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information for patients Urodynamics The urinary tract Your kidneys filter waste chemicals from the blood to form urine, which passes into the kidneys’ collecting system and then on to the ureters and bladder. The bladder is a hollow muscular balloon-like organ that collects urine which it stores until you are ready to urinate. The tube from the bladder to the outside world is called the urethra. In women, the urethra is a short tube immediately in front of the vagina (birth canal). In men, the tube is a longer one that passes through the prostate gland and along the penis. A muscle called the urethral sphincter surrounds the urethra. When your bladder is storing urine the sphincter muscle and the pelvic floor compresses the urethra and keeps you continent by preventing urinary leakage. When you urinate your bladder muscle contracts (squeezes) and the sphincter muscle relaxes (opens) and urine is expelled along your urethra. What are urodynamic studies? Urodynamics is the study of the pressure of urine in the bladder and the flow of urine leaving the bladder which can give useful information to help work out the cause of bladder problems. The test measures the way the bladder contracts to start the flow of urine and how much pressure there is in the bladder and urethra (the tube that carries urine out of the bladder). Why do I need to have this examination? The test is done because the same symptoms can be caused by different bladder problems so it is not always possible to make a diagnosis by talking and simple examination. What are the benefits of having Urodynamics? The test may help to choose an effective treatment. It might be that you and your doctor are thinking about surgery and the test is to see if an operation could help. Occasionally, the test is done to see if your bladder pressure is so high that it could cause kidney damage. What are the alternatives to having a Urodynamics? The alternative is not to have the test. Urodynamic tests are needed to decide on treatments aimed at improving your quality of life rather than improving your life expectancy. You do not have to have the test or treatment if you prefer to put up with your symptoms. What problems can Urodynamics diagnose? An overactive bladder muscle is where the bladder muscles contract without you wanting it to creating a strong desire to pass urine known as urgency. Urgency can be difficult to suppress and may require frequent visits to the toilet or may result in leakage (known as urge incontinence). Bladder muscle weakness is when a bladder is not able to produce a good enough contraction to empty properly. Obstruction to the flow can be caused by many problems including a narrowing of the outlet tube from the bladder (a stricture) or (in men) enlargement of the prostate gland and in women, a prolapse. Sphincter and pelvic floor weakness can cause stress incontinence, which is leakage when you do anything that raises the pressure in your abdomen, for example, cough, laugh or take exercise. information for patients What happens when I have the test? Urodynamics is not painful but some people do find it embarrassing. Try not to worry, we will do our best to put you at ease and make sure you are treated sensitively. When your bladder is full you will be asked to pass urine again tin the special toilet. This is usually done whilst you are standing. We have a special device to catch the urine for both men and women. When you have changed in to a gown all you will be asked to do is lie down on a special x-ray table that can be tilted into an upright position. If you experience leakage please do not worry, it is all part of the test and you will be able to wash in the changing rooms at the end. The fluid you leak is XR dye and does feel a little sticky. Some patients are given an injection of an antibiotic called Gentamicin. A fine tube, called a catheter, is inserted into your bladder—through the opening in the tip of the penis in men and in the small opening above the vagina in women. You will also have a second catheter inserted into your rectum (back passage). The first catheter is used to fill your bladder with fluid and is also attached to a sensor that records the pressure inside your bladder. The second is also attached to a sensor and it records the pressure in your abdomen. These sense bladder pressure and record what happens when you cough or move around. All these catheters are linked to a computer that prints out a graph of all the changes. Once the tubes are in place, the doctor or nurse will start filling your bladder. They will usually ask you to say when you first feel the need to pass urine and describe how you feel as your bladder fills. You may be asked to do a few simple things, such as cough or strain to test how the bladder sphincter muscle and pelvic floor behaves when put under stress from increases in pressure. Are there any risks involved? There is a small risk of infection from the test. Such infections are treatable and your doctor will give you advice if you feel concerned. When will I get the results? Your consultant will normally discuss the findings with you after the test and often again at a later appointment. Advice and treatment may then be offered depending on the bladder problem diagnosed. What happens after the test? You will be shown back to the changing rooms where you will find various hygiene products for washing. You can go home as soon as you have changed. What should I do when I get home? Drink plenty of water (at least two to three pints) for the rest of the day and three to four pints a day for the next day. This will help to prevent infection. You can usually resume sexual activity immediately. During the test the table will slowly tilt so you will end up in the standing position, unless you Avoid travelling long journeys for the next are usually unable to stand up of course. Do two days. not worry about falling off whilst the table is moving: it is very safe! information for patients General things to remember: • If you think you may have an infection or feel ill, contact your own GP or the numbers below • If you have been given antibiotics, make sure you complete the course • If you are unsure about the tablets given to your contact your GP for advice • If you have any problems or are unsure what to do please do not hesitate to contact any of the ward staff for advice. We hope that you have found this information useful. If you have any questions, or you are worried about anything, please speak to your family doctor (GP) or contact the above numbers. You can get copies of this and other leaflets from our website: www.chesterfieldroyal.nhs.uk Do you have special communications needs? Speak to a member of staff if you need interpreting services (including sign language) at your appointments, or if you would prefer information in another format. Who can I contact after the procedure? If you think you may have an infection or feel generally unwell, please see your GP who will refer you back to the hospital if necessary. If you need further advice contact: The Urology Department Monday to Friday 8.30 am — 5 pm Telephone: 01246 512349 Urodynamics reviewed: April 2015 Next planned review: April 2017 Division: Surgical Specialities