Int Urogynecol J (2012) 23:269–277
DOI 10.1007/s00192-011-1585-y
REVIEW ARTICLE
Normal urodynamic parameters in women
Part II—invasive urodynamics
Wally Mahfouz & Tala Al Afraa & Lysanne Campeau &
Jacques Corcos
Received: 3 May 2011 / Accepted: 6 October 2011 / Published online: 20 October 2011
# The International Urogynecological Association 2011
Abstract
Introduction and hypothesis This literature review, provid-
ing reference ranges of normal variability in urodynamic
parameters, is the second part of a two-part article. The first
part addresses non-invasive urodynamics (UDS), while the
second part addresses invasive techniques.
Methods Data were obtained through MEDLINE from
articles published between January 1956 and February
2011, International Continence Society meeting abstracts,
and standardization reports. Search terms included cystom-
etry, urethral pressure profilometry, leak point pressure,
video UDS, normal volunteer, pressure flow studies, and
electromyography.
Results Normal values varied widely in the literature. How-
ever, with the help of clinical data, it was possible to define
“normality” ranges for most of the different parameters.
Conclusions Urodynamic evaluation of lower urinary tract
(LUT) function is not a physiological test. However, it is
still the best available tool for LUT function assessment.
Even if normality in UDS can be defined, tests must always
be interpreted against patient characteristics, complaints,
and symptoms.
Keywords Urodynamics . Normal volunteer . Cystometry .
Pressure flow study . Urethral pressure profilometry .
Electromyography (EMG)
W. Mahfouz : T. Al Afraa : L. Campeau : J. Corcos
Department of Urology, Jewish General Hospital,
McGill University,
Montreal, Quebec, Canada
J. Corcos (*)
Department of Urology, Jewish General Hospital,
3755 Côte Sainte-Catherine,
Montreal, QC H3T 1E2, Canada
e-mail: jcorcos@uro.jgh.mcgill.ca
Introduction
Non-invasive urodynamics (UDS) consists of tests [voiding
diaries, flowmetry, post-void residual (PVR) estimation and
pad tests], which do not require any patient manipulation.
In contrast, invasive UDS warrants the insertion of
catheters, transducers, and/or needle sets into patients.
While non-invasive tests are useful tools for screening (i.e.,
flowmetry) or diagnosis (i.e., voiding diaries), invasive tests
are necessary to confirm the diagnosis and refine the findings.
The invasiveness of these tests raises the problem of their non-
physiological recording. Acknowledging their limitations,
such tests must always be interpreted by an experienced
urologist with knowledge of recording conditions and
patients’ complaints and symptoms.
Method
Data were obtained from various sources, including
MEDLINE search via PubMed, for articles published
between January 1956 and February 2011, International
Continence Society (ICS) meeting abstracts and Standardiza-
tion Committee reports as well as the bibliographies of
retrieved articles and book chapters. The key terms searched
were UDS, cystometry, urethral pressure profilometry, leak
point pressure, PVR urine, video UDS, normal volunteer,
pressure flow studies, and electromyography (EMG). Based
on a literature review, we report normal UDS values and
ranges in women.
Limits
Such a review, gathering together results from normal
volunteers as well as patients, and trying to define
270
normality have limits. The heterogeneity of the population,
the absence of standardized technical methods for some
testings, and the frequent absence of gender and age
consideration in the interpretation of data, are many
limiting factors for such articles. Taking this into consider-
ation, we hope that future research in urodynamics will
address this heterogeneity by studying a large cohort of
normal volunteers to conform or modify our findings.
Cystometry
The principal aim of cystometry is to reproduce patient
symptoms and relate them to any synchronous urodynamic
events [1]. During the filling phase, abdominal and bladder
pressures are recorded via rectal and urethral catheters,
respectively, whereas detrusor pressure (Pdet) is calculated
by subtracting abdominal pressure from bladder pressure.
