








































This is an open access article under the terms of a license that permits non-commercial use, provided the original work is properly cited.  
© 2021 The Authors. Société Internationale d'Urologie Journal, published by the Société Internationale d'Urologie, Canada.

Key Words Competing Interests Article Information

Lower urinary tract symptoms, overactive 
bladder, urinary leakage, detrusor overactivity, 
urge urinary incontinence, stress urinary 
incontinence, voiding dysfunction, ambulatory 
urodynamics

None declared. Received on May 6, 2021 
Accepted on July 31, 2021

Soc Int Urol J.2021;2(6):354–361

DOI: 10.48083/MHMI1178

354 SIUJ  •  Volume 2, Number 6  •  November 2021 SIUJ.ORG

ORIGINAL RESEARCH

Ambulatory Urodynamic Findings  
Change Patient Outcomes
Richard G. Axell,1 Vahit Guzelburc,2 Habiba Yasmin,1 Bogdan Toia,2 Mahreen H. Pakzad,2 Rizwan Hamid,2 
Jeremy L. Ockrim,2 Tamsin J. Greenwell2

1Medical Physics and Bioengineering, UCLH NHS Foundation Trust, London, United Kingdom 
2Department of Urology, UCLH NHS Foundation Trust, London, United Kingdom

This work was performed at UCLH NHS Foundation Trust, London, United Kingdom

Abstract

Objectives Whilst ambulatory urodynamics (aUDS) may be used as a second-stage test for patients with refractory 
lower urinary tract symptoms (LUTS) having non-diagnostic conventional urodynamics (UDS), the evidence for their 
use is limited. We have assessed the diagnostic utility and consequent symptomatic outcome of aUDS in patients with 
refractory LUTS.

Methods A retrospective review of a prospectively acquired urodynamics database was made of 84 consecutive 
patients (23 male) with a median age 50.5 years (range 18 to 79) having aUDS following non-diagnostic or 
contradictory baseline UDS over a 12-month period. Patient demographics and urodynamic and clinical diagnosis 
before and after aUDS were recorded. Forty-six patients (55%) had formal urinary symptom assessment recorded 
before and a minimum of 6 months following aUDS-related change in management.

Results Eighty-two patients (98%) had a urodynamic diagnosis made following aUDS, 57(68%) of whom  
had detrusor overactivity (DO); the final 2 patients had no abnormalities detected on aUDS. Change in primary UDS 
diagnosis occurred in 66 patients (79%). Of these 66 patients, 59 (89%) also had their clinical diagnosis changed, and  
55 (83%) had their management pathway changed. There was a significant improvement in urinary symptoms  
6 months following aUDS.

Conclusion Change in primary diagnosis following aUDS led to a significant change in treatment care pathway and 
resulted in significant improvement in urinary symptoms.

Introduction

Conventional urodynamics (UDS) is considered to be the gold standard investigation for lower urinary tract symptoms 
(LUTS)[1,2]. Conventional UDS use rapid bladder filling and are performed in an unnatural environment. In a 
significant sub-group of patients, up to 54% to 56% of conventional UDS studies are unable to provide a urodynamic 
diagnosis that correlates with the patient’s presenting LUTS[3,4]. Ambulatory urodynamics (aUDS) is recognised 
by the International Continence Society (ICS) as an important second-line diagnostic tool for providing a definitive 
diagnosis in patients who have previously had a non-diagnostic or symptomatically contradictory conventional UDS[5]. 
In contrast to conventional UDS, aUDS allows for natural (orthograde) bladder filling in a more natural environment, 
with the patient able to undertake relatively normal daily activities away from the UDS suite. aUDS also allow the 



patient to perform activities they know will provoke 
their most troubling urinary symptoms and improve the 
likelihood of a diagnostic test. They are, however, both 
time and personnel intensive and hence more costly than 
routine urodynamics, with limited availability in general 
urological practice.

We aimed to determine the diagnostic value of 
aUDS in patients with refractory LUTS of unknown 
cause following non-diagnostic or symptomatically 
contradictory conventional UDS (filling cystometry and 
pressure flow studies +/₋ video) and to assess if a change 
in patient diagnosis and/or treatment following aUDS 
led to a symptomatic improvement in patients.

