BJU International (1999), 84, 449–453 The tolerability of urodynamic studies and flexible cysto- urethroscopy used in the assessment of men with lower urinary tract symptoms B.B.M. KORTMANN, G.S. SONKE*, F.C.H. D’ANCONA, D.L. FLORATOS, F.M.J. DEBRUYNE and J.J.M.C.H. de la ROSETTE Department of Urology, University Hospital Nijmegen, and *Department of Epidemiologic Urology, University of Nijmegen, The Netherlands Objective To determine the overall tolerability of urodyn- bined investigations, compared with 24% and 5%, respectively, after a urodynamic study alone. Three amic studies used in the assessment of men with lower urinary tract symptoms (LUTS), by assessing the objec- patients (3%) had a symptomatic urinary tract infec- tion. Haematuria, increased voiding frequency and tive and subjective morbidity experienced during and after urodynamic studies, and to assess the voiding increased nocturia occurred occasionally. Most of the patients found the urodynamic study less bothersome complaints caused by the combination of urodynamic studies with flexible cysto-urethroscopy. than they had expected (64%) and only 9% found it worse than expected. The overall degree of discomfort, Patients and methods A total of 103 men with LUTS, who underwent a urodynamic study combined with experienced during and after the urodynamic study combined with cysto-urethroscopy, was low, and after flexible cysto-urethroscopy, completed a questionnaire designed to assess objective and subjective symptoms a second urodynamic study was even lower. Conclusion In contrast with earlier results, this clinic- and degree of bother, with emphasis on the urodyn- amic study. In addition, a urine specimen was analysed based urodynamic investigation was associated with a low proportion of urinary tract infection, and low and cultured. In all, 78 patients who underwent a second urodynamic study completed the question- objective and subjective morbidity. The combination of a urodynamic study with a flexible cysto- naire twice. Results The results of the first questionnaire showed that urethroscopy does not cause significant additional voiding complaints. Most patients find urodynamic more than half of the patients experienced some urge after the urodynamic study and cysto-urethroscopy studies tolerable and not very bothersome. Keywords Urodynamics, morbidity, tolerability, LUTS, (56%); 35% of the patients experienced little and 19% experienced severe voiding discomfort after the com- benign prostatic obstruction are better when BOO has been confirmed by a UDS with Introduction pressure-flow analysis [9]. Consequently, the ICS-‘BPH’ study group advised using such studies in evaluating and LUTS are common among elderly men [1]; most of these patients have symptoms that are caused by benign pros- choosing treatment for the patient presenting with LUTS [8]. Disregarding these considerations, the need for UDS tatic obstruction, whereas up to one-third of the symp- toms have other causes of LUTS, e.g. detrusor instability in the standard evaluation of patients with LUTS remains controversial [2,10,11]. Those who are not in favour of or detrusor underactivity [2]. It is generally accepted that a urodynamic study (UDS), including pressure-flow their routine use argue that they are invasive, costly, time-consuming and bothersome for the patient. analysis, is the ‘gold standard’ in diagnosing BOO [3,4]. The combination of symptom scores, uroflowmetry, ultra- Moreover, the success rate after surgery is also high, even though no urodynamic documentation of BOO is obtained sonography of the prostate, cysto-urethroscopy and measurements of postvoid residual volume (PVR) have [10]. These are strong arguments for not performing a UDS routinely; but are these arguments really valid? Are been unable to accurately identify the precise pathology underlying LUTS [5–8]. Moreover, treatment outcomes these studies really very bothersome to the patients and to what extent does the invasive character of the UDS cause morbidity? Accepted for publication 27 April 1999 449 © 1999 BJU International