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Purpose The primary aim of this study was to evaluate the indications and additional information provided by videourodynamic study (VUDS) over urodynamic studies (UDS) in men with spinal cord injury (SCI) and neurogenic lower urinary tract dysfunction (NLUTD). The secondary aim was to determine the added value of VUDS and its impact on bladder management. Materials and Methods Single‐centre retrospective study of all men with SCI who underwent VUDS between 2011 and 2021. Participant characteristics, clinical data and indications for UDS and VUDS as well as bladder management were recorded. The added value of VUDS was defined as additional information not provided by standard UDS that impacted on bladder management (choice of voiding mode, surgical indication or type of surgery). Results Eighty‐eight men with a median age of 52 years were included. In 20 men who were unable to perform self‐catheterisation, the VUDS clarified the nature and extent of the obstruction and enabled targeted surgery to achieve reflex bladder emptying in all of them. VUDS also clarified the type and level of obstruction in 28 patients, enabling targeted surgery in 24. In 11 men, VUDS was performed as part of the preoperative assessment for a Brindley procedure or after this operation if a complication occurred during follow‐up to confirm the need for further surgery or to target surgical revision. Overall, VUDS had added value in 59 patients (67%). Conclusions VUDS had added value over UDS in specific situations; the additional information provided impacted on bladder management in men with SCI and NLUTD.

Introduction: The utility of a clinical tool lies in its clinical performance evaluation and describes the relevance and usefulness of that tool in a medical setting. The utility of urodynamic and video-urodynamic studies in the management of specific urodynamic profiles in the diagnosis, treatment, and prognostic approach in neuro-urological patients is the focus of the current review. Methods: For this narrative review, a PubMed® search was performed by cross-referencing the keywords “urodynamics”, “neurogenic bladder”, “utility”, “clinical utility” and “clinical performance” with various terms related to the management of neurogenic lower urinary tract dysfunction. Clinical practice guidelines and landmark reviews from the most renowned experts in the field were also used. Analysis: Assessment of the utility of urodynamic study was performed during the diagnostic, therapeutic and prognostic steps of the neuro-urological patients’ management. We focused on its clinical performance in the identification and evaluation of several unfavorable events, such as neurogenic detrusor overactivity, detrusor-sphincter dyssynergia, elevated detrusor leak point pressure and the presence of vesico-ureteral reflux, which may be indicators for a higher risk for the development of urological comorbidities. Conclusion: Despite the paucity of existing literature assessing the utility of urodynamic study—specifically video-urodynamic study—in neuro-urological patients, it does remain the gold standard to assess lower urinary tract function precisely in this patient category. With regard to its utility, it is associated with high clinical performance at every step of management. The feedback on possible unfavorable events allows for prognostic assessment and may lead us to question current recommendations.

Pain and discomfort may occur in catheterization during a urodynamic examination. A lidocaine gel combined with a water-based lubricant is sometimes used to reduce pain during catheterization. Several studies claimed that intraurethral lidocaine administration could cause inaccurate urodynamic parameters results. However, its definite effects in urodynamics testing on humans are still not clear. We aimed to evaluate the effects of intraurethral lidocaine on pain and urodynamic study parameters in patients undergoing an invasive urodynamic examination. A systematic search adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol was performed in the MEDLINE, PubMed, and ScienceDirect databases for randomized controlled trials (RCTs). The bias of the studies is evaluated using the Cochrane risk of bias tool by two independent reviewers. The analyses of continuous outcomes were displayed as mean difference (MD), whereas odds ratio is used to analyze dichotomous data. Heterogeneity between studies is determined using the I2 value. A total of three RCTs out of 622 discovered that articles were eligible for analysis. Forest plot analysis of the mean visual analogue scale difference of the studies indicated an insignificant difference between the lidocaine and placebo group (MD –7.68; 95% CI –34.04 to –18.68, P ¼ .57). All urodynamic parameter results were also similar between the two groups (P > .05). Routine intraurethral lidocaine injection prior to a urodynamic study does not affect pain intensity and urodynamic parameters. Cite this article as: Paramita Oktaviani D, Ayodhia Soebadi M, Pradnyan Kloping Y, Hidayatullah F, Aulia Rahman Z, Soetojo S. Intraurethral lidocaine use during urodynamics in female patients: A systematic review and meta-analysis. Turk J Urol. 2021; 47(5): 366-374.

Abstract   Urodynamic studies assess the function of the bladder and bladder outlet. They are often useful in the assessment and diagnosis of patients presenting with lower urinary tract symptoms (LUTS). The evidence regarding the value and risks of invasive urodynamics remains insufficient. However, men with LUTS who are assessed by invasive urodynamics are more likely to have their management changed and less likely to undergo surgery. This review discusses the role of urodynamic diagnosis and application in the diagnosis and treatment of male LUTS.   Cite this article as: Gürbüz C, Drake MJ. Where can urodynamic testing help assess male lower urinary tract symptoms? Turk J Urol 2019; 45(3): 157-63.

