Patient-reported burden and adverse events of urodynamic investigation in adults with neurogenic lower urinary tract dysfunction

Abstract

Abstract Urodynamic investigation (UDI) is the gold standard for evaluating refractory lower urinary tract symptoms but may cause pain, emotional discomfort, and adverse events, particularly urinary tract infections. In this secondary analysis of a randomized controlled trial, adults undergoing UDI for neurogenic lower urinary tract dysfunction rated pain and emotional discomfort on an 11-point numeric rating scale (0–10), with ≥ 4 defining moderate-to-severe burden; a structured telephone interview at 7–14 days assessed post-procedural adverse events. Among 490 patients, most reported low pain and emotional discomfort (median 2, IQR 0–4 and 0–5). Pain did not differ by sex, whereas emotional discomfort was higher in females (median 2.5 vs 1; p = 0.004). Post-procedural symptoms included pain (30%), worsening lower urinary tract symptoms (18%), and macrohematuria (8%); 99% were transient. Urinary tract infection occurred in 6% and was associated with pre-procedural bacteriuria (OR 6.69; 95% CI 2.15–20.81). Assuming risk equalization, the number needed to treat to prevent one infection was 15 (95% CI 9.6–38.6). In conclusion, UDI is generally well tolerated, although approximately one-third of patients experience moderate-to-severe pain or emotional discomfort. Pre-procedural bacteriuria increases infection risk, but the number needed to treat does not support antibiotic prophylaxis.