• Posted March 24, 2025

Uncomfortable Bladder Tests For Women Can Be Avoided

A small urine leak might prompt a woman to worry she’ll need an uncomfortable and invasive bladder test to treat her incontinence.

But good news -- such bladder pressure tests probably aren’t necessary, according to results from the first randomized clinical trial assessing their effectiveness.

A range of other assessments work just as well as a bladder test in guiding treatment of female incontinence, researchers reported March 22 in The Lancet.

Bladder tests -- also called urodynamics testing -- involve filling the bladder with water through a catheter inserted into the urethra, researchers said in background notes. Another catheter is inserted into the vagina or rectum to measure the pressure inside the bladder and abdomen.

These tests have become standard practice in diagnosing and treating incontinence, even though there isn’t a lot of evidence that the practice is effective, researchers said in background notes.

“Invasive urodynamics tests can be embarrassing and uncomfortable procedures,” lead researcher Dr. Mohamed Abdel-Fattah, director of the University of Aberdeen’s Center for Women’s Health Research in the U.K., said in a news release.

In this first clinical trial, researchers randomly assigned nearly 1,100 women to either receive a comprehensive clinical assessment from a doctor or get the assessment along with a bladder test.

The women all were suffering from overactive bladder or urge urinary incontinence, and were being treated at one of 63 U.K. hospitals.  They hadn’t responded well to first-line treatments like medication, pelvic floor exercises or bladder retraining drills.

The assessment involved providing a detailed medical history, filling out a three-day bladder diary, and undergoing a doctor’s exam, researchers wrote.

During a 15- to 24-month follow-up, the patients were asked to report on the success of the treatment offered as a result of their examination.

Results showed no significant difference between those who did and didn’t get a bladder test.

About 24% of women who got a bladder test said their symptoms were “very much” or “much” improved, compared with 23% in the group that only underwent a medical evaluation.

Women who only got a clinical evaluation also reported earlier improvement in their symptoms, researchers said.

Clinical assessments are easier for women to line up, researchers noted. They can be performed by a nurse or doctor without any extra equipment, while a bladder test involves a referral to a specialist clinic and a wait of weeks or months to be seen, potentially delaying treatment.

“For many women who are struggling with finding a treatment that works for this type of urinary incontinence, our trial shows they no longer have to go through that experience to achieve an improvement in their symptoms and quality of life,” Abdel-Fattah said.

“While women who underwent invasive urodynamics testing received more tailored treatments based on the test result, this did not translate to better patient reported success rates following treatments, better improvement in women’s quality-of-life, or less adverse events,” he added.

Researchers also presented their findings at the European Association of Urology’s annual meeting in Madrid on Saturday.

“Many European countries have long waiting lists for urodynamics testing, and the invasive tests can be an unpleasant experience for women,” EAU member Dr. Benoit Peyronnet, professor at the Rennes University Department of Urology in France, said in a news release.

The new trial’s findings “are very important as they are the first to show that invasive urodynamics testing could be avoided in a subgroup of patients and the outcomes for women – based on their own reports of whether their treatment is successful – could be just as good,” said Peyronnet, who was not involved in the study.

“However, in busy clinical settings, there may not be time to undertake the series of comprehensive assessments carried out in the trial, so invasive urodynamics tests may still be valuable and important in some settings - and especially in some groups of patients,” he added.

“We also need to be mindful that this is just a two-year study based on patient reported outcomes, so while the evidence is of high enough quality to influence practice, the results of a longer-term follow-up trial will be very interesting to see,” Peyronnet concluded.

More information

The Cleveland Clinic has more on urodynamic bladder testing.

SOURCE: European Association of Urology, news release, March 22, 2025