The Role of Videourodynamics in the Assessment of Bladder Dysfunction

Diagnosis and management of lower urinary tract symptoms can sometimes represent a challenge. In complex cases, first-line diagnostic approaches and conservative treatment often fail, and the clinical condition may require advanced investigational methods. Videourodynamics is the most complete diagnostic evaluation of the lower urinary tract. Due to its minimally invasive characteristics, such as the need for bladder and rectal catheterization, the use of X-rays, and costs that are higher than non-invasive procedures (such as ultrasound), the international guidelines recommend the use of Videourodynamic in the following selected cases: when a conclusive diagnosis has not been achieved through first-line methods, in patients suffering from bladder dysfunction of neurogenic origin, and in those cases that require advanced diagnostic procedures for decision-making, especially before surgery. Experience with Videourodynamic is not widely represented in all urological centers and usually, this procedure is performed by dedicated, well-trained, expert urologists. For this reason, specific data on this topic are poorly represented in the scientific literature. In this chapter historical, technical, and clinical aspects of videourodynamics are described, reporting the application of this tool in different urological conditions: bladder outlet obstruction, neurologic disease, urinary incontinence, congenital disorders, inflammatory disease, and renal transplantation. For each of these topics, clinical indications, methods, outcomes, and utility of Videourodynamic are clearly described, showing the advantages that it can provide for proper diagnosis, contributing to making the best therapeutic choice.