Initial resting abdominal and bladder pressures are 5–20 cm
H2O in the supine position, 15–40 cm H2O in the sitting
position, and 30–50 cm H2O in the standing position [2].
Pdet in an empty bladder varies between 0 and 10 cm H2O
in 90% of cases [3]. Normal Pdet during bladder filling at a
rate of 50–60 ml/s should be <20 cm H2O [4].
The ICS report 2002 divides the filling rate of the
bladder during filling cystometry into: (a) physiological
filling rate, which is defined as filling rate less than the
predicted maximum − predicted maximum body weight in
kilogram divided by 4 expressed as milliliter/minute and (b)
non-physiological filling rate, which is defined as filling
rate greater than the predicted maximum − predicted
maximum body weight in kilogram divided by 4 expressed
as milliliter/minute [5].
Several other parameters are recorded during the filling
phase: bladder sensations, bladder compliance, detrusor
overactivity (DO), and maximum cystometric capacity
(Fig. 1 and Table 1).
1. Bladder sensations
Wyndaele et al. studied bladder sensations in 50 normal
volunteers (32 female and 18 male) by cystometry. They
described three normal bladder sensation patterns: (a) the
first sensation of bladder filling, which is felt when the
volunteers first become aware of bladder filling (it is vague
sensation, felt in the lower pelvis, which waxes and wanes,
and could be easily ignored for few minutes); (b) first desire
to void, a familial constant sensation that would lead the
patient to void in the next convenient moment, but still
voiding can be delayed (it is felt in the lower abdomen and
gradually increases with bladder filling); and (c) strong
desire to void, a persistent desire to void without fear of
leakage, and felt in the perineum or urethra. Furthermore,
Wyndaele and De Wachter [6] reported that volumes in all
Int Urogynecol J (2012) 23:269–277
three types of sensation were lower in women: The first
sensation manifested at 175 ml, the first desire to void was
felt at 272 ml, and the strong desire to void presented at
429 ml.
2. Bladder compliance
Bladder compliance is the relationship between changes in
volume and pressure. It is calculated by dividing change in
volume by change in Pdet and is expressed in milliliter/
centimeter H2O [5]. Normal values of bladder compliance
have not been well defined. In patients with neurogenic
bladder, values of 13–40 ml/cm H2O have been associated
with a high risk of upper urinary tract complications [7].
Accordingly, normal bladder compliance values vary
between 30 and 100 ml/cm H2O. They are higher in
women than in men [5, 8–10]. Bladder compliance is
considered to be compromised if it is below 30 ml/cm H2O
[11] (Table 2). Harris et al. [12] studied 270 neurologically
intact women and reported that normal bladder compliance
was >40 ml/cm H2O. Wyndaele [10] conducted a urody-
namic study of 30 volunteers (20 male and 10 female
volunteers), and found that compliance was higher in
female than in male volunteers, with normality exceeding
100 ml/cm H2O. The ICS [5] recommends two standard
points for measuring bladder compliance: detrusor pressure
at empty bladder and at maximum bladder capacity or
immediately before the start of any detrusor contraction that
causes significant leakage. Both points are measured
excluding any detrusor contraction. Wahl et al. [13, 14]
developed another method for measuring bladder compli-
ance that they claimed was more accurate and practical,
especially in children. They standardized bladder compli-
ance according to a complex mathematical formula.
3. Detrusor stability during bladder filling
The absence of involuntary detrusor contractions is consid-
ered to be normal and is defined as “stable detrusor
activity” [10, 15]. Uninhibited detrusor contractions occur
in 10–18% of asymptomatic volunteers and do not need
any further evaluation in asymptomatic patients [10, 16].
Advance in ambulatory UDS has complicated discussion of
DO, which has been shown to arise in 60% of asymptom-
atic women undergoing ambulatory UDS [17]. The signif-
icance of these DO in normal volunteers is not very well
understood as shown by the study looking for correlation
with other variables in this population. The mere absence of
documented overactivity on cystometrograms (CMG) does
not rule out its existence. Up to 40% of patients with urge
incontinence do not show DO on CMG [18].
