as a consultant in the management of female urinary incontinence.