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Urodynamic testing or urodynamics is a study that assesses how the
bladder The urinary bladder, or simply bladder, is a hollow organ in humans and other vertebrates that stores urine from the kidneys before disposal by urination. In humans the bladder is a distensible organ that sits on the pelvic floor. Urine enters ...
and
urethra The urethra (from Greek οὐρήθρα – ''ourḗthrā'') is a tube that connects the urinary bladder to the urinary meatus for the removal of urine from the body of both females and males. In human females and other primates, the urethra con ...
are performing their job of storing and releasing urine. Urodynamic tests can help explain symptoms such as: *
incontinence Incontinence or Incontinent may refer to: *Fecal incontinence, the involuntary excretion of bowel contents *Urinary incontinence, the involuntary excretion of urine * Lack of moderation or self-control, especially related to sexual desire - see I ...
*
frequent urination Frequent urination, or urinary frequency (sometimes called pollakiuria), is the need to urinate more often than usual. Diuretics are medications that increase urinary frequency. Nocturia is the need of frequent urination at night. The most common c ...
* sudden, strong urges to urinate but nothing comes out * problems starting a urine stream * painful urination * problems emptying the bladder completely ( Vesical tenesmus, detrusor failure) * recurrent
urinary tract infections A urinary tract infection (UTI) is an infection that affects part of the urinary tract. When it affects the lower urinary tract it is known as a bladder infection (cystitis) and when it affects the upper urinary tract it is known as a kidney ...
Urodynamic tests are usually performed in
Urology Urology (from Greek οὖρον ''ouron'' "urine" and '' -logia'' "study of"), also known as genitourinary surgery, is the branch of medicine that focuses on surgical and medical diseases of the urinary-tract system and the reproductive org ...
,
Gynecology Gynaecology or gynecology (see spelling differences) is the area of medicine that involves the treatment of women's diseases, especially those of the reproductive organs. It is often paired with the field of obstetrics, forming the combined are ...
,
OB/GYN Obstetrics and Gynaecology (also spelled as Obstetrics and Gynecology; abbreviated as Obs and Gynae, O&G, OB-GYN and OB/GYN) is the medical specialty that encompasses the two subspecialties of obstetrics (covering pregnancy, childbirth, and t ...
, Internal medicine, and
Primary care Primary care is the day-to-day healthcare given by a health care provider. Typically this provider acts as the first contact and principal point of continuing care for patients within a healthcare system, and coordinates other specialist care t ...
offices. Urodynamics will provide the physician with the information necessary to diagnose the cause and nature of a patient's incontinence, thus giving the best treatment options available. Urodynamics is typically conducted by
urologists Urology (from Greek οὖρον ''ouron'' "urine" and ''-logia'' "study of"), also known as genitourinary surgery, is the branch of medicine that focuses on surgical and medical diseases of the urinary-tract system and the reproductive organ ...
or
urogynecologist Urogynecology or urogynaecology is a surgical sub-specialty of urology and gynecology. History In 1893, Howard Kelly, a gynecologist and pioneering urogynecologist, invented an air cystoscope which was simply a handheld, hollow tube with a glass ...
s.


Purpose of testing

The tests are most often arranged for men with enlarged prostate glands, and for women with incontinence that has either failed conservative treatment or requires surgery. Probably the most important group in whom these tests are performed are those with a neuropathy such as spinal injury. In some of these patients (dependent on the level of the lesion), the micturition reflex can be essentially out of control and the detrusor pressures generated can be life-threatening. Symptoms reported by the patient are an unreliable guide to the underlying dysfunction of the lower urinary tract. The purpose of urodynamics is to provide objective confirmation of the pathology that a patient's symptoms would suggest. For example, a patient complaining of urinary urgency (or rushing to the toilet), with increased frequency of urination can have overactive bladder syndrome. The cause of this might be detrusor overactivity, in which the bladder muscle (the
detrusor The detrusor muscle, also detrusor urinae muscle, muscularis propria of the urinary bladder and (less precise) muscularis propria, is smooth muscle found in the wall of the bladder. The detrusor muscle remains relaxed to allow the bladder to stor ...
) contracts unexpectedly during bladder filling. Urodynamics can be used to confirm the presence of detrusor overactivity, which may help guide treatment. An overactive detrusor can be associated with
urge incontinence Overactive bladder (OAB) is a condition where there is a frequent feeling of needing to urinate to a degree that it negatively affects a person's life. The frequent need to urinate may occur during the day, at night, or both. If there is loss ...
. The American Urogynecologic Society does not recommend that urodynamics are part of initial diagnosis for uncomplicated overactive bladder., which cites: *


