Are video-urodynamics superior to traditional urodynamic studies in changing treatment decision with urinary symptoms?

Objective: To investigate the utility of video-urodynamic studies (VUDS) in patients with various urinary conditions and to evaluate if the addition of fluoroscopic imaging changes the treatment plans one would pursue if urodynamic studies (UDS) alone were performed as VUDS increases cost, radiation exposure, and patient discomfort. Patients and Methods: A retrospective chart review was conducted on all women who underwent VUDS from 2013 to 2015 at one institution. We hypothesised that the addition of the fluoroscopic images would not change the treatment plan. The protocol was conducted in two parts: (i) analysis of the patients’ demographics, history, presentation, and VUDS results; then (ii) comparison of the documented VUDS diagnosis and plan with the theoretical diagnosis and plan of UDS alone. Results: Charts from 156 women were analysed. Fluoroscopic findings impacted the treatment plan in 60 patients. In 38 patients, fluoroscopic findings changed or added to the diagnosis. Vesico-ureteric reflux (VUR) was detected in 16 patients, nine were incidental findings (P < 0.001) in which there were no UDS findings of urinary retention (P = 0.01) or poor compliance (P = 0.02). Fluoroscopic findings of VUR significantly changed diagnosis (P < 0.001), but did not significantly change the treatment plan (P = 0.09). Conclusion: We conclude that fluoroscopic findings from VUDS do not add to or change the treatment plan. If there is a clinical concern for VUR, UDS with renal imaging would be able to detect findings or potential damage to the upper urinary tract without needing VUDS. Abbreviations: DESD: detrusor–external sphincter dyssynergia; LUT: lower urinary tract; POP: pelvic organ prolapse; PVR: post-void residual urine volume; SUFU: society of urodynamics, female pelvic medicine and urogenital reconstruction; (V)UDS: (video-) urodynamic study; UI: urinary incontinence