The 1988 ICS report [8] differentiated types of detrusor
storage function, as determined by filling cystometry, into:
Int Urogynecol J (2012) 23:269–277 271

Fig. 1 The normal cystometrogram curve has two phases: a filling phase, including all normal parameters during the storage phase (first
sensation, detrusor function, bladder compliance, and capacity) and a voiding phase on pressure flow study

(a) normal detrusor function, which allows filling with little
or no change in pressure and no involuntary phasic
contractions despite provocation, and (b) overactive detru-
sor function, which is urodynamic observation character-
ized by involuntary detrusor contractions during the filling
phase and may be spontaneous or provoked [19].
DO has a variety of patterns on urodynamic tracing. The
2002 ICS report [5] describes two types: (a) phasic DO,
defined by its characteristic waveform, which may or may
not lead to urinary incontinence, and (b) terminal DO,
classified as a single involuntary detrusor contraction
occurring at cystometric capacity, which cannot be sup-
pressed and causes incontinence often resulting in complete
bladder emptying [17].
The first ICS report [20, 21] stated that, in order to
diagnose “detrusor instability,” the contraction should be at
least 15 cm H2O. However, it was subsequently realized that
involuntary detrusor contractions of <15 cm H2O could cause
significant symptoms. The ICS [5, 8] stated that there is no
standardized minimum value. In practice, it may be difficult
to be certain whether an involuntary detrusor contraction has
occurred if the phasic wave is <5 cm H2O [17].
4. Maximum cystometric bladder capacity
Maximum cystometric capacity is the bladder volume at the
end of filling CMG when patients have a strong desire to
void, feel they can no longer delay micturition, and are

Table 1 Normal reported cys-

tometric parameters during Parameter Wyndaele [10, 49] Pfisterer et al. [43] Normal range
filling in females
Number of volunteers 38 (28 men and 10 women) 24 (women)
Mean age (years) 24 50.2
First sensation (ml) 153 107 100–250
First desire to void (ml) 211 188 200–330
Strong desire to void (ml) 456 372 350–560
Bladder compliance (ml/cm H2O) 70.9 119 ≥ 50
Detrusor activity Stable Stable
Maximum cystometric capacity (ml) 453 580 450–550
272
Table 2 Normal bladder com-
pliance (reproduced with per- Definition
mission from Corcos and
Schick [50]) Compliance index [51]
Volume (in ml)/detrusor pressure (in cm H2O)
at bladder capacity
Compliance [52]
Volume in ml/1 cm H2O
Compliance [53]
cm H2O/100 ml
given permission to void [5]. This volume includes both the
amount voided and residual urine left after the void (PVR)
[17]. Normal cystometric capacity varies widely, but is
normally between 300 and 500 ml, with higher values in
men than in women [10].
Wyndaele [10] conducted a urodynamic study of 30
volunteers (20 male and 10 female), with a mean age of
24 years, and reported wide variability of normal ranges.
Bladder capacity was found to be larger in men than in
women, ranging from 300 to 550 ml.
Summary
The bladder should have constantly low pressure that
usually does not reach more than 6–10 cm H2O above
baseline at the end of filling (end-filling pressure), and there
should be no involuntary contractions, with normal first
sensation ranging between 100 and 250 ml, bladder
compliance between 30 and 100 ml/cm H2O, and maximum
bladder capacity between 450 and 550 ml.
Pressure flow (P/Q)
P/Q study simultaneously measures Pdet and flow rate during
voiding. P/Q assessment is considered to be the gold
standard for quantifying and grading bladder outlet obstruc-
tion (BOO) and differentiating between BOO and detrusor
underactivity [22–28]. P/Q data can be plotted on pressure
flow nomograms to classify patients as being either
obstructed or not obstructed and, at the same time, grade
the severity of obstruction. Different types of nomograms
have been developed. The most common in clinical practice
are ICS nomogram [22], Abrams–Griffiths nomogram,
Schafer nomogram, bladder contractility nomogram, urethral
resistance factor, and the composite nomogram [17], but
these nomograms are used in men only.
