A URODYNAMIC STUDY

The Whole Works

Wendy McArthur

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Components Of Test

• Homework

• Free Flow

• Transperineal Scan

• Peritron Test

• Cystometry

• Leak Point Pressure

• Pressure Flow

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Urodynamics

• Examination of the lower urinary tract

• Test the bladder pressures during filling and emptying

• Helps determine the cause of bladder symptoms

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Aim Of Urodynamics

• To reproduce the symptoms under controlled and measured conditions

• Need technically reliable measurements

• Experience so technique is second nature

–put patient at ease

–reproduce their usual behaviour

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Homework

• Uro Kit includes

• Questionnaire

• Bladder Diary

• Pad Test

• MSU Form

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Questionnaire

• Relating to bladder symptoms

• Relevant medical history

• Obstetric history

• Medications

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Bladder Diary

• Recordings over 24hours

• Fluid intake

• Fluid output

• Guage output volumes

• Frequency

• Nocturia

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Pad Test

• Pre weighed pad

• Drink 1 litre of water

• Wait 1 hour

• Do set exercises with pad in pants

• Remove pad

• Measure urine

• Weigh pad when returned

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Laboratory Tests

• Mid stream Urine

• Urine Cytology for pts over 60

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Free Flow

• Full bladder

• Privacy, normal as possible

• Measures

–voiding time

–flow rate

–time to maximum flow

–volume passed

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Transperineal Scan

• Measure descent of bladder neck

• Push into bottom

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Peritron

• Measures strength of pelvic floor muscles

• Probe in vagina

• Connect to abdominal pressure line

• Squeeze and hold - try for 40 seconds

• Normal strength = 30-40 cm H2O

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Cystometogram

• Recording of bladder pressure as filled

• Sensory catheter in bladder = Pves

• Balloon catheter in rectum = Pabd

• Computer calculation of detrussor pressurePdet = Pves - Pabd

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Assessment of Cystometogram

• Note first sensation in bladder

• First urge - about 50% capacity

• Normal desire - able to hold on

• Strong desire - persistant with no leakage

• Does the bladder relax and accommodate the fluid

• Does the detrussor pressure stay even

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Leak Point Pressure

• Valsalva movement sitting

• Full bladder

• Cough standing

• Measure leak point pressure

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Pressure Flow

• Pressure lines recording

• Detrussor pressure

• Abdomonal pressure

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