Urodynamic assessment of the bashful bladder

Purpose: We prospectively studied the potential contribution of ambulatory urodynamic monitoring in men with urinary symptoms unable to initiate a voi d on conventional video cystometrography. Materials and Methods: A total of 40 consecutive symptomatic men with a med ian International Prostate Symptom Score of 19 (range 1 to 29) and median a ge of 51.9 years (range 30 to 75) who were unable to void during video cyst ometrography underwent ambulatory urodynamic monitoring. Solid-state transd ucers mounted on silicone coated catheters were inserted urethrally and rec tally, and connected to a portable recorder. Subjects voided in private int o a specially designed flow meter, which they connected to the recording de vice. Results: Of the patients 2 (5%) failed to attend ambulatory urodynamic moni toring, despite multiple reminders, and in 1 (2.5%) the trace was uninterpr etable. Pressure flow data were available for the remaining 37 patients wit h mean plus or minus standard deviation 2.72 +/- 0.1 storage void. cycles r ecorded per patient. All 6 patients (15%) with obstruction were older than 40 years. In 6 cases (15%) obstruction was equivocal and the remainder were unobstructed. Transurethral prostatic resection in 2 and urethrotomy in 1 of 6 patients with obstruction resulted in subjective and objective improve ment. Conclusions: The bashful bladder syndrome was not associated with any speci fic urodynamic diagnosis. Ambulatory urodynamic monitoring will yield a uro dynamic diagnosis in more than 90% of cases after failure to record void da ta on video cystometrography. A surgically correctable cause of symptoms ca n be found in about 20% of men older than 40 years. The contribution of amb ulatory urodynamic monitoring compared to more conventional evaluation in m en younger than 48 years is negligible.