Urodynamic Findings in Pelvic Floor Dysfunction

Introduction to Pelvic Floor Dysfunction

The American Urological Association guidelines note that urodynamic testing is valuable in diagnosing voiding dysfunction in patients with complex lower urinary tract symptoms 3
Pelvic floor dysfunction is a common finding in patients with chronic pelvic pain and lower urinary tract symptoms with normal urinalysis, characterized by perineal pain, constipation, intermittent dysuria, and pelvic muscle tenderness on rectal exam 1

The typical urodynamic pattern for dysfunctional voiding is a staccato or intermittent flow with reduced maximal flow rate and prolonged flow time 2
Urodynamic studies would likely reveal a staccato or intermittent flow pattern, reduced maximum flow rate, prolonged flow time, and EMG activity during voiding in patients with detrusor-sphincter dyssynergia 1, 2

The identification of detrusor-sphincter dyssynergia has important treatment implications, including pelvic floor physical therapy as the first-line treatment, biofeedback therapy to improve coordination between detrusor contraction and sphincter relaxation, and treatment of constipation to prevent exacerbation of pelvic floor dysfunction 1, 2
Treatment of constipation has been shown to result in significant improvement in bladder emptying, highlighting the importance of addressing bowel dysfunction in patients with pelvic floor dysfunction 2
Urodynamic testing is necessary to confirm the diagnosis of detrusor-sphincter dyssynergia, as relying solely on physical examination may lead to misdiagnosis 3