Standard and extramural ambulatory urodynamic investigation for the diagnosis of detrusor instability-correlated incontinence and micturition disorders

Forty-six patients were evaluated for complaints of urinary incontinence or voiding disorders. Diagnostic testing included a detailed history, physical examination, urine analysis, and urodynamic studies consisting of a conventional urodynamic test (S.I.) including provocative manoeuvres and extramural ambulatory urodynamic monitoring (e.a.m.). We compared the pre-classification diagnoses obtained from the medical history with both urodynamic tests. Conventional cystometry detected detrusor instability in 8 patients out of 16 with a history of urgency, while a normal detrusor behaviour was observed in the other 8. "Provocative" manoeuvres yielded an additional 13.3%. Extramural ambulatory monitoring confirmed the diagnosis in the 8 patients with hyperactivity and revealed detrusor instability in a further 7. E.a.m. proved adequate in 93.7% of patients with symptoms of detrusor instability. In the group of patients with urinary stress incontinence (USI) e.a.m. revealed detrusor instability in 18.7% of the patients, but did not significantly improved the diagnostic results obtained by S.I. Coughing was the most effective stimulus to objectify stress incontinence. The comparison of the results obtained with S.I. and those obtained with home e.a.m. will probably lead to a more rational use of both methods. Our data confirm the promising impact of ambulatory urodynamic investigation.