Common indications

1. Complex urinary incontinence
   • Mixed urinary incontinence
   • Urgency urinary incontinence when diagnosis is uncertain or treatment has failed
   • Incontinence without demonstrable stress leak on examination
   • Recurrent incontinence after prior anti-incontinence surgery
   • Suspected intrinsic sphincter deficiency or voiding dysfunction
2. Before invasive or irreversible treatment for stress urinary incontinence
   • Especially when symptoms and examination are discordant, or prior surgery/neurological disease/coexisting prolapse is present.
   • It is an option, rather than a necessity, in uncomplicated, demonstrable stress incontinence. The AUA/SUFU adult urodynamics guideline specifically states that multichannel UDS may be used before invasive, potentially morbid, or irreversible treatment.
3. Voiding symptoms or suspected bladder outlet obstruction
   • Weak stream, hesitancy, straining, intermittency
   • High post-void residual or urinary retention
   • To distinguish outlet obstruction from detrusor underactivity
   • Evaluation of suspected dysfunctional voiding
4. Neurogenic lower urinary tract dysfunction
   • Spinal cord injury, spina bifida, multiple sclerosis, Parkinsonism, stroke, etc.
   • To assess detrusor overactivity, detrusor-sphincter dyssynergia, bladder compliance, and risk of upper urinary tract damage.
5. Pelvic organ prolapse
   • Prolapse with urinary symptoms, especially when occult stress urinary incontinence, obstruction, or impaired emptying is suspected.
   • Preoperative assessment in selected complex cases.
6. Persistent symptoms despite treatment or uncertain diagnosis
   • Refractory overactive bladder/urgency
   • Symptoms that do not match physical examination, uroflowmetry, residual urine, or imaging findings
   • To decide whether escalation such as botulinum toxin, surgery, or catheterization is appropriate.
7. Upper tract risk or poor-compliance bladder
   • Hydronephrosis, recurrent febrile UTI, vesicoureteral reflux, or renal-function concern in suspected high-pressure storage dysfunction.

Key point

• “Is poor emptying caused by obstruction or weak detrusor contraction?”
• “Is there high-pressure storage in this neurogenic bladder?”
• “Is the incontinence truly stress-related before surgery?”