Outline Of Urodynamic

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Outline Of Urodynamic

• Nadia gantri

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• Urodynamic is generally defined as all the
  investigation used by gynaecologist to assess the
  function of the lower urinary tract.

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Initial assessment

• All urinary tract assessment must begin with
  thorough history and examination to ascertain,
  nature , severity of symptom.

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URODYNAMIC MEASUREMENTS

• Bladder pressure - storage and voiding
• Abdominal pressure
• Urethral pressure
• Urine flow
• Bladder capacity
• Volume voided
• Residual

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FILLING CYSTOMETRY

• First desire to micturate
• Capacity
• Detrusor activity

WHEN TO DO A CYSTOSCOPY?

• Microscopic hematuria
• Abnormal cytology
• Periurethral abnormality
• For reassurance

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UROFLOWMETRY

• Patient voids into a flow meter
• Flow rate
• Volume voided
• Residual - catheter
• - ultrasound

URINE FLOW RATES WOMEN

• Under 50 years - 25 ml/sec
• Over 50 years - 18 ml/sec

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Basic tests

• Mid stream urine specimen.
• Urinary diary-is a simple record of the patients
  fluid intake and output . It should be complete
  by all patient for one week.
• Flow studies (uroflowmeter).
• Simple investigation.

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Basic tests

• Indicated in women with complaints of hesitancy
  or difficulty in voiding .
• To evaluate patient before incontinence surgery
  .Rate of 15 ml/s is normal.
• Pad test weight of gt 1 gram is considered a
  significant loss.

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Basic tests

• Cystometry involve the measurement of the
  pressure/volume relationship of the bladder
  during filling and voiding.
• Simple accurate investigation.
• Easy to perform.
• Take 15-20 minute per patient.

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Indication

• Multiple symptoms.
• Voiding disorder.
• Prior to any bladder neck surgery.
• Neuropathic bladder disorder.

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Intravenous Urography

• Neuropathic baldder.
• Suspected ureterovaginal fistula.

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Video Cystourethrography

• Radiology screening of the bladder synchronized
  with pressure study of the bladder ,it is not a
  routine.
• Neuropathic bladder.
• Post micturation dribble.
• Suspicion of ureteric reflux.

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Ultrasound

• Bladder morphology.
• Residual urine volumes.
• TV scan help in studying bladder neck anatomy .
• Urethral pressure measurement.

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Cystourethroscopy

• Not a routine.

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Indicated in

• Reduced bladder capacity.
• A suspected urethrovaginal or vesicovaginal
  fistula.
• Suspicion of interstitial cystitis.
• A need to exclude neoplasm

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Electromyogarphy (EMG)

• To investigate neuropathy myopathy

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Key points

• Clinical history is often not a good predictor of
  urodynamic finding .
• Urinary infection must be excluded before any
  urodynamic study.
• Stress incontinence diagnosed on cystometry is a
  diagnosis of exclusion.
• All patient undergoing repeat continence surgery
  must have urodynamic studies performed.