Objective: To determine the frequency of various neurogenic bladder patterns in patients with traumatic spinal cord injury presenting at Armed Forces Institute of Rehabilitation Medicine Rawalpindi based on urodynamic studies. Study Design: Descriptive cross sectional study. Place and Duration of Study: Armed Forces Institute of Rehabilitation Medicine (AFIRM) Rawalpindi, from Jul 2014 to Jun 2016. Material and Methods: One hundred and forty traumatic spinal cord injury patients fulfilling the inclusion criteria were included both from indoor and outdoor departments through non-probability purposive sampling. Urodynamic studies were performed using the urodynamic equipment at urodynamic laboratory. Data were collected and recorded on specialized proforma by the principal investigator. Results: Among 140 study participants detrusor overactivity was found in 100 patients out of which 76 (76%) had thoracic level of injury, 20 (20%) had cervical level and 4 (4%) had lumbar level of injury. Detrusor areflexia was the bladder pattern in 40 patients out of which 26 (65%) had thoracic level of injury, 10 (25%) had cervical level, and 4 (10%) had lumbar level of injury. Conclusion: Detrusor overactivity was the commonest neurogenic bladder pattern among the traumatic spinal cord injury patients.  , , , 

According to National Spinal Cord Injury Statistical Center (NSCISC) of United States (U.S.) the annual incidence of SCI is approximately 54 cases per million population or approximately 17,000 new cases each year and prevalence is approximately 282,000 persons2. According to ASIA impairment scale classification most of the patients i.e. 102 (72.9%) were in ASIA A (fig-2). According to the latest statistics from NSCISC of U.S.2, the average age at injury is 42 years and our study shows that the mean age was 40.7 ± 11 years. Wyndaele JJ and others concluded that clinical neurological examination alone is inadequate to predict type of NB dysfunction especially in the setting of combined supra-sacral and sacral injuries16-18. [...]the old fashioned way of according to the NSCISC statistics of U.S.2, is RTA in 38%, and so was in our study where RTA was the etiology of SCI in 47.9% but according to our results acts of violence (blast injuries and gunshot injuries) account for a greater percentage of patients (13.6% and 10.7% respectively) as compared to NSCISC statistics of U.S.2 according to which acts of violence (gunshot wounds) in account for the etiology in 14%.

To investigate the applicability of ChatGPT, in answering conceptual and non-conceptual questions related to urodynamic quality control, including trace analysis and report interpretation. Utilizing a structured questioning approach, the study employs ChatGPT3.5 and ChatGPT4.0. Questions are mainly divided into conceptual questions and non-conceptual questions related to urodynamic quality control, and trace analysis. Evaluation criteria include alignment with the “Good Urodynamic Practice” guideline and literature. ChatGPT excels in delivering hierarchical responses to conceptual questions, providing comprehensive insights in a structured format. Challenges arise in offering specific references to published literature, with a 50% accuracy rate in 10 basic conceptual questions. For non-conceptual urodynamic quality control questions, ChatGPT achieves a 50% accuracy rate, accurately addressing various aspects. However, in both cases, we found no statistically significant difference in accuracy rate between conceptual questions and non-conceptual questions. However, challenges persist when questions are linked to recent literature, leading to misunderstandings and inaccurate responses. Regarding urodynamics trace interpretation, ChatGPT states its inability to directly analyze images, emphasizing reliance on qualified healthcare professionals for detailed clinical analysis. This study preliminarily demonstrates ChatGPT’s limited performance in answering conceptual and non-conceptual questions related to urodynamic quality control, without finding significant differences between the two kinds of questions. Additionally, ChatGPT’s capability to process image data for urodynamic trace analysis is non-existent. The study suggests that ChatGPT only has the potential to serve as an \"electronic dictionary” to aid urodynamic operators, but it should be noted that this study cannot prove ChatGPT’s ability to change the overall quality of urodynamic examinations.

