Urology Annals

COMMENTARY
Year
: 2013  |  Volume : 5  |  Issue : 4  |  Page : 268--269

Evolutions of urodynamic studies: Toward less invasive and more physiological diagnostic tool


Ahmed S El-Hefnawy 
 Department of Urology, Voiding Dysfunction and Urodynamic, Consultant of Urology, Urology and Nephrology Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt

Correspondence Address:
Ahmed S El-Hefnawy
Voiding Dysfunction and Urodynamic Consultant of Urology, Urology and Nephrology Center, Faculty of Medicine, Mansoura University, Mansoura
Egypt




How to cite this article:
El-Hefnawy AS. Evolutions of urodynamic studies: Toward less invasive and more physiological diagnostic tool.Urol Ann 2013;5:268-269


How to cite this URL:
El-Hefnawy AS. Evolutions of urodynamic studies: Toward less invasive and more physiological diagnostic tool. Urol Ann [serial online] 2013 [cited 2021 Nov 30 ];5:268-269
Available from: https://www.urologyannals.com/text.asp?2013/5/4/268/120304


Full Text

The main purpose of urodynamic study (UDS) is to measure and record various physiologic variables while the patient is experiencing those symptoms which constitute his usual complaints. Therefore, upon completion of any UDS, the examiner should ask certain questions; "Does UDS represent effectively the patient's symptoms? Do the obtained parameters exactly reflect the true condition of the patient?" For an answer to be "yes," UDS must pass the test of accuracy. Standardization of methodology and continuous technical evolutions to improve structural quality of used equipments has been always considered as a base to achieve the goal of accuracy. Therefore, the nature of the catheters and their calibers, nature of filling agents, rate of filling, and position of the patients have been considered as points of investigation to improve the accuracy of UDS.

Under the umbrella of these efforts, this timely article comes to confirm the obstructive effect of 6-Fr urethral catheters on urine flow of 133 men during pressure flow study. Despite the limitations of the current study, which have been acknowledged in authors' comments; nevertheless, this report is valuable given that data from other reports regarding the obstructive effect of small-caliber catheters are conflicting. [1],[2]

On the other hand, there is current trend toward avoidance to perform UDS whenever possible. There is no doubt that results of UDS including pressure flow study may direct the management strategy. However, many randomized and quasi-randomized trials have failed to show enough evidence suggesting that treatment according to an urodynamic-based diagnosis, compared to treatment based on history and examination, led to more effective clinical care or better clinical outcomes. [3],[4]

Taking into consideration the invasive and time-consuming nature of the current UDS, [5] new horizons of non-invasive diagnostic tools have been visited. A non-invasive transperineal urodynamic technique using doppler ultrasonography has been recently described. [6] Measurement of detrusor wall thickness, intravesical prostatic protrusion, and other ultrasound measurable indices are other examples for such non-invasive tools. [7]

The take-home message is that until reaching a solid proof on promising results of these new tools by passing the tests of reliability done on large sample size and by using well-designed trials, efforts must be continued to improve the quality of what we have and what is considered as the gold standard of diagnosis, a catheter-based UDS.

References

1Anikwe RM. The effect of a 6FG urethral catheter on urinary flow in benign prostatic hypertrophy. Int Surg 1976;61:417-8.
2Klausner AP, Galea J, Vapnek JM. Effect of catheter size on urodynamic assessment of bladder outlet obstruction. Urology 2002;60:875-80.
3Glazener CM, Lapitan MC. Urodynamic studies for management of urinary incontinence in children and adults. Cochrane Database Syst Rev 2012;1:CD003195. Doi: 10.10021/14651858.
4Wadie BS, El-Hefnawy AS. Urethral pressure measurement in stress incontinence: Does it help? Int Urol Nephrol 2009;41:491-5.
5Arnolds M, Oelke M. Positioning invasive versus noninvasive urodynamics in the assessment of bladder outlet obstruction. Curr Opin Urol 2009;19:55-62.
6Ozawa H, Igarashi T, Uematsu K, Watanabe T, Kumon H. The future of urodynamics: Non-invasive ultrasound videourodynamics. Int J Urol 2010;17:241-9.
7Oelke M, Höfner K, Jonas U, de la Rosette JJ, Ubbink DT, Wijkstra H. Diagnostic accuracy of noninvasive tests to evaluate bladder outlet obstruction in men: Detrusor wall thickness, uroflowmetry, postvoid residual urine, and prostate volume. Eur Urol 2007;52:827-34.