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    2017 05 13 GSD Cathy Rumble GP Urodynamics Made Easy Information Sheet

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    anjelika
    Urodynamics testing measures bladder and urethra function during storage and voiding of urine. There are two main types of cystometry - simple and multichannel. Simple cystometry determines first sensation and capacity but not intrinsic sphincter defects, while multichannel determines this and other measurements. Testing involves catheterization and saline infusion with pressure readings from the bladder, urethra, and abdomen to diagnose stress or urge incontinence based on pressure increases during actions like coughing. Abnormal flowmetry curves can indicate outlet obstruction or hypotonic bladder based on related pressure readings.

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    2017 05 13 GSD Cathy Rumble GP Urodynamics Made Easy Information Sheet

    Uploaded by

    anjelika
    101 views5 pages
    Urodynamics testing measures bladder and urethra function during storage and voiding of urine. There are two main types of cystometry - simple and multichannel. Simple cystometry determines first sensation and capacity but not intrinsic sphincter defects, while multichannel determines this and other measurements. Testing involves catheterization and saline infusion with pressure readings from the bladder, urethra, and abdomen to diagnose stress or urge incontinence based on pressure increases during actions like coughing. Abnormal flowmetry curves can indicate outlet obstruction or hypotonic bladder based on related pressure readings.

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    2017-05-13-GSD-Cathy-Rumble-GP-Urodynamics-Made-Easy-Information-Sheet

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    Urodynamics testing measures bladder and urethra function during storage and voiding of urine. There are two main types of cystometry - simple and multichannel. Simple cystometry determines first sensation and capacity but not intrinsic sphincter defects, while multichannel determines this and other measurements. Testing involves catheterization and saline infusion with pressure readings from the bladder, urethra, and abdomen to diagnose stress or urge incontinence based on pressure increases during actions like coughing. Abnormal flowmetry curves can indicate outlet obstruction or hypotonic bladder based on related pressure readings.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    101 views5 pages

    2017 05 13 GSD Cathy Rumble GP Urodynamics Made Easy Information Sheet

    Uploaded by

    anjelika
    Urodynamics testing measures bladder and urethra function during storage and voiding of urine. There are two main types of cystometry - simple and multichannel. Simple cystometry determines first sensation and capacity but not intrinsic sphincter defects, while multichannel determines this and other measurements. Testing involves catheterization and saline infusion with pressure readings from the bladder, urethra, and abdomen to diagnose stress or urge incontinence based on pressure increases during actions like coughing. Abnormal flowmetry curves can indicate outlet obstruction or hypotonic bladder based on related pressure readings.

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    of 5

    Urodynamics made easy

    [email protected] Dr.Tanushree Rao MBBS, M.S , MRCOG (U.K) Obstetrician & Gynaecologist

    What is urodynamics?
    It’s basically testing how the bladder and urethra are doing their job in terms of storing and
    releasing urine.
    What are the types of cystometry?
    The battery of tests that measure bladder function are called cystometrics.
    There are 2 types – 1. Simple and 2. Multichannel
    Simple – it is inexpensive and helps to determine SUI and DO. It also determines
    measurement of first sensation, desire to void, and bladder capacity. But it will NOT
    measure ISD (intrinsic sphincter defect).
    Multichannel– in addition to all that simple cystometrics determines it also helps to
    diagnose ISD.
    Procedure– testing is performed with the woman standing or sitting on a specialised chair.
    Initially women are asked to empty their bladder into a commode connected to a
    flowmeter (uroflowmetry). After a maximal flow rate is recorded, the patient is catheterised
    to measure post void residual volume.
    Then two catheters are used one placed in bladder and one in the rectum. The bladder is
    filled with room-temperature sterile normal saline, and the patient is asked to cough and to
    perform a valsalva manoeuvre at regular intervals.
    Additionally, during filling, the volumes at which a first desire to void and maximal bladder
    capacity is reached are noted. These two catheters give us the following measurements

    1) intra abdominal pressure,


    (2) vesicular pressure,
    (3) calculated detrusor pressure,
    (4) bladder volume, and
    (5) saline-infusion flow rate.