Methods and Methods
Study Population
Eighty-four consecutive patients (23 male) having aUDS 
at our tertiary referral centre between 1 January 2015 and 
31 December 2015 were identified from our prospectively 
acquired urodynamic database and their records 
retrospectively reviewed. This time period was chosen 
to allow sufficient time to evaluate diagnostic outcomes, 
change in treatment, and treatment outcomes. The 
median age of the patients was 50.5 years (range 18 to 79). 
Forty-six unselected patients (55%) had formal assessment 
of their urinary symptoms recorded before and at a 
minimum of 6 months following aUDS. The remaining 
38 patients did not have complete symptomatic follow-up 
data available for review. All patients had previously had 
conventional filling cystometry and pressure flow studies 
(n = 11) or video-urodynamics (vUDS) (n = 73). aUDS was 
performed when conventional UDS were non-diagnostic 
(n = 36) or when the conventional UDS diagnosis was 
contradictory to the patients’ major presenting symptoms 
(Table 1).

All patients before proceeding to simple urodynamics 
(filling cystometry and pressure f low studies) had 
received (as appropriate) lifestyle advice, continence 
therapist input with respect to bladder training +/- pelvic 
floor muscle exercise, and medications (as indicated by 

clinical diagnosis). Those progressing to ambulatory 
urody namics w ished to consider more invasive 
treatments for their symptoms, and it is a requirement of 
our National Health Service (NHS) system and National 
Institute for Health and Care Excellence (NICE) 
guidance that a urodynamic diagnosis is made prior to 
these more invasive treatments. 

Urodynamics Procedures
aUDS studies were performed in accordance with the ICS 
guidelines test protocol[1,5] using the MMS Solar LUNA 
module (Medical Measurement Systems, Gladbeck, 
Germany) and a fluid filled catheter system. A flow rate 
and post-void residual and urinalysis were performed 
before the test. After residual urine was measured, a 4.5fr 
bladder catheter (Mediplus 5716, Wycombe, UK) and a 
4.5fr rectal balloon catheter (Mediplus 5410, Wycombe, 
UK) were inserted for the measurement of intra-vesical 
and abdominal pressures respectively. A conductance 
leak pad sensor (Digitimer Pe-Que Sensor Pad, 
Welwyn Garden, UK) was used in all patients reporting 
symptoms of urinary incontinence. After zeroing the 
f luid filled pressure measurement transducers and 
flushing the measurement lines with saline, a cough was 
used to ensure good cancellation and accurate pressure 
measurement readings. The patients were advised on the 
use of the LUNA module events buttons to mark urgency 
and leakage and to activate the f lowmeter to record 
voiding (Figure 1). As per the ICS guidelines, each patient 
was advised to drink 1L of water over the first hour and 
to delay micturition as long as possible. During studies 
the patients were encouraged to perform activities/
manoeuvres known to be provocative for their typical 
LUTS. This included coughing, walking, climbing stairs, 
performing star jumps, going from a seated to a standing 
position, listening to running water, and hand washing. 
Patients were reviewed by the urodynamicist on an hourly 
basis to ensure patient compliance and the accuracy of the 
pressure measurement readings. Studies typically lasted 
between 2 and 4 hours depending on the time taken to 
demonstrate a urodynamic cause for the patient’s most 
troubling urinary symptom. Tests were continued until 
patient’s symptoms were reproduced in all studies.

All conventional UDS, vUDS, and aUDS studies 
were analysed by an experienced urodynamicist in 
accordance with the ICS guidelines, and BOO was 
determined in males with the Abrams-Griff iths 
nomogram[6] and in females with the Solomon-
Greenwell nomogram[7]. The results were subsequently 
reviewed at a multidisciplinary team (MDT) meeting to 
ensure accuracy of diagnosis and to determine treatment 
options.

Statistical Analysis
Data are expressed as mean ± standard deviation and 
P-values were calculated using a 2-tailed unpaired Student 

Abbreviations 
aUDS ambulatory urodynamics
DO detrusor overactivity
ICS International Continence Society
LUTS lower urinary tract symptoms
OAB overactive bladder
SUI stress urinary incontinence
UDS urodynamics
UUI  urge urinary incontinence
vUDS video-urodynamics

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Ambulatory Urodynamic Findings Change Patient Outcomes



t-test for pairwise comparisons of parametric data, 
unless otherwise stated. Categorical data are expressed 
as number (percentage) and compared with the Fisher 
exact test. P < 0.05 was considered statistically significant. 
Analysis was performed using SigmaPlot 12.5 (Systat 
Software Inc, San Jose CA) statistical analysis package.

