A critical view on the value of urodynamics in non-neurogenic incontinencein women

The requirements for reliable urodynamics are standardized techniques, incl uding uniform pressure sensors, filling rates, position and posture during the investigation. and uniform diuresis. Physiological variations in flow a nd urethral pressure profile (UPP) (menstrual cycle, intensity of coughing, circadian variations) must be considered. Parameters of the UPP (maximum ( closure) urethral pressure, pressure-transmission ratio and leak-point pres sure) are useful if interpreted with caution. Uninhibited detrusor contract ions are more frequently recorded in ambulatory urodynamics, and range from 'subthreshold' to very strong. No quantification formulae correlate with s ubjective symptoms or degree of urge (incontinence). Mixed incontinence can make the results of surgery worse, but do not so necessarily. Postoperativ e dysuria cannot be predicted from urodynamics, as surgical factors are mor e important. Electromyography is not useful in non-neurogenic female incont inence. For routine non-neurogenic incontinence extensive urodynamic testin g can be reduced to one pressure measurement; more complicated cases must b e tested by a physician with large practical experience and a theoretical b ackground.