Diagnosing underlying causes of nonneurogenic male lower urinary tract symptoms associated with bladder outlet obstruction (BOO) is challenging. Video-urodynamic studies (VUDS) and pressure-flow studies (PFS) are both invasive diagnostic methods for BOO. VUDS can more precisely differentiate etiologies of male BOO, such as benign prostatic obstruction, primary bladder neck obstruction, and dysfunctional voiding, potentially outperforming PFS. These examinations' invasive nature highlights the need for developing noninvasive predictive models to facilitate BOO diagnosis and reduce the necessity for invasive procedures. We conducted a retrospective study with a cohort of men with medication-refractory, nonneurogenic lower urinary tract symptoms suspected of BOO who underwent VUDS from 2001 to 2022. In total, 2 BOO predictive models were developed-1 based on the International Continence Society's definition (International Continence Society-defined bladder outlet obstruction; ICS-BOO) and the other on video-urodynamic studies-diagnosed bladder outlet obstruction (VBOO). The patient cohort was randomly split into training and test sets for analysis. A total of 6 machine learning algorithms, including logistic regression, were used for model development. During model development, we first performed development validation using repeated 5-fold cross-validation on the training set and then test validation to assess the model's performance on an independent test set. Both models were implemented as paper-based nomograms and integrated into a web-based artificial intelligence prediction tool to aid clinical decision-making. Among 307 patients, 26.7% (n=82) met the ICS-BOO criteria, while 82.1% (n=252) were diagnosed with VBOO. The ICS-BOO prediction model had a mean area under the receiver operating characteristic curve (AUC) of 0.74 (SD 0.09) and mean accuracy of 0.76 (SD 0.04) in development validation and AUC and accuracy of 0.86 and 0.77, respectively, in test validation. The VBOO prediction model yielded a mean AUC of 0.71 (SD 0.06) and mean accuracy of 0.77 (SD 0.06) internally, with AUC and accuracy of 0.72 and 0.76, respectively, externally. When both models' predictions are applied to the same patient, their combined insights can significantly enhance clinical decision-making and simplify the diagnostic pathway. By the dual-model prediction approach, if both models positively predict BOO, suggesting all cases actually resulted from medication-refractory primary bladder neck obstruction or benign prostatic obstruction, surgical intervention may be considered. Thus, VUDS might be unnecessary for 100 (32.6%) patients. Conversely, when ICS-BOO predictions are negative but VBOO predictions are positive, indicating varied etiology, VUDS rather than PFS is advised for precise diagnosis and guiding subsequent therapy, accurately identifying 51.1% (47/92) of patients for VUDS. The 2 machine learning models predicting ICS-BOO and VBOO, based on 6 noninvasive clinical parameters, demonstrate commendable discrimination performance. Using the dual-model prediction approach, when both models predict positively, VUDS may be avoided, assisting in male BOO diagnosis and reducing the need for such invasive procedures.

Post-prostatectomy continence status, in addition to lower urinary tract symptoms, is a major concern among patients after robotic-assisted radical prostatectomy (RaRP). In this prospective study, we enrolled patients undergoing RaRP to evaluate subjective urinary symptoms and objective urodynamic parameters before and after surgery. Patients were recruited before RaRP surgery between January 2019 and August 2020. One day before surgery, the participants completed three questionnaires and pressure-flow studies, which were repeated approximately 3 months postoperatively. Of the total 135 patients initially enrolled, 85 (63.0%) completed the entire follow-up period. Three months after RaRP, the International Prostate Symptom Score showed significant increases in storage symptoms. Similar trends were observed in the Urinary Distress Inventory Short Form, and Overactive Bladder Symptom Score questionnaires. More than half of the patients regained continence within 2 months, although 9.6% remained incontinent after 1 year. Postoperative urodynamic studies indicated increased bladder hypersensitivity and significantly decreased detrusor pressure at peak flow. Furthermore, the bladder contractility index and bladder outlet obstruction index were reduced postoperatively. Ten patients (11.8%) developed de novo detrusor overactivity. The multivariate analysis identified age and cross-sectional area of the bladder neck as predictors of immediate continence after RaRP.

Introduction and Hypothesis This study was aimed at investigating non-invasive indicators correlated with detrusor overactivity (DO) and at developing a prediction model for DO by reviewing clinical and urodynamic data of female patients. Methods We retrospectively enrolled 1,084 female patients who underwent a urodynamic study (UDS) at Tongji Hospital between September 2011 and April 2021. Associated factors and the independent prediction factors of DO were demonstrated by univariate and multivariate analysis. A non-invasive prediction model of DO was developed and validated by applying these data. Results A total of 194 patients (17.9%) were classified as having DO. A logistic regression of a multivariate nature showed that DO risk factors were independent of age, nocturia, urgency, urgency urinary incontinence (UUI), and the lack of stress urinary incontinence (SUI). The DO prediction model had good performance, with an area under the curve of 0.880 (95% CI 0.826–0.933), which was verified by urodynamic data of patients in Tongji Hospital to be 0.818 (95% CI 0.783–0.853). An outstanding correspondence between the anticipated probability and the observed frequency was revealed by the calibration curve. Decision curve analysis demonstrated that clinical net benefit can be obtained by applying the DO prediction model when the DO risk probability was between 8 and 97%. Conclusions A non-invasive prediction model of DO was developed and validated using clinical and urodynamic data. Five independent factors associated with DO were identified: age, nocturia, urgency, UUI, and SUI. This prediction model can contribute to assessing the risk of female DO without the need for invasive urodynamic studies.