Results
Following aUDS, all studies were evaluable, and a 
definitive urodynamic diagnosis was made in 98% 
(n = 82) of patients, 68% (n = 57) of whom had detrusor 
overactivity (DO) (Figure 2). The 2 remaining patients 
(2%) were diagnosed as having normal bladder function. 
A change in the primary UDS diagnosis occurred in 
79% (n = 66) of patients following aUDS, as detailed in 
Table 1. Of these 66 patients 89% (n = 59) also had their 
clinical diagnosis changed and 83% (n = 55) subsequently 
had their management changed (Figure 3). “Clinical 
diagnosis” is the working diagnosis made after taking 
a full history, examining the patient, and performing 
simple tests such a MSSU, blood tests, flow rate, and post-
void residual assessment.

Of the remaining 18 patients for whom aUDS did 
not change their initial UDS diagnosis following 
conventional or vUDS, change in clinical diagnosis 
occurred in 10 (56%), all of whom had their management 
changed. Management was also changed in 4 (50%) of 

TABLE 1. 

Change in primary urodynamic diagnosis following ambulatory urodynamic assessment

Primary Baseline 
Urodynamic 

Diagnosis 
(Total)

Primary Ambulatory Urodynamic Diagnosis Change in 
Diagnosis

N (%)Acon BOO DSD Hypo IDO LOC Normal
Red 
Cap

SU SUI Other

Acon (1) 1 1 (100)

BOO (9) 2 4 1 2 7 (78)

DSD (1) 1 0 (0)

Hypo (2) 1 1 2 (100)

IDO (11) 11 0 (0)

LOC (2) 2 2 (100)

Normal (36) 2 1 23 1 2 4 3 35 (98)

Red cap (4) 2 1 1 3 (75)

SU (10) 1 8 1 9 (90)

SUI (8) 6 1 1 7 (89)

Other (0) NA

Total N (%) 0 4 1 2 57 0 2 1 6 7 4 84 (100)

Acon: acontractile; BOO: bladder outflow obstruction; DSD: detrusor sphincter dyssynergia; Hypo: hypocontractile; IDO: idiopathic detrusor overactivity; 
LOC: loss of compliance; Red cap: reduced capacity; SU: sensory urgency.

FIGURE 1. 

LUNA ambulatory module

356 SIUJ  •  Volume 2, Number 6  •  November 2021 SIUJ.ORG

ORIGINAL RESEARCH



the 8 patients with no change in their UDS or clinical 
diagnosis following aUDS (Figure 3).

Overall, by providing a definitive urodynamic 
diagnosis in 98% of the patients, aUDS led to change 
in clinical diagnosis in 82% (n = 69) of patients and a 
change in management in 82% (n = 69) of patients, as 
detailed in Table 2. 

Sub-Group Analysis of Symptoms Pre- and 
Post- AMB UDS
Of the 46 unselected patients (55%) who had ≥ 6 months 
symptomatic follow-up data, change in clinical diagnosis 
and management following aUDS led to a statistically 
significant improvement in their symptoms of daytime 
frequency, nighttime frequency, urgency, urge urinary 
incontinence (UUI), stress urinary incontinence (SUI), 
urinary incontinence of unknown cause (not UUI or 
SUI), poor flow, and strain void (Table 3). There was a 
significant improvement in ICIQ-OAB (130±35 versus  
55 ±70, P < 0.001) and ICIQ-SU (15.1±9.6 versus  
7.2 ±10.1, P < 0.001) scores following the changes to 
clinical diagnosis and management.

Symptoms as a Predictor of Definitive  
UDS Diagnosis
The patients’ presenting symptoms were non-specific and 
were not significantly different between UDS diagnostic 
categories following aUDS (Table 4).

Discussion

We have demonstrated that aUDS is an extremely useful 
diagnostic tool with a 98% definitive diagnosis rate. 
Following aUDS, a change in urodynamic diagnosis was 
made in 79%, a change in clinical diagnosis in 70%, and 

a change in treatment in 75%. All patients felt ambulatory 
urodynamics was worth their while. They were all fully 
informed and had provided consent for the ambulatory 
urodynamics tests. Their motivation was wishing to 

FIGURE 3. 

