Diagnostic and Therapeutic Outcomes of Ambulatory Urodynamics in a Tertiary Referral Center

Introduction: Conventional urodynamic studies have been variably reported to be unable to reproduce a patients' symptoms (3.5%–68%) and detrusor overactivity (DO) can be missed in up to 54% of cases. Tertiary referral centers have reported successful diagnostic yield of ambulatory urodynamic studies (AUDS) in 74%–98%. However, it's clinical utility has been questioned. We aimed to evaluate the diagnostic and therapeutic outcomes of our tertiary AUDS service. 

Methods: A retrospective review was undertaken of consecutive patients attending for AUDS, including local and regional referrals. Data was collected on patient demographics, indication, urodynamic diagnosis, and subsequent management. 

Results: One hundred and forty two AUDS procedures were evaluated. Median age was 59 years (range 23–90); 18% were male and 42% regional referrals. A urodynamic diagnosis was made in 80% patients. Thirty-five percent were diagnosed with idiopathic detrusor overactivity, 32% with stress urinary incontinence and 11% were found to have mixed urinary incontinence. There was a change from baseline urodynamic diagnosis in 69%. Of those with follow-up information available (n = 81), 74% had a change in management, including 59% considered for surgical intervention. No patients went on to require further urodynamic investigation when symptoms were not reproduced on AUDS. 

Conclusion: AUDS successfully diagnosed 80% of patients referred with inconclusive conventional UDS, translating to change in management and surgical intervention. AUDS is an important tool in select patient groups, to reproduce symptoms and guide management, where conventional UDS has failed.