Introduction to Complex Urodynamics_On-Demand-Introduction to Complex Urodynamics

Video Transcription

Video Summary

Dr. Patrick Leck delivered an insightful webinar on complex urodynamics, focusing on clinical evaluation and management of patients with complex voiding dysfunction, emphasizing there are complex patients rather than complex tests. He highlighted when urodynamic studies are most useful: suspected upper tract compromise due to lower urinary tract dysfunction, diagnosis confirmation difficult without urodynamics, pre-surgical assessment in frail patients, and unclear or discordant symptom presentations.<br /><br />The talk concentrated on two key pathologies: female bladder outlet obstruction (BOO) and impaired bladder compliance. Dr. Leck reviewed various urodynamic criteria and nomograms proposed over decades to define female BOO, noting variability and advocating a clinical approach combining high-pressure, low-flow patterns with radiographic evidence. He stressed the importance of fluoroscopy during urodynamics to localize anatomical or functional levels of obstruction, using several patient cases to illustrate diagnoses like urethral strictures, primary bladder neck obstruction, and high-tone pelvic floor dysfunction.<br /><br />Concerning impaired compliance, Dr. Leck emphasized early identification to protect upper tracts, presenting cases of neurogenic bladder patients with elevated storage pressures and vesicoureteral reflux visible only on video urodynamics. Treatment options include intravesical botulinum toxin and augmentation cystoplasty, guided by repeated urodynamics and clinical monitoring.<br /><br />In Q&A, Dr. Leck recommended selective repeat urodynamics post-intervention when results could influence management, described bladder neck incision techniques, and advised prioritizing urodynamics for patients with suspected impaired compliance or BOO rather than routine use in index uncomplicated cases. He advocated for pragmatic, symptom-driven approaches paired with urodynamics and fluoroscopy for diagnostic clarity and individualized treatment planning.

Keywords

complex urodynamics

voiding dysfunction

female bladder outlet obstruction

impaired bladder compliance

urodynamic studies

fluoroscopy in urodynamics

neurogenic bladder

botulinum toxin treatment

augmentation cystoplasty

bladder neck incision