Presentation of pelvic floor electrodiagnostic techniques including surface and needle electromyography (EMG), nerve conduction and terminal latency studies, evoked potentials, and reflex response studies. The clinical, urodynamic, and electrophysiologic findings to be expected with neuropathy in various areas, from the cerebral cortex to the peripheral pelvic floor nerves, are also described. Because of widespread technical advances and great increase in the amount of information about human neuro-urology, concepts are continually undergoing modification and change. This chapter also concentrates on the present aspects of clinically useful knowledge, although modification of many concepts will soon be needed. EMG requires additional expertise but should be considered in the difficult clinical situation.

Urodynamic studies provide insight into the functioning of individual components of the lower urinary tract, bladder, and urethra, and into their interactions. Debate continues on the role of urodynamic studies in prediction of surgical outcome and in patient counseling before surgery. The purpose of this review is to set forth general principles of pitfalls in urodynamic studies and illustrate with a few representative tracings. The refinement of urodynamic techniques, in the context of rapidly evolving strategies to treat stress urinary incontinence, pelvic-organ prolapse and overactive bladder, has allowed physicians caring for women with disorders of the pelvic floor to bladder function more accurately. This review also highlights some of the ongoing debates over the performance, interpretation, and utility of urodynamic testing, and provides references for further reading on these topics. Problems arise if the urodynamic studies are of poor quality or difficult to interpret, and if repeat testing is required.