During P/Q assessment, several parameters are recorded,
including detrusor opening pressure, maximum detrusor
pressure (Pdet.max), Pdet at maximum flow (Pdet :Qmax ),
minimum detrusor pressure during voiding, maximum flow
rate (Qmax), voided volume (VV), and PVR. The ICS has
defined the following terms in the interpretation of P/Q [3,
Int Urogynecol J (2012) 23:269–277
Comment
Normal=20–100 (with bladder capacity >650 ml)
Normal=30–55
Capacity=300–500 ml
Normal ≤10
Low >10
5]. Pre-micturition pressure is intravesical pressure just
before the onset of isovolumetric detrusor contraction.
Detrusor opening pressure is Pdet recorded at the onset of
measured flow, which tends to be elevated in patients with
infravesical obstruction. Opening time is the time that
elapses from the initial rise in Pdet to the onset of flow
through the urethra.
However, because flow rate is measured at a downstream
location (i.e., flowmeter outside the urethra), flow rate
measurement is slightly delayed from bladder pressure
measurement. This flow delay, generally between 0.5 and
1 s, should be factored into the analysis [29]. Pdet :Qmax is the
magnitude of detrusor contraction when flow rate is at its
maximum [5]. Pdet.max is the maximal pressure recorded
regardless of flow. This pressure can exceed pressure at
maximal flow if the bladder is contracting isometrically
against a closed outlet. Isometric detrusor pressure is
obtained by mechanical obstruction of the urethra or by
active contraction of the distal sphincter mechanism during
voiding.
Post-micturition contraction (after contraction) is a
reiteration of detrusor contraction after flow has ceased,
and its magnitude is typically greater than that of
micturition pressure at maximal flow. After contractions
are not well-understood, but they seem to be more common
in patients with unstable or hypersensitive bladders [30].
PVR is the volume of urine remaining in the bladder
immediately after voiding. Although the test situation often
leads to inefficient voiding and falsely elevated residual
urine, the absence of residual urine does not exclude
infravesical obstruction or bladder dysfunction [17].
Wyndaele [10] attempted to define what can be
considered as normal parameters by urodynamics in 38
healthy adult volunteers (28 men and 10 women) with a
mean age of 24 years. Free flow rate, water cystometry, and
P/Q assessment were performed in all of them. Micturition
bladder pressure was higher in men than in women,
reflecting higher outflow resistance in men, but Pdet was
not statistically different between the sexes. Flow time was
significantly longer, and Qmax was significantly lower
during P/Q evaluation than during free flow rate measure-
ment in both sexes. There was no residual urine at all in the
Int Urogynecol J (2012) 23:269–277
majority of volunteers estimated by urethral catheter, but
six men and three women had <50 ml residual urine.
Pressure flow (P/Q) studies (Table 3)
Blaivas and Groutz studied 50 women with BOO (mean
age, 65 years) and 20 normal controls (mean age, 67 years)
by videourodynamics (VUDS) assessment [31]. The P/Q
parameters recorded in the control group were: free Qmax of
24±9 ml/s, Qmax of 13±6 ml/s, Pdet :Qmax of 18±8 cm H2O,
Pdet.max of 22±9 cm H2O, VV of 312±131 ml, and PVR of
103±100 ml. These authors described a nomogram to
diagnose BOO in women, known as Blaivas nomogram
(Fig. 2). Two parameters are needed to construct this
nomogram: free Qmax and Pdet.max. Free Qmax is preferred to
Qmax during P/Q because Pdet :Qmax and Qmax cannot be
evaluated if the patient does not void during the test.