Specific tests

These tests may be as simple as urinating behind a curtain while a doctor listens, but are usually more extensive in western medicine. A typical urodynamic test takes about 30 minutes to perform. It involves the use of a small catheter used to fill the bladder and record measurements. What is done depends on what the presenting problem is, but some of the common tests conducted are; * Post-void residual volume: Most tests begin with the insertion of a urinary catheter/transducer following complete bladder emptying by the patient. The urine volume is measured (this shows how efficiently the bladder empties). High volumes (180 ml) may be associated with
urinary tract infection A urinary tract infection (UTI) is an infection that affects part of the urinary tract. When it affects the lower urinary tract it is known as a bladder infection (cystitis) and when it affects the upper urinary tract it is known as a kidney ...
s. A volume of greater than 50 ml in children has been described as constituting post-void residual urine. High levels can be associated with
overflow incontinence Overflow incontinence is a concept of urinary incontinence, characterized by the involuntary release of urine from an overfull urinary bladder, often in the absence of any urge to urinate. This condition occurs in people who have a blockage of the ...
. * The urine is often sent for microscopy and culture to check for infection. * Uroflowmetry: Free uroflowmetry measures how fast the patient can empty his/her bladder. Pressure uroflowmetry again measures the rate of voiding, but with simultaneous assessment of bladder and rectal pressures. It helps demonstrate the reasons for difficulty in voiding, for example bladder muscle weakness or obstruction of the bladder outflow. * Multichannel
cystometry Cystometry, also known as flow cystometry, is a clinical diagnostic procedure used to evaluate bladder function. Specifically, it measures contractile force of the bladder when voiding. The resulting chart generated from cystometric analysis is kno ...
: measures the pressure in the rectum and in the bladder, using two pressure catheters, to deduce the presence of contractions of the bladder wall, during bladder filling, or during other provocative maneuvers. The strength of the urethra can also be tested during this phase, using a cough or
Valsalva maneuver The Valsalva maneuver is performed by a forceful attempt of exhalation against a closed airway, usually done by closing one's mouth and pinching one's nose shut while expelling air out as if blowing up a balloon. Variations of the maneuver can ...
, to confirm genuine stress incontinence. * Urethral pressure profilometry: measures strength of sphincter contraction. *
Electromyography Electromyography (EMG) is a technique for evaluating and recording the electrical activity produced by skeletal muscles. EMG is performed using an instrument called an electromyograph to produce a record called an electromyogram. An electromyog ...
(EMG) measurement of electrical activity in the
bladder neck The urinary bladder, or simply bladder, is a hollow organ in humans and other vertebrates that stores urine from the kidneys before disposal by urination. In humans the bladder is a distensible organ that sits on the pelvic floor. Urine enter ...
. * Assessing the "tightness" along the length of the urethra. *
Fluoroscopy Fluoroscopy () is an imaging technique that uses X-rays to obtain real-time moving images of the interior of an object. In its primary application of medical imaging, a fluoroscope () allows a physician to see the internal structure and functio ...
(moving video x-rays) of the bladder and bladder neck during voiding.


Standardization

Men with benign prostate hyperplasia are influenced by
urination Urination, also known as micturition, is the release of urine from the urinary bladder through the urethra to the outside of the body. It is the urinary system's form of excretion. It is also known medically as micturition, voiding, uresis, ...
position: sitting improves three measures — namely, the maximum urinary flow rate (Qmax), voiding time (TQ) and post-void residual volume (PVR). Qmax, in particular, improves by an amount similar to that achievable with four alpha-1 blockers, medicines commonly prescribed for BPH. This information offers a non-pharmaceutical way of managing the condition, and shows that urodynamics measurements should use a standardized position, to avoid misleading results.


References


External links


National Institute of Health

4/Feb/2012 Archive of Doug Small's urodynamic pages
{{Urologic procedures Urine tests Urologic procedures