Hypothesis / aims of study
Invasive urodynamics (UDS) plays a central role in the evaluation of lower urinary tract function. The aim of our study was to perform a review of the literature to identify the current evidence about patient perception, anxiety, tolerability, and pain during UDS, along with any potential strategies to improve them.
Study design, materials and methods
We performed a narrative literature search in PubMed / Web of Science databases and on Google Scholar, using the terms combination [Urodynamics] AND [Reluctance, Barrier, Worries, Anxiety, Embarrassment, Tolerability, Pain]. The search was completed by February 1st, 2026. We included English-written papers related to invasive UDS in adults only, reporting on: patient motivational issues about UDS; studies investigating patient perception / anxiety / tolerability / pain during UDS; papers reporting on attempted strategies to reduce patient anxiety / pain related to the test. According to the aim of the study, papers investigating on pediatric population, indications to UDS, and tests other than invasive UDS were excluded.
Results
After duplicates removal and abstracts screening, 46 studies were selected.
Some papers reported high UDS acceptance and tolerability by female patients undergoing the test to evaluate the need for pelvic organs prolapse surgery.[1]
As for discomfort / approach matters, according to some studies, neurogenic and older patients reported lower discomfort rates, while young age and apprehension, anxiety, or depression were correlated with less tolerance. UDS appeared to be well tolerated in women, with just a minority of female patients finding the test embarrassing, distressful or painful.
Several studies investigated how to improve patient comfort and tolerability. The universally accepted key element consisted in a friendly environment and a good communication during the test.[2] Some studies investigated the role of emotional support, including animated explanatory videos: they showed promising preliminary results, yet with some concerns about the real cost-effectiveness, according to the high UDS tolerability reported in the literature. Too detailed explanations failed to reduce patient anxiety.
Number of studies investigated the potential role of ancillary tools during UDS, including water running sound, music, aromatherapy, virtual reality headphones, mindfulness meditation, etc. The results showed conflicting findings if compared to usual care.[3]
Interpretation of results
Women expectations to avoid potentially “undesired/unneeded” surgery appeared as a valid motivational reason to accept UDS. This may represent a comforting note for physicians willing to have a UDS evaluation prior to surgery. Ancillary tools during UDS provided conflicting results: despite further studies could give more insights into this issue, in our opinion the currently debated benefit from ancillary tools may be interpreted as a confirmation that UDS is a generally well-tolerated procedure.