Blaivas nomogram consists of four zones, which classify
patients into four categories: zone 0 (normal or no
obstruction), zone 1 (mild obstruction), zone 2 (moderate
obstruction), and zone 3 (severe obstruction) [31].
Defreitas et al. [32] investigated 169 women with BOO
and 20 asymptomatic volunteers by P/Q assessment. They
reported normal Qmax and Pdet :Qmax as 16 ml/s and 24 cm
H2O, respectively, in the asymptomatic group. The cut-off
values to detect BOO with Pdet :Qmax and Qmax were 25 cm
H2O and 12 ml/s, respectively, with sensitivity, specificity,
and accuracy of 68%. Chassagne et al. [33] mentioned that
the combined cut-off values for diagnosing BOO in women
are Qmax <15 ml/s and Pdet :Qmax >20 cm H2O, yielding
sensitivity of 74.3% and specificity of 91.1%.
Brostrom et al. [34] performed a P/Q study in 30 normal
female volunteers with a mean age of 52 years. Two sets of
measurements were recorded. They found that, between
two repeated measurements, there was a statistically
Fig. 2 Bladder outlet obstruction nomogram (Blavias nomogram) for
women indicating that normal women should be in an area of no
obstruction (grade 0)
273
significant increase in first desire to void (171 and
205 ml) and a normal desire to void (284 and 351 ml)
with a decrease in bladder opening pressure, whereas no
change was noted in maximum cystometric capacity (572
and 570 ml). Kuo [35] investigated 441 women with BOO
and stress urinary incontinence (SUI) as well as 30
asymptomatic volunteers. He reported that Pdet :Qmax ≥30 cm
H2O combined with Qmax ≤15 ml/s indicated BOO with
specificity of 93.9% and sensitivity of 81.6%.
Summary
In asymptomatic females, Qmax ranges from 13 to 25 ml/s,
Pdet :Qmax ranges from 18 to 30 cm H2O, Pdet.max ranges from
22 to 46 cm H2O and VV ranges between 250 and 650 ml.
Leak point pressures
1. Detrusor leak point pressure
Detrusor leak point pressure (DLPP) is defined by the ICS
as the lowest Pdet at which urine leakage occurs in the
absence of either detrusor contraction or increased abdom-
inal pressure [5]. The rise in bladder pressure is secondary
to low bladder compliance. This value reflects resistance
that the urethra offers to the bladder, mainly by the action
of the striated sphincter [17, 36].
In patients with neurogenic bladder, a high DLPP can
jeopardize upper urinary tract function. McGuire et al. [37]
followed the urodynamic evolution of 42 myelodysplastic
children and observed that those with DLPP ≥40 cm H2O
developed upper tract damage if not treated.
2. Abdominal leak point pressure or Valsalva leak point
pressure
Abdominal leak point pressure (ALPP) or valsalva leak
point pressure (VLPP) is intravesical pressure at which
urine leakage occurs because of increased abdominal
pressure in the absence of detrusor contraction [5]. It
measures the ability of the urethra to resist an increase in
abdominal pressure. ALPP should be tested during cyst-
ometry after the bladder has been filled to at least 150–
200 ml. The patient is then asked to do a valsalva maneuver
until he or she leaks. VLPP is the lowest pressure at which
incontinence occurs [17]. This test assesses the severity of
SUI and may be useful in detecting intrinsic sphincter
deficiency (ISD). In normal individuals, no incontinence
should be recorded, whatever the increase in abdominal
pressure. Therefore, there is no “normal ALPP.” However,
studies have attempted to determine a cut-off between
patients with or without ISD [17].
