Establishing the benefit of video-urodynamics after non-diagnostic cystometrograms
BAUS ePoster online library. Toia B. Jun 24, 2019; 259517; P3-3
Bogdan Toia
Bogdan Toia
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Abstract
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INTRODUCTION

Complementing cystometrograms (CMG) with fluoroscopic imaging (video-urodynamics, VCMG) contributes additional anatomic detail and possibly pathophysiology of the urinary tract. Literature on the utility of this supplementary information is sparse and contradictory. We assessed whether the addition of fluoroscopic imaging changed diagnosis and management in a cohort of patients with lower urinary tract symptoms

Methods 
Fifty consecutive patients that underwent CMG, followed subsequently by VCMG were included. The data extracted included CMG and VCMG findings (diagnosis), surgical management and functional outcomes. All cytometrograms were performed for indications in accordance to NICE guidelines and ICS protocols

RESULTS

The patients included 24 men and 26 women, of whom 17 had neuropathic LUTS and the rest had non-neuropathic incontinence. The VCMG changed the primary CMG diagnosis in 16 patients (32%), leading to a change in treatment decision in 14 patients (26%). Two patients had a new diagnosis of stress urinary incontinence seen on fluoroscopy treated by pessaries and pelvic floor physiotherapy respectively. Two patients had significant bladder descent quantified, changing intervention from a mid-urethral sling procedure to colposuspension. De novo detrusor overactivity was identified in 5 patients.

Conclusions
VCMG following a non-diagnostic CMG changed the diagnosis in 32% of patients. In 10 patients (20%) the diagnosis was altered by the fluoroscopy, and in five others (10%) de novo overactivity was picked up in the second more detailed study. Patient interventions were altered by these findings. Further research is required to outline subpopulations and establish the risk and cost benefits ratios
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