Change in urodynamic diagnosis, clinical diagnosis and management following aUDS

Urodynamic Diagnosis 
Changed  

n = 66 

Urodynamic Diagnosis 
Unchanged  

n = 18  

aUDS Performed  
n = 84  

Clinical Diagnosis 
Unchanged  

n = 7  

Clinical Diagnosis 
Changed  
n = 10  

Management Changed  
n = 0  

Management Changed  
n = 10  

Clinical Diagnosis 
Changed  

n = 59  

Management Changed  
n = 59 

Clinical Diagnosis 
Unchanged  

n = 8  

Management Changed  
n = 4  

FIGURE 2. 

A 47-year-old female patient presenting with frequency, 
urgency, flooding incontinence episodes (3 to 5 pads 
per day) (a) Essentially normal filling phase urodynamics 
study with small leaks demonstrated on coughs (1mL  
to 2mL) on vUDS. (b) DO (pp137cmH2O) with associated 
urgency and large volume UUI was demonstrated on 
aUDS.

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Ambulatory Urodynamic Findings Change Patient Outcomes



have a definitive diagnosis and perhaps more effective 
treatment of their urological issues following a “normal” 
simple urodynamic study.

All aUDS in this study were evaluable, which is much 
higher than the 74% evaluable aUDS studies reported 
by Pannek and Pieper[8] but similar to the 97% rate 
reported by Gorton and Stanton[9]. Patient symptoms 
were reproduced in 100% of the aUDS studies, and a 
urodynamic diagnosis was made in 98%. This is higher 
than the 72% rate reported by Pannek and Pieper[8]. 
the 74% reported by Cantu et al.[10], and the 77.3% in 
women with UI by Dokmeci[4] Our unit performs 80 
to 100 aUDS per year, more than in either of the studies 
detailed, and therefore has significant experience in 
performing and interpreting aUDS, which may account 
for the 98% diagnosis rate. However, the lower diagnosis 
rate seen in the Pannek and Pieper[8] study may also 
be related to their patient group and/or advances in 
the technical aspects of aUDS since 2008. Additionally, 

whilst both Dokmeci[4] and Pannek and Pieper[8] relied 
on the patient pressing the leak event marker to indicate 
an episode of UI, both the aUDS system of Gorton and 
Stanton[9] and that used in this study incorporated a 
leak pad sensor, which allows for definitive diagnosis of a 
true episode of UI.

aUDS has been shown to have a higher diagnostic 
y ield t ha n convent iona l / vU DS. R ad ley et a l. 
demonstrated this in 106 women presenting with 
symptoms of overactive bladder (OAB); DO was detected 
in 32 and 70 women on vUDS and aUDS, respectively; 
ie, DO was missed in up to 54% of women presenting 
with OAB on conventional UDS when compared 
with aUDS[3]. Dokmeci et al. showed aUDS detected 
the underlying pathophysiology in 77% of women 
presenting with urinary incontinence as compared 
with only 6.8% of women on conventional UDS[4]. 
While no cases of urodynamic SUI were demonstrated 
on conventional UDS in their study, 56% of patients 

TABLE 2. 

Changes in patient management following aUDS

Changes in patient management following aUDS Number of patients

Intravesical botulinum toxin injection 16

Sacral neuromodulation 14

Percutaneous tibial nerve stimulation 7

Combined medical therapy after refusing surgical intervention 7

Continued conservative management after refusing surgical intervention 12

No intervention after normal urodynamic function confirmed 2

Cognitive behavioural therapy for sensory urgency syndrome 5

Reduced fluid intake after refusing surgical intervention 1

Clean intermittent self-catheterisation after refusing surgical intervention 7

Bladder neck incision 1

Urethral dilatation 1

Rectus facia sling 5

Artificial urinary sphincter 2

Milking bulbar urethra 1

Vesicovaginal fistula repair* 1

Clam cystoplasty 1

*  The fistula repair was in a patient with a previous history of fistula repair (elsewhere), negative imaging, negative cystoscopy, and methylene blue 
test, normal simple urodynamics and ambulatory urodynamics indicating an ongoing continuous low volume leakage not related to abdominal 
or detrusor pressure changes. After full discussion of all options, the patient elected to have a repeat vaginal repair with complete separation of 
the bladder from the vagina, closure of any small fistula (none were seen), and interposition of a Martius labial fat pad flap, with resolution of her 
symptoms.

