Some women with lower urinary tract symptoms will require more extensive investigation than that outlined in chapter 3. Additional assessment may require any or a combination of urodynamics, cystoscopy and urinary tract imaging. It is important that any clinician referring a patient for such tests has an understanding of what the tests entail and the indications for them.

Urodynamic studies

Urodynamic studies include uroflowmetry, post-void residual measurement and cystometry.

CLINICAL INDICATIONS FOR URODYNAMIC ASSESSMENT

Complex mixed lower urinary tract symptoms

Some women present with such a complicated history that it is impossible to make any judgement as to whether they are suffering from urinary stress incontinence, detrusor overactivity or voiding dysfunction. Such women cannot be treated empirically and they should progress without delay to a urodynamic assessment so that treatment can be tailored appropriately.

Before surgery for urinary stress incontinence

Stress incontinence is the most common cause of urinary leakage in women. If pelvic floor physiotherapy fails, surgery is the definitive treatment. History alone may be an adequate preoperative assessment in women presenting with pure stress incontinence symptoms and the National Institute for Health and Clinical Excellence (NICE) recommends that such women have primary continence surgery without further urodynamic investigation.