Ambulatory urodynamics: do they help clinical management?

OBJECTIVE: To assess the contribution of ambulatory urodynamics to the treatment of women with urinary incontinence.
DESIGN: A retrospective casenote review of all women referred from the urogynaecology clinic for ambulatory urodynamic monitoring from 1 April 1994 to 31 December 1997.
SETTING: A teaching hospital tertiary referral centre urodynamic laboratory. PARTICIPANTS: Notes were retrieved of 71 women, 80% of whom had had the investigation because the conventional cystometrogram had been normal.
RESULTS: Technical difficulties occurred in 30 traces, two of which were not interpretable. Detrusor instability was diagnosed in 32 women, including three women who also had stress incontinence (42% of interpretable traces). Of these, 20 women were treated with anticholinergics compared with nine of 37 women where detrusor instability was not diagnosed. None of the women with detrusor instability were offered anti-incontinence surgery, compared with five of those where the bladder remained stable. Less than half the women who were treated with anticholinergic medication improved, but none were considered suitable for more aggressive treatment.
CONCLUSIONS: Although the diagnosis of detrusor instability may be increased by ambulatory urodynamics, this does not always translate into more effective treatment. Ambulatory urodynamic testing does not yet result in clinical improvements in diagnosis and treatment.