The contribution of urethrocystoscopy to evaluation of lower urinary tract dysfunction in women

The aim of this study was to determine whether the evaluation of lower urinary dysfunction with urodynamics and urethrocystoscopy provides unique information that is missed by urodynamics alone. Eighty-four women underwent multichannel urodynamics and urethrocystoscopy. Retrospective analysis included evaluation of the relationships between lower urinary tract lesions and risk factors using ² and Fisher's exact tests. Urethrocystoscopic findings changed the diagnosis and managment in 6 patients. New urethrocystoscopic findings included papillary transitional-cell carcinoma, cystitis glandularis, an intravesical suture and a urethral diverticulum. Clinical parameters were not predictive of these findings. Urethrocystoscopic findings also contributed to the final diagnosis in 10 patients with intrinsic sphincter deficiency. Considered alone, maximum urethral closure pressure 20 cm H₂O had a sensitivity of only 20% and a positive predictive value of 40% for this diagnosis. Urodynamics without urethrocystoscopy would have missed important diagnoses in 19% of women. Urethrocystoscopy and urodynamics complement one another, and both have a role in the evaluation of women with lower urinary tract dysfunction.EDITORIAL COMMENT: Urethrocystoscopy as an integral part of urinary incontinence evaluation was popularized by Dr Robertson in the early 1970s. With the appearance of the sensitive microtip pressure transducers and multichannel urodynamics, these modes of evaluation became the gold standard. The popularization of urodynamic studies has put a question mark against the role of cystourethrscopy in evaluating incontinence. This study provides important information on the role of urethrocystoscopy in addition to urodynamic studies. The change of managment based on endoscopic findings in 19% of women in this series, is the answer. One disturbing finding in this report is the very high incidence (5%) of cancer or precancer in women with urinary incontinence. Many urogynecologists do not find 1 in 20 of their patients having cancer or precancer of the lower urinary tract, except perhaps for referral centers for oncologists. Still we should keep these number in mind and look for bladder abnormalities when performing endoscopic studies in the evaluation of urinary incontinence.