Indications for Video Urodynamic (VUD) Study
Video urodynamic studies should be performed in patients with neurogenic bladder, particularly those with elevated post-void residual or urinary symptoms, to identify specific sites of obstruction, detect vesicoureteral reflux with associated urodynamic parameters, and identify anatomic abnormalities of the bladder and urethra. 1
Primary Indications
Neurogenic Lower Urinary Tract Dysfunction
- Patients with relevant neurologic disease at risk for neurogenic bladder (NGB) or those with other neurologic disease and elevated PVR or urinary symptoms should undergo VUDS when available. 1
- VUDS is considered the gold standard for evaluating neurogenic lower urinary tract dysfunction, particularly in patients with spinal cord injury and myelomeningocele. 2, 3
- The study helps delineate specific sites of obstruction and identify bladder neck abnormalities in patients with NGB due to various neurologic conditions. 1
- VUDS can distinguish the etiology of NGB with respect to the underlying neurological disease. 1
Vesicoureteral Reflux Assessment
- VUDS identifies the presence and grade of vesicoureteral reflux as well as the urodynamic parameters present at the time of reflux. 1
- In pediatric patients with suspected secondary VUR, such as those with severe neurogenic bladder dysfunction, VUDS is important for comprehensive evaluation. 1
- The study is particularly valuable in boys with suspected posterior urethral valves. 1
Complex Bladder Outlet Obstruction
- Female bladder outlet obstruction represents a crucial indication where VUDS is often considered the gold standard. 2
- VUDS helps distinguish between bladder outlet obstruction and detrusor hypo-contractility/acontractility in patients who are "voiding" or leaking between catheterizations. 1
Secondary Indications
Refractory Lower Urinary Tract Symptoms
- Male LUTS refractory to medical treatment for benign prostatic hyperplasia. 4
- Overactive bladder syndrome refractory to first-line medication. 4
- Female stress urinary incontinence with postoperative LUTS. 4
Specific Clinical Scenarios
- Female voiding dysfunction and urinary retention. 4
- Congenital anomalies of the lower urinary tract. 2
- Recurrent bacterial cystitis when anatomic abnormalities are suspected. 4
- Pediatric urinary incontinence and enuresis when initial management fails. 4
Key Diagnostic Advantages
Anatomic and Functional Integration
- VUDS provides simultaneous functional and anatomical evaluation of the lower urinary tract, promoting accurate diagnosis of the etiology responsible for patient symptoms. 2
- The synchronous fluoroscopy during cystometry and pressure-flow studies provides additional diagnostic information beyond what either study alone could provide. 1
Specific Pathology Detection
- Identifies detrusor-external sphincter dyssynergia, bladder neck dysfunction, and intrinsic sphincter deficiency. 3
- Detects anatomic and physical abnormalities of the bladder and urethra that may not be apparent on standard urodynamics. 1
Important Clinical Considerations
Patient Selection Criteria
- VUDS should not be used as a screening test for any LUTS but should be considered when initial management cannot relieve symptoms or when invasive surgical procedures are planned. 4
- Patients should be carefully selected considering the increased cost and risks associated with radiological imaging. 2
- The study is recommended as second-line investigation when initial diagnosis and treatment based on symptoms alone or noninvasive tests fail to improve LUTS. 4
Risk-Benefit Assessment
- Radiation exposure is additive; studies should be performed in a manner that provides desired clinical information at the lowest possible radiation dose. 1
- In patients with neurogenic bladder, the benefits must be weighed against risks of infection and autonomic dysreflexia. 1
- Clinicians performing VUDS in patients at risk for autonomic dysreflexia must be adept in its detection and prompt management. 1