Cystometry determines the compliance and the capacity of the bladder. However, other routes, such as suprapubic, are also options where necessary. Cystometry provides information regarding bladder sensations that occur as the bladder fills as well as the reaction of the detrusor to this filling. Catheters are most commonly inserted transurethrally. It begins with the infusion of fluid into the bladder with a catheter. The 2 phases of standard invasive urodynamic testing include cystometry during the filling phase and a pressure-flow study during the voiding phase.Ĭystometry is the dynamic measurement of detrusor pressure during the continuous filling of the bladder. Therefore, patient dignity and privacy should be maintained, with anxiety and discomfort kept to a minimum. The act of micturition is affected by psychological factors. The next step is recording the post-void residual volume to evaluate the extent of bladder emptying. This test is performed in the patient's preferred voiding position and should be representative of the patient's typical voiding and voided volume. Uroflowmetry is the non-invasive assessment of the free flow of urine voided per unit time, measured in milliliters per second (ml/s). Urinalysis should occur before invasive urodynamic testing.Ī multi-channel urodynamic test comprises of five components: Furthermore, patients should complete a 3-day bladder diary (frequency volume chart) to assist in arriving at a urodynamic diagnosis. Patients investigated for LUTS are expected to complete a relevant, validated symptom score which includes a bother to life indicator. Male patients should undergo an examination of the external genitalia as well as digital rectal examination to assess the prostate. Female patients should have a pelvic exam. A physical examination is necessary, with completion of appropriate neurological examination including assessment of gait, sacral sensation, and relevant reflexes. A urological symptom history should be taken, as well as a review of the patient's past medical history and medications. The International Continence Society (ICS) guidelines advise for a standard urodynamics protocol where all patients undergo thorough clinical assessment as part of a urodynamic investigation. It is a second line investigation aiming to reproduce symptoms through normal ambulatory activity in patients for whom standard urodynamic testing has not yielded definitive answers. Natural filling of the bladder occurs through diuresis, rather than infusion via a catheter. Īmbulatory urodynamics has a portable device continuously monitoring bladder and abdominal pressures via invasive catheters. This form of assessment is particularly more informative in neurological patients who have neurogenic bladders and in patients who have had previous surgery or trauma-related anatomical defects. Video urodynamics is when standard urodynamics is combined with fluoroscopic imaging with radiographic contrast used in bladder filling. The addition of tests such as concurrent electromyography (EMG) of pelvic floor muscles and urethral pressure profiles can supplement the investigation for further clinical detail. Standard urodynamic testing is performed in patients with LUT symptoms (LUTS). It involves noninvasive uroflowmetry, followed by invasive cystometry and a pressure-flow study. Urodynamic testing is a collaborative and dynamic investigation involving both the patient and clinician and should incorporate clear communication and open cooperation. A clear question should, therefore, be posed and answered when performing standard urodynamic testing, and its results should guide therapeutic intervention. Invasive monitoring utilizes the insertion of catheters into the bladder and other body cavities. The test involves noninvasive evaluation of bladder emptying, and invasive assessments of bladder storage function and bladder emptying function. The standard urodynamic test includes both forms of assessment. Urodynamics is the measurement of the relevant physiological parameters of the LUT to assess its function and dysfunction. Clinicians can perform urodynamics noninvasively and invasively. The lower urinary tract (LUT) consists of the bladder and urethra and allows for the low-pressure storage of urine with conscious control of micturition.
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