Video Urodynamics in the Digital Age: What Have We Overlooked?

Copyright © 2023 Korean Continence Society This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. A urodynamic study is an important test that helps clinicians objectively evaluate a patient’s subjective voiding symptoms and decide on the optimal treatment. Additionally, video urodynamic studies enable a more in-depth investigation of the causes of voiding dysfunction by observing structural changes and motions of the bladder and urethra. Several studies have reported evidence questioning the role of urodynamics in some diseases [1,2]; this is an important issue that medical professionals responsible for treating voiding dysfunction should address. As a clinician who has been caring for patients with voiding dysfunction and performing urodynamic tests for 30 years, I (the first author of this editorial) believe that one of the most important functions of urodynamic studies is to train clinicians to be experts in the field of voiding dysfunction, even though this is difficult to objectively demonstrate. In any case, this is a suitable time to discuss the history of urodynamics, how it has evolved over time, and the challenges we are currently facing. Video urodynamic studies are the most technologically advanced clinical method for diagnosing voiding dysfunction, and it serves as a prototypical illustration of the successful transition from analog to digital machine technology that has accompanied rapid industrial development in recent years. However, as a clinician who has performed urodynamic tests in both eras, I would like to point out one critical disadvantage of modern digital machines. The most significant advantage of video urodynamic studies in the analog era was that the functionsynchronized bladder and urethral movements were recorded on videotape and could be viewed and analyzed at any time following the test. Modern digital machines lack this advantage of older analog machines. The original definition of “video” refers to a recording of an image or moving images [3]. The majority of medical professionals who carry out urodynamic tests agree that these tests involve moving images. For the human eye to be able to detect motion, a frame rate of greater than 15 per second is required [4]. Storing large numbers of images to show motion was not a problem with videotape, but it appears to be an issue in the digital era. Therefore, it is presumed that this technical limitation with computers was handled by limiting the number of images that could be saved. For this reason, I think that the term “cystographic urodynamic study,” rather than “video urodynamic study,” would better describe what is done with modern digital urodynamic study devices, because the images do not appear to be in motion. Our group has made several attempts to overcome these limitations of digital machines, and we would like to briefly introduce recent success stories and over 200 experiences. We initially attempted to solve this problem by installing screen-capture software on the computer used for urodynamic testing, but we soon realized that the screen-capture software interfered with the urodynamic examination software being run at the same time. To store screen data without impacting the urodynamic examination software, an external device and another computer were attached to the urodynamic monitor in place of the urodynamic computer. The videos saved by the current urodynamic machine are now perceived as videos where motion can be seen, just like with the video urodynamic machines Editorial