Understanding Urodynamics

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Understanding Urodynamics

• Kim Duggan, RNC

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Understanding Urodynamics

• Urodynamics is a study that assess how the
  bladder and urethra are performing their jobs of
  storing and releasing urine
• Urodynamics testing assesses how well the bladder
  and sphincter muscles work to explain symptoms
• Urodynamic testing tells the physician if the
  patient has a Functional Problem or a Structural
  Problem

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Patient Complaints
Incontinence Frequent Urination Sudden,
Strong urges to urinate Problems starting a
urine stream Painful urination Problems
emptying your bladder completely Recurrent
urinary tract infections Pelvic Pain
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Contributing Factors to Incontinence

• We get older
• We loose our hormones
• We gain weight
• We carry children
• We give birth
• Our pelvic floor weakens

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Psycho-Social Issues with Incontinence

• Urinary Incontinence Effects Quality of Life By
• Fear of having urine odor
• Unable to Exercise
• Fear of Leaking in Public
• Life revolves around Looking for Restrooms
• Effects Traveling and Social Life
• Feelings of being unclean or dirty
• Effects Intimacy
• Expensive Undergarment Padding
• Im getting old or Im too young for this to
  be happening

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Types of Incontinence

• 1. Urge Incontinence
• The sudden, intense urge to urinate,
  followed by a loss of urine. Patients feel like
  they never get to the bathroom fast enough.
  These patients are up several times a night with
  the strong urge to urinate.
• 2. Stress Incontinence
• The unintentional release or leakage of
  urine during sudden movements such as coughing,
  sneezing, laughing or exercising.

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Types of Incontinence

• Mixed Incontinence
• Occurs when women have symptoms of both
  stress and urge Incontinence.
• Overflow Incontinence
• Occurs when the bladder doesnt completely
  empty. It may be caused by dysfunctional nerves
  or a blockage in the urethra that prevents the
  flow of urine.

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URGE INCONTINENCE

• A sudden involuntary contraction of the muscular
  wall of the bladder causing urinary urgency, an
  immediate unstoppable urge to urinate.

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A Functional Problem
Also known as overactive bladder or OAB or
OAD Treatment option Anticholinergics to block
the nerve signals related to bladder muscle
contractions.
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Structural Problems

• Stress urinary incontinence - accidental leaks
  when you cough, laugh or sneeze - is the most
  common form of urinary incontinence in women.
• SUI happens when your sphincter, which acts like
  a valve to the bladder, cant stay closed when
  theres pressure in your abdomen.

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SUI is a Structural Problem
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Steps to Diagnosis

• Talk with your patients
• Gather symptoms
• Understand the emotional component
• Order a Urodynamic Study
• A urodynamic study takes the guess work out of
  diagnosing. It will absolutely define the
  problem

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Asking The Right Questions

• Do you leak with you cough, laugh, or sneeze?
• Do you ever get the feelings of gotta go,
• gotta go, gotta go!?!
• Do you not always make it when you are racing
  for the bathroom?
• How many times do you get up during the night?
• Do you feel a bulge?
• Do you have to shift your upper body to
  urinate?

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The Urodynamic Test
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The Uroflowmetry

• A uroflowmeter automatically measures the amount
  of urine and the flow ratethat is, how fast the
  urine comes out.
• Then a Measurement of Postvoid Residual is
  obtained (PVR)

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Cystometry
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Abdominal Pressure Monitoring

• Another catheter will be placed in the rectum to
  record pressure there as well.
• The bladder will be filled slowly with warm
  water.
• During this time you will be asked how your
  bladder feels, noting sensation.
• The volume of water and the bladder pressure will
  be recorded, noting capacity and compliance.
• You will be asked to cough or strain during this
  procedure. Involuntary bladder contractions can
  be identified.

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Electromyography

• Electroymyography measures external sphincter
  activity
• We obtain this measurement by placing EMG leads
  on the anal sphincter
• The anal sphincter mimics the external sphincter
• This allows us to see is that the external
  sphincter is working in synergy with the
  detrusor muscle.

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Valsalva Leak Point Pressure

• VLPP
• Measures the lowest abdominal pressure required
  during a stress activity (such as coughing) that
  would cause the urethra to open and, therefore,
• leak.
• This is where we are checking for urethral
  competency

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Pressure Flow Study

• This is the last step with a urodynamic study.
• It determines the amounts of detrusor pressure
  required for the patient to void
• A detrusor pressure less than 30 is normal for a
  female

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What does a urodynamic test tell us

• Sensation
• Capacity
• Compliance
• Detrusor Activity

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Capacity

• The amount of fluid that the patient can
  comfortably hold

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Compliance

• The ability of the bladder to expand and
  accommodate urine at a low pressure
• There should be no more than one centimeter of
  detrusor pressure for every 30 mls of fluid
  infused
• Therefore, 300 mls infused volume, the detrusor
  pressure should be 10 cm or less.

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Sensation

• Evaluation of the following four sensation
• First Desire First sensation of filling
• Normal Desire First urge to go to bathroom
• Strong Desire Stronger urge to go, but not yet
  imamate
• Urge Cannot wait any longer for fear of
  accidents

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Detrusor Activity

• Normal- No contractions are seen during filling
  phase
• OAD- One or more contractions during filling
  phase, regardless of amplitude

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Detrusor Activity

• Hyperreflexia Poorly compliant bladder, where
  the detrusor pressure ramps up during filling
  phase
• Hypotonic- Highly compliant bladder, where the
  detrusor pressure remains very low even at
  capacity gt 500 mls.

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Detrusor Activity

• Areflexia- No detrusor activity at all, even with
  attempt to void. Complete absence of detrusor
  contraction
• Autonomic- Usually low volume, high amplitude
  detrusor contractions with complete bladder
  emptying

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Understanding Urodynamics

• Information that we gather from a Urodynamic
  Study is used to make a definitive diagnosis and
  treatment plan