Should a Urodynamics (urinary dynamics) test be postponed if a clinic lacks a lab to perform tests beyond the dipstick test?

Urodynamics Testing Without Laboratory Capabilities

Urodynamics testing should not be postponed solely due to lack of laboratory facilities beyond dipstick testing, as dipstick urinalysis is sufficient for pre-procedure infection screening. 1

Pre-Procedure Infection Screening Requirements

The primary concern before urodynamic studies is ruling out urinary tract infection (UTI), which can be adequately accomplished with dipstick testing:

• Dipstick testing alone is acceptable for UTI screening before urodynamics, as it provides reasonable assessment of infection risk when positive for nitrites and/or leukocytes 2
• Urine collected from the flowmeter (the first step of urodynamics) can be tested with dipstick, eliminating the need for separate specimen collection and showing 100% consistency for nitrite detection and 89% consistency for leukocyte detection compared to catheterized specimens 2
• If dipstick is positive for nitrites and/or leukocytes, the urodynamic test should be abandoned and the patient treated for presumed UTI before rescheduling 2

When Laboratory Testing Beyond Dipstick Is NOT Required

• Post-void residual (PVR) measurement can be performed during urodynamics without laboratory support 1
• Uroflowmetry requires no laboratory testing 1
• Multichannel filling cystometry and pressure-flow studies do not require concurrent laboratory analysis beyond infection screening 1

Clinical Context for Decision-Making

The lack of laboratory facilities becomes relevant only in specific scenarios:

• If dipstick testing is negative, further laboratory confirmation with culture is not required before proceeding with urodynamics 1, 2
• If dipstick testing is positive, the patient should be treated empirically for UTI and urodynamics postponed regardless of laboratory availability 2
• Urodynamic findings should be interpreted in the context of global assessment including examination, voiding diaries, and PVR measurements—none of which require advanced laboratory testing 3, 4

Important Caveats

• The absence of infection on a single dipstick test does not rule out recurrent or chronic infections, but this does not preclude proceeding with urodynamics at that time 3
• Urodynamic testing carries risks including infection, urethral trauma, and pain from catheterization, but these risks are not increased by lack of laboratory facilities 1
• Conservative or empiric noninvasive treatments may be instituted without urodynamic testing if the clinical scenario does not warrant invasive evaluation 1