274 Int Urogynecol J (2012) 23:269–277

Table 3 Normal reported P/Q parameters in women

Brostrom et al. Blaivas and Groutz Pfisterer et al. Defreitas et al. Chassagne et al. Normal range
[34] [31] [43] [32] [33]

Number of patients 30 female 50 female 24 female 20 female 124 unobstructed

volunteers volunteers volunteers volunteers women
Mean age (years) 52 64.4 50.2 42
Qmax (ml/s) 25 13 22 16 23 13–25
Qave (ml/s) 12 12
TQ (s) 67 60–70
Pdet.open (cm H2O) 22 22
Pdet :Qmax (cm H2O) 30 18 27 24 20 18–30
Pdet.max (cm H2O) 46 22 44 22–46
VV (ml) 651 312 264 330 250–650

Qmax maximum flow rate, Qave average flow rate, TQ flow time, Pdet.open opening detrusor pressure, Pdet :Qmax detrusor pressure at maximum flow;
Pdet.max maximum detrusor pressure during voiding

McGuire et al. [38] employed VUDS and demonstrated
that 80% of women with VLPP below 60 cm H2O had type
III SUI. They also showed that VLPP values above 90 cm
H2O could rule out ISD. In fact, in women suffering from
SUI without genital prolapse, high ALPP of 100 cm H2O or
more is usually associated with urethral hypermobility.
Those with values between 60 and 100 cm H2O have
features of both ISD and hypermobility [39].
Summary
There should be no DLPP in normal individuals. In
neurogenic patients, DLPP higher than or equal to 40 cm
H2O is considered dangerous for the upper tract.
In normal individuals, no abdominal pressure increase
should cause incontinence. Therefore, there is no “limit of
normal ALPP.”
In women with SUI, VLPP below 60 cm H2O is highly
suggestive of ISD. VLPP of 100 cm H2O or more is usually
associated with urethral hypermobility. Values between 60
and 100 cm H 2O are suggestive of both ISD and
hypermobility.
Urethral pressure profilometry
Urethral pressure is defined by the ICS as the fluid pressure
needed to just open a closed urethra [5], and the urethral
pressure profilometry (UPP) is a graph indicating changes
in intraluminal pressure along the length of the urethra.
UPP quantifies the occlusive pressure generated by
active and passive structures of the urethra and allows the
evaluation of urethral competence. Two variations of this
measurement are commonly reported: static UPP, with its
variants stress UPP and pressure transmission ratios, and
micturitional UPP [17].
Maximum urethral pressure (MUP) is categorized as
maximum pressure of the measured profile, while maxi-
mum urethral closure pressure (MUCP) is defined as the
maximum difference between urethral pressure and intra-
vesical pressure.
UPP rises in “normal” healthy individuals with increasing
bladder volume. It is the so-called “guarding reflex.”
However, continuous recording of MUP shows variations
and oscillations between 10 and 25 cm H2O [40]. MUCP
below 20 cm H2O is considered hypotonic, raising the
possibility of ISD. MUCP values above 75 cm H2O in
women and 90 cm H2O in men are considered hypertonic
[17]. Sorensen et al. [41] analyzed urethral pressure
variations in 10 healthy, fertile female volunteers (mean
age, 32 years) and 12 healthy post-menopausal volunteers
(mean age, 58.7 years). In the fertile group, they observed
that mean maximum urethral pressure (mMUP) and mean
maximum urethral closure pressure (mMUCP) had median
values of 66.5 and 60 cm H2O, respectively. Postmenopausal
women had significantly lower mMUP and mMUCP: 55.5
and 43.5 cm H2O, respectively. Van Geelen et al. [42]
studied 27 nulliparous healthy women between the ages of
19 and 35 years and recorded mMUP of 98±17 cm H2O in
the supine position, with mean MUCP of 84±18 cm H2O.
Pfisterer et al. [43] examined bladder function parameters in
pre-, peri-, and postmenopausal, continent women, discern-
ing mMUCP of 94, 74, and 42 cm H2O, with functional
urethral lengths of 3.3, 3.3, and 3.5 cm, respectively.
It is desirable that the urethral catheter is perfused at a
constant rate. This necessitates the use of a motorized
syringe pump or a very accurate peristaltic pump. A
perfusion rate of between 2 and 10 ml/min gives an
accurate measurement of closure pressure. Perfusion rates
of <2 ml/min usually fail to record the true urethral pressure
unless the withdrawal rate is extremely slow [1].
