Neurourology and Urodynamics ICS Teaching Module: Ambulatory Urodynamic Monitoring G. Alessandro Digesu, 1 * Clara Gargasole, 1 Caroline Hendricken, 1 Michelle Gore, 1 Ervin Kocjancic, 2 Vik Khullar, 1 and Peter F. Rosier 3 1 Department of Urogynaecology, Imperial College Healthcare NHS Trust, London, United Kingdom 2 Department of Urology, University of Illinois at Chicago, Chicago, Illinois 3 University Medical Centre Utrecht—Urology, The Netherlands Aim: To present the ICS Teaching Module on ambulatory urodynamics monitoring (AUM). Methods: This teaching module has been developed by the ICS Urodynamics Committee to assist ICS members in their routine clinical practice. A detailed literature search on studies published on the clinical role of AUM as well as expert opinions have been considered. A slide set on AUM has been developed, approved by all members of the ICS Urodynamics Committee and is available to the ICS membership on the ICS website. The final approved teaching module has been presented at the ICS Annual Scientific Meeting in Brazil 2014. Results: The scientific evidence on the clinical role of AUM in patients with lower urinary tract symptoms is summarized. The catheters and recording systems used, the patient preparation for the test, the technique, the instructions to the patient, the analysis, interpretation, and quality control assessment of AUM trace as well as the contraindications for AUM are described. Conclusions: The clinical role of AUM is still controversial. The scientific evidence on the usefulness of AUM is still limited but the ICS Urodynamics Committee recommends its use as a second line diagnostic tool when office laboratory urodynamics have failed to achieve a diagnosis. AUM has been showed to be more sensitive than laboratory urodynamics in diagnosing detrusor overactivity but the level of evidence for this measurement is not high. This manuscript summarizes the evidence and provides practice recommendations on AUM for teaching purposes in the framework of an ICS teaching module. Neurourol. Urodynam. 9999:1–4, 2015. # 2015 Wiley Periodicals, Inc. Key words: ambulatory urodynamics; ICS teaching module; inconclusive urodynamics; lower urinary tract symptoms INTRODUCTION Ambulatory Urodynamic Monitoring (AUM) has been men- tioned in International Continence Society (ICS) standards. 1–2 AUM may be considered a useful tool to investigate lower urinary tract dysfunction (LUTD) in patients with lower urinary tract symptoms (LUTS) and inconclusive results on laboratory urodynamic testing. 3,4 The clinical sensitivity and specificity of AUM are not very well established and the specific technical demands and the technical reliability are deliberated. 1–2,5 To date there is no clear consensus about the role of AUM in the assessment of LUTD. 6,7 Although the here above mentioned standards suggest some practical aspects, they do not cover all issues arising with clinical testing. The ICS Urodynamics Committee presents the teaching module ‘‘Ambulatory Urody- namic Monitoring’’ to serve as a standard education of Good Urodynamic Practice for everyone involved in indicating, performing, and analyzing urodynamic testing in general and more specifically, performing AUM. The teaching module consists of a PowerPoint presentation, in combination with this manuscript. This manuscript serves as a scientific background review; the evidence base for the ICS PowerPoint presentation, which is available via http://www.icsoffice.org/ eLearning. The presentation explains testing requirements, clinical workup, and analysis. The presentation and this manuscript are based on the highest-level available published evidence, graded according to the modification of the Oxford Center for Evidence-Based Medicine levels of evidence as also used by the 5th International Consultation on Incontinence. Where evidence is unavailable, experts’ opinion has been used and the sentence is marked as ‘‘eo’’ (experts’ opinion). The aim of this ICS Teaching Module is to provide a summary of the published literature on the role of AUM in clinical research practice, including indications. Furthermore the technique and a practice protocol for AUM including troubleshooting and interpretation are presented. Evidence and Philosophy of AUM Conventional urodynamics is the standard clinical tool to investigate LUTD. 2,8 However, it has been reported that it can fail to precisely demonstrate the cause of (storage) LUTS in 19–44% of the cases. 2–4 This may be due to the shorter duration of the test, thus abnormalities are not detected before the end of recording. Lack of correlation between abnormalities detected and symptoms reported by patients may also play a role since it is well known that in LUTD, signs and symptoms are neither very specific nor sensitive towards the dysfunction. 9 When conventional urodynamics is inconclusive, AUM may be helpful in diagnosing the cause of the symptoms and guiding more appropriate management of patients. In particular, AUM has been observed to have an increased detection of detrusor overactivity. 10–16 However, the fact that AUM shows abnormalities, especially detrusor overactivity, in healthy volunteers may also be consid- ered a sign of lesser specificity, apart from the fact that a person’s perception of LUT function may be ‘‘false negative.’’ 17–20 There is single center expert retrospective evidence that stress urinary incontinence became detectable during AUM with a leakage Prof. Christopher Chapple led the peer-review process as the Associate Editor responsible for the paper. Potential conflicts of interest: Nothing to disclose. Ã Correspondence to: G. Alessandro Digesu, M.D., Ph.D., Department Of Urogynae- cology, St. Mary’s Hospital, Cambridge Wing, Praed Street, W2 1NY London, United Kingdom. E-mail: a.digesu@imperial.ac.uk Received 3 November 2015; Accepted 5 November 2015 Published online in Wiley Online Library (wileyonlinelibrary.com). DOI 10.1002/nau.22933 # 2015 Wiley Periodicals, Inc.