Characteristics Associated With Abnormal Video Urodynamics.

IMPORTANCE

Urodynamics evaluates lower urinary tract function. Video urodynamics (VUDS) provides additional anatomic information with fluoroscopy. Fluoroscopy requires additional personnel, equipment, and radiation precautions. However, VUDS can be valuable in certain patients.

OBJECTIVE

The objective of this study was to identify patient characteristics associated with abnormal fluoroscopy findings to improve VUDS patient selection.

STUDY

DESIGN

A retrospective chart review of women 18 years or older undergoing urodynamic studies was conducted from January 2022 to September 2025 at an urban academic institution. Demographics, relevant medical history, fluoroscopy findings, evidence of neurogenic lower urinary tract dysfunction (NLUTD), and radiation time and exposure were collected. Statistical analyses used R version 4.4.2 (R Core Team, 2025) and JMP v.16.2 software (SAS Institute Inc, Cary, NC).

RESULTS

Of 223 patients, 148 (66.4%) had a normal bladder appearance, whereas 75 (33.6%) had abnormalities. Older age was associated with abnormal findings (P<0.001). Mixed urinary incontinence (MUI) was the primary VUDS indication in the normal group (36.9%), compared with urinary retention in the abnormal group (56.0%). The abnormal group experienced higher radiation time (0.22 vs 0.28 min, P<0.001) and exposure (4.22 vs 5.50 mGy, P=0.02). The most common NLUTD etiology was early-stage multiple sclerosis in the normal group (31.2%) and diabetic cystopathy in the abnormal group (19.0%).

CONCLUSIONS

Abnormal VUDS findings were associated with diabetic cystopathy or urinary retention, whereas normal VUDS findings were associated with MUI or early-stage multiple sclerosis. Our findings highlight the potential opportunity to use VUDS judiciously based on individual clinical scenarios.