Int Urogynecol J (2012) 23:269–277
Stress UPP measures the rise in intra-abdominal pressure
transmitted to the proximal urethra. In normal women
without urethral hypermobility, increases in intravesical
pressure and proximal urethral pressure should be similar.
The pressure transmission ratio is a different parameter,
recording the increment of urethral pressure with stress as a
percentage of intravesical pressure elevation. In normal
women, this value should exceed 100 cm H2O [44].
Micturitional UPP serves to identify the presence and
location of BOO [45]. It is performed in a manner similar to
static UPP except that the patient voids as the catheter is
being withdrawn. This allows bladder pressure to be
compared with urethral pressure at points along the urethra.
If a significant drop is encountered on catheter withdrawal,
it corresponds to the site of obstruction.
Summary
MUCP below 20 cm H2O raises the possibility of ISD.
MUCP values above 75 cm H2O for women are considered
hypertonic [17].
Electromyography of the pelvic floor and external urethral
sphincter
Clinical neurophysiological studies, which include sphinc-
ter EMG, record bioelectric potentials generated during
muscle depolarization. They enable clinicians to completely
evaluate the striated sphincter complex and pelvic floor
activity during bladder filling, storage, and voiding.
Clinically, the most important information obtained from
sphincter EMG is coordination or discoordination between
the external urethral sphincter (EUS) and the bladder [17].
EMG is undertaken with electrodes. The needle is placed
lateral to the urethral meatus and is advanced parallel to the
urethra to a distance of about 1–2 cm. For representative
EMG studies of the perineal floor, needle and wire
electrodes may be placed in the superficial anal sphincter
in women [17].
Kinesiologic investigations may be performed with a
variety of electrodes and display methods. Needle/wire
electrodes are preferable because they are positioned in the
muscle of interest, allowing the detection of activity in
individual motor units [17].
Normally, EMG activity from the EUS is low at rest. It
intensifies as fluid volume in the bladder grows, during
bladder filling, due to EUS contraction. It is known as the
guarding reflex. During voiding, EMG activity disappears
completely for a few seconds before detrusor contraction starts.
Once the bladder is empty, EMG activity resumes [46, 47].
Failure of the sphincter to relax or stay completely
relaxed during micturition is abnormal [5]. When it occurs
in patients with neurologic disease, it is termed detrusor–
275
sphincter dyssynergia; it is typical in patients with supra-
sacral spinal cord injury. The term detrusor–sphincter
dyssynergia cannot be used in the absence of neurologic
disease. Instead, the applicable term is pelvic floor
hyperactivity or dysfunctional voiding [17].
Summary
EMG activity increases progressively during bladder filling.
The rise in EMG activity during heightened abdominal
pressure (cough, straining, etc.) is proportional to the level
of stress. EMG activity of the external sphincter and pelvic
muscles should be silent during voiding.
Reproducibility of urodynamics in healthy women
Reliability and reproducibility of different urodynamic
procedures are questionable. Short-term reproducibility
(same session or duplicate) was studied in several reports
[34, 48]. An increase in first and normal desires on second
fill was noted, yet maximum cystometric capacity reamined
unchanged.
Conclusions
Urodynamic tests are useful tools to evaluate LUT
dysfunction. They are gold standards for the diagnosis of
BOO and urinary incontinence. Urodynamic evaluation is a
good predictor of outcomes after therapeutic intervention.
Urodynamic normality in healthy populations is not well
known and illustrates a wide variety of data and patterns.
Several important parameters, such as age, sex, and body
mass index, affect urodynamic values, rendering it more
challenging to precisely define normality from tests
performed on patients.
Mathematical models and simulation may help in the
future to generate more data on normality, but additional
studies on healthy volunteers must be encouraged to gather
more information.
Conflicts of interest None.
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