To assess the use relationship between clinical and urodynamics (UD) diagnosis.

This was a national multicenter study on correspondence between clinical indications and UD results in Italy in the pre-Covid era 2018-19. Additional UD diagnoses were also recorded. This period has been chosen to have a real UD management scenario, because access to hospitals and UD offices has been reduced in the last 2 years due to the Covid-Sars limitations. Urological and gynecological centers were involved. Data on men and women were retrospectively collected between January and December 2022. Indications to UD and related UD diagnosis were evaluated to investigate the rate of correspondence. In females main indications recorded were: urinary incontinence (stress, urtgency, mixed), voiding dysfunction. Pelvic organ prolapse was assessed to investigate the UD results in this group of women. In men, bladder outlet obstruction (BOO), urinary retention (UR), iatrogenic urinary incontinence (UI) in 81%, overactive bladder syndrome (OAB), voiding dysfunctions (VD) were recorded as main indications.

Centers involed were 13: 11 urological, 2 gynecological. Data were collected on 2358 patients, 1329 (56.4%) women with median age 62 y.o and 1029 men (43.6%) with median age 68 y.o.. The relationship between the main females indications and UD outcomes, with addional UD diagnoses, are reporte in table 1. In males, correspondences were as follows: bladder outlet obstruction (BOO) in 79.1%, urinary retention (UR) in 81.9%, iatrogenic urinary incontinence (UI) in 81%, overactive bladder syndrome (OAB) in 81.7%, voiding dysfunctions (VD) in 86.9%, concomitant BOO and OAB in 87.2%.

The correlation between clinical indications and UD outcomes was high in males, so outpatient evaluation was highly reliable. Correspondence between BOO clinical and UD diagnosis was great, and, interestingly, also the association BOO/OAB was highly detected at UD. In females, the match rate was >50% in SUI and VD conditions only. The most misleading clinical diagnoses were those related to urgency (UUI and MUI); in the latter, UD demonstrated different diagnoses in many patients. The low correspondence between clinical urgency (UUI and MUI) and UD diagnosis may be related to an incorrect clinical diagnosis or to a most complicated patient’s condition misleading the clinical diagnosis, or to a limit in the UD diagnosis. However, this finding highlights the relevance of UD investigation in female UI to obtain a proper diagnosis and avoid further unnecessary treatment. Among women with SUI, approximately 10% had detrusor overactivity (DO) or voiding disorders. In patients with symptomatic POP, UD demonstrated that VD and DO were often associated, while DUA occurred only in a smaller proportion of women.

A high relationship between clinical indications and UD  results was found in men, while in females only in case of SUI and VD. UD was still usefull in helping to reach a correct diagnosis avoiding potential further unnecessary treatments.

Continence 12S (2024) 101458
DOI: 10.1016/j.cont.2024.101458