ICS Urodynamic Standardized Fact Sheet

Page 1: Signal Quality Checkgate & Reference Metrics Matrix

1. Signal Quality Control Checkgate
A. Baseline Resting Pressures (Pves & Pabd) B. Signal Transmission & Symmetry
• Supine: 5 – 20 cmH2O
• Seated: 15 – 40 cmH2O
• Standing: 30 – 50 cmH2O
• Pdet Baseline (All Positions): -5 to +10 cmH2O 		• Cough Test: Spikes in Pves and Pabd must be equal in amplitude.
• Pdet Check: Zero net deflection rules out squeeze and transmission artifacts.
2. Storage Phase: Sensations, Capacity & Leak Pressures
Storage Sensations & Normative Volumes Leak Point Pressures (LPP) & Sphincter Profile
• First Sensation (FS): 100–150 mL (~30-40% MCC)
• First Desire (FD): 150–250 mL (~50-60% MCC)
• Strong Desire (SD): 250–400 mL (~75-80% MCC)
• Max Capacity (MCC): 350–600 mL 		• ALPP > 100 cmH2O: Urethral Hypermobility
• ALPP < 60 cmH2O: Intrinsic Sphincter Deficiency (ISD)
• DLPP > 40 cmH2O: Upper Tract Risk (High Storage Pdet)
• MUCP < 20 cmH2O: Incompetent Urethra (ISD)
3. Key Diagnostic Formulas & Reference Thresholds
Male Indices (ICS Abrams-Griffiths) Female Indices (Solomon-Greenwell)
BOOI (Obstruction Index): PdetQmax - (2 × Qmax)
• BOOI > 40 Obstructed
• BOOI 20–40 Equivocal
• BOOI < 20 Unobstructed

BCI (Contractility Index): PdetQmax + (5 × Qmax)
• BCI > 150 Strong Contractility
• BCI 100–150 Normal Contractility
• BCI < 100 Detrusor Underactivity (DU) 		fBOOi (Female BOO Index): PdetQmax - (2.2 × Qmax)
• fBOOi > 18 Severe BOO (>90% prob)
• fBOOi > 5 Likely BOO (>50% prob)
• fBOOi ≤ 5 Unobstructed

PIP1 (Provisional Inotropy Index): PdetQmax + Qmax
• PIP1 < 30 Weak Contractility
• PIP1 30–150 Normal Female Range
CRITICAL UPPER TRACT RISK: Bladder Compliance (C)
• Formula: (V2 - V1) / (Pdet2 - Pdet1)  |  Threshold: < 20 mL/cmH2O (Normal > 30 mL/cmH2O)
• Low compliance transmits high storage pressure to kidneys. Requires immediate pressure lowering therapy (Antimuscarinics / Botox / CIC) to protect renal function.

ICS Urodynamic Standardized Fact Sheet

Page 2: ICS Diagnostic Decision & Action Flowchart

1. Storage Phase Diagnostic Flow
Condition Diagnostic Criteria Clinical Action
Detrusor Overactivity (DO) Involuntary Pdet waves during filling OAB pathway (Antimuscarinics / Beta-3 / Botox)
Low Compliance Compliance < 20 mL/cmH2O Renal protection, high-pressure lowering therapy
Stress Incontinence (SUI) Involuntary leakage during cough/strain Evaluate ALPP (< 60 = ISD Risk, > 100 = Hypermobility)
2. Voiding Phase Diagnostic Pathway
MALE PATHWAY (BOOI & BCI) FEMALE PATHWAY (fBOOi & PIP1)
1. BOOI > 40 & BCI ≥ 100:
High probability of surgical success based on EAU criteria (TURP/HoLEP). High recovery chance.

2. BOOI > 40 & BCI < 100:
BOO + Detrusor Underactivity. Surgery reduces resistance, but elevated PVR may persist.

3. BOOI < 20 & BCI < 100:
Primary Detrusor Underactivity. Surgical outcomes are guarded; focus on CIC or conservative management. 		1. fBOOi > 5:
Female Bladder Outlet Obstruction. Investigate anatomical stricture, post-MUS sling over-tensioning, or pelvic floor dysfunction.

2. fBOOi ≤ 5 & PIP1 < 30:
Female Detrusor Underactivity. Urethral dilation is not recommended. Focus on conservative emptying strategies (CIC).
3. Clinical Action Plan (Aims of Investigation)
1. Symptom Reproduction 2. Diagnostic Precision 3. Therapeutic Pathway
Verify that patient LUTS / incontinence symptoms were accurately reproduced during the test. Differentiate mechanical outflow resistance from detrusor muscle weakness. Select appropriate surgical or conservative management based on contractility indices.