Videourodynamics combines a routine urodynamic study with X-ray or ultrasound imaging. Videourodynamics/ fluorourodynamics (FUDS) is used for patients with complicated lower urinary tract dysfunction. In patients with neurologic conditions and lower urinary tract dysfunction, videourodynamics may enable a more accurate diagnosis. Because of the invasiveness, radiation exposure, and high initial and running costs, FUDS should not be considered as a first-line evaluation.

The indications for videourodynamics in incontinent patients are neurogenic lower urinary tract dysfunction and incontinence. In these patients, FUDS may help define the cause of incontinence when simple urodynamic studies do not lead to a definite diagnosis, or after failure of initial therapy based on less complicated methods of diagnosis.

The advantages of videourodynamics stem from the simultaneous measurement of pressure and visualization of the anatomy. Videourodynamics may reveal the following:

• Incompetent bladder neck

• Inadequate urethral closure during filling

• Location of urethral obstruction during voiding

• Descent of the bladder base

• Bladder base hypermobility (Figure 3-2.12)

• Intrinsic sphincter deficiency

• Incontinence as a leakage of contrast medium, which is demonstrated fluoroscopically

• Dyssynergia between detrusor and external sphincter or bladder neck

• Any sign of reflux during the filling or voiding phase

• Bladder or urethral diverticulum or other anatomical malformations

Figure 3-2.12. Bladder neck movement 2 cm during cough (hypermobility).
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