    1
    How to interpret the data?
    In the graph there are three lines given.

    Trace A is abdominal pressure. (pressure in the abdomen while coughing / straining etc).
    Sometimes this can be seen during rectal peristalsis too.
    Trace B is vesical pressure. (pressure inside the bladder cavity)
    Trace C is detrusor pressure. (pressure in the wall of the bladder)

    The graph also has two parts – first part is the filling /storage phase. The second part is the
    voiding phase. Based on where the abnormality is noted it is termed as storage defect or
    voiding defect.

    2
    How to make sense of these lines?

    The first line, abdominal pressure is raised when the person coughs or strains. During
    coughing you need to see other lines too to make complete diagnosis.
    The second line, vesical pressure is usually raised when there is increase in bladder wall /
    abdominal pressure. This can also raise if there is an outlet obstruction like a urinary
    stricture, cystocele (kinking urethra) etc as the normal detrussor tries to overcome the
    obstruction.
    The third line, detrussor pressure is usually raised when there is increased tone in the
    detrussor muscle leading to urge incontinence. The cause may be idiopathic or neurogenic.
    The increase in pressure can be phasic or continuous.
    If the detrussor pressure is low it may be because of conditions like neurological problems
    involving the lumbosacral nerves, diabetes, chronic UTI, anticholinergics etc.
    Is it stress incontinence or urge incontinence?

    If its stress incontinence – the Pab will be raised as she is coughing. Simultaneously you will
    see the Pves pressure raised and a leak noted below. It would look something like this.

    3
    If it’s detrussor over activity there would be increase in vesicular and detrussor pressure but
    abdominal pressure would be normal. Something like this

    Flowmetry

    Uroflowmetry is the measurement of the speed and volume of urine. This just needs an
    equipment to catch the urine and measure it while a computer produces the graph.
    Normally, it’s a bell shaped curve.

    If there was an abnormality it would probably look like this

    The above graph shows that the urine is unable to flow out normally. This could be because
    of a bladder outlet obstruction or a hypotonic bladder. How to differentiate between the
    two you ask?
    Just measure P-det. If it’s high then it’s obstruction. If it’s low then it’s hypotonic bladder

    4
    This can be summarised as –
    LOW flow rate + LOW P-det + NORMAL P-urethra = hypotonic bladder
    LOW flow rate + HIGH P-det + HIGH P-urethra = outlet obstruction

    Urethral pressure

    This is measured to help in detailed diagnosis of stress incontinence. There are two reasons
    for stress incontinence- intrinsic sphincter defect or hypermobility of the urethra.
    If stress incontinence is diagnosed and
    -If urethral pressure less than 25 mm of H2O – its instrinsic sphincter defect
    -If urethral pressure more than 25 mm of H2O- its hypermobility.

    Normal values
    Bladder capacity: 400 – 600 ml
    First sensation: 150-250 ml
    Detrussor pressure (filling): < 15 cm of H2O
    Detrussor pressure (voiding) : <70 cm of H2O
    Peak flow rate : >15 ml/sec
    Flow time: 15-30 sec
    Q-max: 25 ml/sec
    Residual volume: <50 ml

    Urodynamic Terminology
    If stress incontinence is urodynamically proven it’s called USI (urodynamics stress
    incontinence)
    If urge incontinence is proven through urodynamics it’s called Detrusor overactivity (DO)

    Abbreviations
    SUI- stress urinary incontinence
    DO- detrusor overactivity
    ISD- intrinsic sphincter defect (of urethra)
    Pab- abdominal pressure
    Pves- vescical pressure
    Pdet- detrussor pressure

    References

    1. https://www.ics.org/publications/ici_2/chapters/chap07.pdf
    2. http://www.baus.org.uk/_userfiles/pages/files/professionals/surg/TJW-
    Urodynamics.pdf

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