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had SUI demonstrated on aUDS[4]. This diagnostic 
rate was similar to the 77% diagnostic rate reported 
following aUDS for women with normal conventional 
UDS presented by Patravali[11]. Conversely, Robertson 
et al.[12] demonstrated no significant difference in the 
proportion of men diagnosed with BOO with simple 
UDS compared with aUDS; although aUDS was more 
sensitive for diagnosing DO. Rademakers et al.[13] have 
shown aUDS to be particularly useful in determining 
true acontractility and DO, and assigning a UDS cause 
for UI of unknown cause. Drossaerts et al. have also 
shown that aUDS is a valuable tool when assessing the 
effectiveness of sacral neuromodulation in patients with 
LUTS[14]. Likewise, we found aUDS particularly useful 
in diagnosing detrusor overactivity, stress urinary 
incontinence, and sensory urgency.

Because of the complexity of performing and 
reporting aUDS, it may best be concentrated in specialist 
centres. aUDS must be performed by an experienced 
urodynamicist (doctor, clinical scientist, or nurse 
specialist) following a strict test protocol. Conventional 
and vUDS are performed with the urodynamicist in 
the same room as the patient observing the entire test, 
allowing them to identify measurement artefacts and 
directly relate provocations to the UDS finding. This is 
not possible during aUDS where the patient leaves the 

TABLE 4. 

Symptoms as a predictor of definitive UDS diagnosis

Urodynamic 
Diagnosis

Symptoms, N (% of Urodynamic Diagnosis Category) Total,
n (% of total 
urodynamic 
diagnosis)

Frequency
(n = 91)

Urgency
(n = 105)

Urge Incontinence 
(n = 76)

Stress Incontinence 
(n = 47)

Detrusor overactivity 43 (70) 53 (87) 43 (70) 22 (26) 61 (48)

Urodynamic stress 
urinary incontinence 

15 (75) 16 (80) 11 (55) 11 (55) 20 (16)

Sensory urgency 5 (83) 5 (83) 2 (33) 3 (50) 6 (5)

Bladder outflow 
obstruction 

7 (58) 9 (75) 6 (50) 3 (25) 12 (9)

Hypocontractile 10 (83) 10 (83) 6 (50) 2 (17) 12 (9)

Acontractile 1 (50) 2 (100) 2 (100) 0 (0) 2 (2)

Normal 2 (100) 1 (50) 1 (50) 1 (50) 2 (2)

Other (vaginal reflux/ 
urethral pooling/ 
detrusor sphincter 
dyssynergia/ reduced 
capacity)

8 (62) 9 (69) 5 (38) 5 (38) 13 (10)

TABLE 3. 

Patients presenting urinary symptoms pre UDS and 6 
months post change in management following aUDS 

Urinary Symptom
Pre-Simple 

UDS
N = 46 (%)

6 Months  
Post Change in 
Management 

Consequent to 
aUDS

N = 46 (%)

P value

Day frequency 28 (61) 11 (24)* 0.0005

Night frequency 25 (54) 10 (22)* 0.0021

Urgency 28 (61) 11 (24)* 0.0005

UUI 18 (39) 8 (17)* 0.0344

SUI 14 (30) 4 (9)* 0.0158

UI of unknown cause 3 (7) 2 (4) 1.0

Poor flow 13 (29) 2 (4)* 0.0034

Strain void 11 (24) 2 (4)* 0.0137

Pain on filling 3 (7) 1 (2) 0.6162

Pain on voiding 5 (11) 0 (0)* 0.0554

359SIUJ.ORG SIUJ  •  Volume 2, Number 6  •  November 2021

Ambulatory Urodynamic Findings Change Patient Outcomes



UDS suite and is relied upon to clearly annotate the 
recording with event markers. It is essential that patients 
having aUDS have the cognitive ability to comply with 
the instructions from their urodynamicist and that the 
test be performed using a strict protocol with regular 
review. Following the test, the extensive traces generated 
must be reviewed by the same urodynamicist, allowing 
for accurate correlation between the patient’s bladder 
symptoms and urodynamic findings. While aUDS is a 
time-consuming and expensive test, it has been shown 
to be well tolerated[15], with 85% of patients happy to 
attend for further studies. Following aUDS,18.6% of 
patients experience mild to moderate de novo dysuria, 
and 1.1% experience asymptomatic bacterial UTI[16].

