Urodynamic evaluation of the incontinent female has come of age. It is no longer accept able to subject women to surgical procedures for urinary incontinence based solely on the physician's clinical impression of the cause of the urine loss. Multiple studies in the uro gynecological literature have told us that the error rate for stress incontinence is about 25% and the error rate for the unstable bladder is 50% when these diagnoses are based solely on historical data obtained from the patient. Unfortunately the patient is a poor witness to her bladder's activities and diagnoses arrived at without further evaluation are subject to error. Urodynamic testing allows the establishment of precise diagnoses using procedures that have been proven to be accurate. For the physician who has not had the opportunity to have fellowship training, the uro dynamic tracing is sometimes more of a mystery than a diagnostic aid. Physician training in the reading of urodynamic tracings is limited to piecing together information from the literature, textbooks and postgraduate courses. Unfortunately none of these sources can provide the experience necessary to become an expert in the interpretation of the physio logical and pathophysiological events depicted on the tracing. Artifacts occur commonly and may lead to misinterpretation of these events and even misdiagnosis if the reader of the tracing is not careful and fully informed on the nuances of the testing procedures. This is why this text was conceived as an atlas of urodynamic testing procedures.

Section I: Routine Office Evaluation

1 The Female Urologic History
2 Voiding Diaries
3 Uroflowmetry in the Female
4 The Lumbosacral Neurologic Examination
5 The Gynecologic Pelvic Examination
6 The Q-Tip Test
7 Urethral Calibration
8 Stress Testing
9 Pad Testing
Section II: Cystourethroscopy and Cystometry
10 Dynamic Urethroscopy
11 Supine Urethroscope Cystometry
12 Cystoscopy
13 Standing Single Channel Cystometry
Section III: Multichannel Urodynamics: Normal Studies
14 Who Needs Urodynamics?
15 Urethral Closure Pressure Profiles
16 Augmenting Urethral Closure Pressure Profiles
17 Dynamic Urethral Closure Pressure Profiles: Valsalva and Cough Profiles
18 Urethral Responses to Position Changes
19 Urethral Responses to Bladder Filling
20 Multichannel Urethrocystometry
21 Voiding Pressure Studies
Section IV: Multichannel Urodynamics: Pathologic Studies
22 Genuine Stress Incontinence
23 Pressure Transmission Ratios
24 Detrusor Instability
25 The Acontractile Bladder
26 Detrusor Sphincter Dyssynergia
27 The Low Compliance Bladder
28 Genital Prolapse
29 The Low Pressure Urethra
30 Urethrovaginal Fistulas
31 Urethral Diverticula
32 Urethral Instability
33 Uninhibited Urethral Relaxation
Section V: Special Tests
34 Prolapse Pessary Tests
35 Urethral Denervation Testing
36 Vesical Denervation Testing
37 The Bladder Cooling Test
38 The Stop lest
39 Pelvic Floor Stimulation: Effect on Detrusor Activity
40 Pelvic Floor Stimulation: Effect on Urethral Closure Pressure Profile
41 The Effect of Hypogastric Nerve Block on Detrusor Instability
42 The Effect of Pudendal Block on the Urethral Closure Pressure Profile
43 Leak Point Pressure Testing
Section VI: Urodynamic Artifacts
44 Rectal and Vaginal Peristalsis
45 Transducer Placement and Poor Calibration
46 Filling Catheter Artifacts
47 False Negative Cough Profiles
48 Transducer-Induced Artifacts
Section VII: Postoperative Urodynamics
49 The Effect of Retropubic Urethropexy on the Resting Urethral Closure Pressure Profile
50 The Effect of Retropubic Urethropexy on the Dynamic Urethral Closure Pressure Profile
51 The Effect of the Suburethral Sling Procedure on the Dynamic Urethral Closure Pressure Profile
52 Postoperative Detrusor Instability
53 Type III Stress Incontinence
Appendices
Appendix A Office Treatment of Urinary Incontinence
Appendix B Terminology of Lower Urinary Tract Function
Appendix C Recording Forms for Urodynamics and Evaluation of Urinary Dysfunction
Appendix D Self Test.