For example, women with classic stress incontinence and a normal PVR can be started on pelvic muscle exercises. Patients with symptoms of urge incontinence and a normal PVR can be started on behavioral therapies or medications. This empirical approach will lead to successful management of a large percentage of incontinent elderly patients. When the cause of the incontinence is unclear or the patient fails to respond to empirical therapy, more detailed urodynamic evaluation may be warranted. Specialized studies include urodynamic and endoscopic tests and imaging studies.
Urodynamic studies determine the anatomic and functional status of the lower urinary tract.
Bedside evaluation of the urinary tract using simple cystometry can be performed by office-based physicians. Multichannel cystometric tests are indicated when the diagnosis remains in question or the patient needs surgical intervention. In the most frail patients, it may not be practical to perform a full array of urodynamic studies. Furthermore, urodynamic diagnosis in these patients does not predict responsiveness to bladder training or prompted voiding. If there is no contraindication, behavioral techniques, environmental modifications, or medications should be tried before urodynamic testing is performed.