Transcript A URODYNAMIC STUDY The Whole Works

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