What is the recommended evaluation and management for a patient with suspected urinary disorders, specifically those undergoing a bladder function test (urodynamic testing)?

From the Guidelines

For patients with suspected urinary disorders requiring urodynamic testing, a comprehensive evaluation should begin with a detailed medical history and physical examination, followed by basic tests including urinalysis and post-void residual measurement, as recommended by the most recent guidelines 1. The evaluation and management of patients with suspected urinary disorders should prioritize a thorough medical history and physical examination to identify potential causes of symptoms.

• Basic tests such as urinalysis and post-void residual measurement should be performed to gather initial information about the patient's condition.
• Urodynamic testing, including uroflowmetry, cystometry, pressure-flow studies, and electromyography, may be recommended to objectively assess bladder function and guide treatment selection, as supported by the AUA/SUFU guideline on urodynamic studies in adults 1. Prior to testing, patients should:
• Maintain normal fluid intake
• Temporarily discontinue medications that affect bladder function, such as anticholinergics, beta-3 agonists, or alpha-blockers, for 3-7 days with their physician's approval
• Receive prophylactic antibiotics, typically a single dose of trimethoprim-sulfamethoxazole or nitrofurantoin, before invasive testing to prevent urinary tract infections During testing, patients should be made comfortable and the procedure thoroughly explained to reduce anxiety, which can affect results.
• After testing, patients should increase fluid intake and may experience mild discomfort or blood-tinged urine, which typically resolves within 24 hours. Urodynamic testing is valuable because it provides objective measurements of bladder and urethral function that correlate with symptoms, helping clinicians distinguish between conditions like detrusor overactivity, stress incontinence, or bladder outlet obstruction, which guides appropriate treatment selection, as noted in the AUA guideline on management of benign prostatic hyperplasia 1.

From the Research

Evaluation and Management of Urinary Disorders

The recommended evaluation and management for a patient with suspected urinary disorders, specifically those undergoing a bladder function test (urodynamic testing), involve a combination of clinical assessment, basic investigations, and urodynamic testing.

• Urodynamic testing aims to obtain objective information regarding urinary bladder storage and voiding function 2.
• The test is essential in defining underlying pathophysiology and directing treatment, particularly in cases of overactive bladder (OAB) 3.
• However, the role of urodynamics in the evaluation of OAB is not well defined, and its routine use is limited 4.

Indications for Urodynamic Testing

Urodynamic testing is indicated in certain situations, including:

• Prior to conservative therapy, a routine urodynamic investigation is not indicated, but it may be helpful in considering various treatment options 2.
• Preoperatively, especially in cases of overactive bladder symptoms, prior incontinence surgery, or disordered bladder emptying 2.
• In patients with pelvic prolapse, urodynamic investigations should be performed during prolapse reposition 2.
• In geriatric patients, urodynamic testing should be tailored to answer the question being asked and only done when the outcome of the test is going to impact decision making regarding management or treatment 5.

Correlation between Urinary Symptoms and Urodynamic Findings

The correlation between urinary symptoms and urodynamic findings is not always reliable, and lower urinary tract symptoms are poor predictors of urodynamic findings 6.

• The agreement between symptoms and corresponding urodynamic findings was found to be poor, especially for overactive bladder (OAB) and urge urinary incontinence (UUI) 6.
• Urodynamic assessment is essential in defining bladder function and providing valuable information to counsel patients and establish optimal clinical guidance 6.