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A URODYNAMIC STUDY The Whole Works Wendy McArthur Components Of Test • • • • • • • Homework Free Flow Transperineal Scan Peritron Test Cystometry Leak Point Pressure Pressure Flow 2 Urodynamics • Examination of the lower urinary tract • Test the bladder pressures during filling and emptying • Helps determine the cause of bladder symptoms 3 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 4 Homework • • • • • Uro Kit includes Questionnaire Bladder Diary Pad Test MSU Form 5 Questionnaire • • • • Relating to bladder symptoms Relevant medical history Obstetric history Medications 6 Bladder Diary • • • • • • Recordings over 24hours Fluid intake Fluid output Guage output volumes Frequency Nocturia 7 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 8 Laboratory Tests • Mid stream Urine • Urine Cytology for pts over 60 9 Free Flow • Full bladder • Privacy, normal as possible • Measures –voiding time –flow rate –time to maximum flow –volume passed 10 11 12 Transperineal Scan • Measure descent of bladder neck • Push into bottom 13 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 14 15 Cystometogram • • • • Recording of bladder pressure as filled Sensory catheter in bladder = Pves Balloon catheter in rectum = Pabd Computer calculation of detrussor pressure Pdet = Pves - Pabd 16 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 17 Leak Point Pressure • • • • Valsalva movement sitting Full bladder Cough standing Measure leak point pressure 18 Pressure Flow • Pressure lines recording • Detrussor pressure • Abdomonal pressure 19 20 21 22 23 24
