Which test is considered the gold standard for diagnosing detrusor overactivity?

• A. Bladder diary.
• B. Urodynamic testing showing detrusor overactivity during bladder filling.
• C. 24-hour pad test.
• D. Post-void residual measurement.

Answer: (B)

Direct demonstration of involuntary detrusor contractions during bladder filling is what defines detrusor overactivity, and the test that best provides this evidence is urodynamic testing with filling cystometry. This procedure records bladder pressures in real time as the bladder is filled, revealing any involuntary contractions that cause leakage, which is the definitive sign of DO. Tools like a bladder diary, a 24-hour pad test, or post-void residual measurement assess symptoms, leakage amounts, or emptying function, but they do not confirm the physiological event of involuntary detrusor activity during filling.