At our centre, we performed 1461 conventional/ 
vUDS in the same time period as the 84 aUDS studies, 
or 1 aUDS to every 17.4 conventional/ vUDS studies. 
W hilst aUDS is t he most accurate urody namic 
diagnostic test, it takes 2 to 4 hours to perform and 1 to 
2 hours to interpret the results compared with 30 to 60 
minutes in total for CMG/vUDS. It is therefore not cost- 
or time-effective to perform aUDS on all patients and 
aUDS should be reserved for patients with significantly 
bothersome symptoms, who are contemplating invasive 
treatment and in whom conventional and/or vUDS 
have been non-diagnostic or contradictory to their 
symptomatology.

In our study, urodynamic diagnosis was changed in 
79% of our cohort following aUDS. This resulted in a 
change in clinical diagnosis in 89% of patients having 
their urodynamic diagnosis changed following aUDS, 
whilst a change in clinical diagnosis was made in 70% of 
all patients having aUDS. This is similar to the 72% to 89% 
[8–10] of successful clinical diagnosis made following 
aUDS in previous studies where aUDS traces were 
evaluable. These changes in urodynamic and subsequent 
clinical diagnosis allowed treatment to be modified in 
83% of our patient cohort having change in urodynamic 
diagnosis post aUDS and in 75% of all patients having 
aUDS, which is higher than the 43%[9] to 63%[8] 
described in previous studies. The higher treatment 
change rates noted in our study might be a consequence 
of patients having aUDS only if they had non-diagnostic 
or contradictory prior conventional or vUDS before 
consideration for operative intervention.

We do not perform invasive urodynamic assessment 
prior to non-operative intervention, as per NICE 
guidance[2]. It was an unexpected finding and of interest 
that some patients would have 2 different urodynamic 
tests to establish a diagnosis based on their wish to 
have further and more invasive treatment—and then 
decline this treatment. This is however their prerogative. 
Our general experience is that while ambulatory 
urodynamics tests are time-consuming, most patients 

tolerate this well and all are happy that a correct 
urodynamic diagnosis can be provided and hence the 
most appropriate treatment offered.

Within the United Kingdom health care system, 
invasive treatment options such as intravesica l 
botulinum toxin and sacral neuromodulation are 
offered only after a proven urodynamic diagnosis of 
DO. At our centre we do not treat patients who have 
mild SUI demonstrated on conventional UDS if this 
does not correlate with their main presenting urinary 
symptom. Our aUDS results demonstrated DO and 
UUI in 6 of the 8 patients who had symptomatically 
contradictory SUI on conventional UDS; therefore, 
aUDS ensured the patients were treated correctly and 
prevented any unnecessary surgical intervention for 
SUI which would not have resolved their predominant 
urinary symptom. In the 21% of patients who did not 
have their urodynamic diagnosis changed following 
aUDS, a change in clinical diagnosis and management 
was effected in 56%. Management was also changed 
in 50% of the patients in whom aUDS changed neither 
urodynamic nor clinical diagnosis. This is most likely 
due to increased clinician and patient confidence in the 
urodynamic and clinical diagnosis and hence treatment.

Previous studies have demonstrated satisfactory 
clinical outcomes in 40%[9] to 42%[8] of patients 
following treatment modification after aUDS. Our 
higher rates of treatment modification following aUDS 
resulted in 79% of our patients having symptomatic 
improvement fol low ing aUDS-initiated cha nges 
in diagnosis a nd treat ment. This sy mptomatic 
improvement was a statistically significant reduction in 
day and night frequency, urgency, UUI, SUI, poor flow, 
strain void, and pain on voiding. Pre-aUDS patients 
had a median of 4 symptoms (range 2 to 10), and post-
aUDS patients had a median of 0 symptoms (range 0 to 
5). Prior to aUDS, patients were having no or maximal 
conservative treatment for their “clinical” diagnosis. Our 
confidence in the post-aUDS urodynamic and clinical 
diagnosis allowed for effective change in treatment and 
hence significant symptom improvement.

There are some limitations to this study. Whilst 
this was a retrospective study, it was of a prospectively 
acquired urodynamics database and of all consecutive 
patients having aUDS during our study time period.

Conclusion
aUDS was able to provide a urodynamic diagnosis in 
98% of patients. This resulted in a change in clinical 
diagnosis and subsequent change in treatment pathway 
in 82% of patients. This study confirms the diagnostic 
and clinical value of aUDS and is the first to clearly show 
an 79% improvement in patient reported symptoms as a 
consequence.

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