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PubMed2002

Urodynamic changes at 18 months post-therapy in patients treated with external beam radiotherapy for prostate carcinoma.

PURPOSE: To quantify the effect of radiotherapy (RT) on urodynamics at 18 months post-therapy, using urodynamic study, in prostate cancer patients undergoing definitive external beam RT. METHODS AND MATERIALS: A total of 17 patients with clinically localized prostate cancer were accrued into a single-arm prospective study. Fifteen of 17 patients completed scheduled multichannel video-urodynamic study at baseline as well as 3 and 18 months after RT. Baseline quantitative urodynamic parameters were compared with those at 18 months post-RT to assess the nature and extent of urodynamic change brought about by RT. These quantitative changes were further correlated to the change in self-assessed qualitative urinary function measured by International Prostate Symptom Score (IPSS), Quality of Life assessment index (QoL), and urinary functional inquiry. RESULTS: The statistically significant quantitative changes detected by the urodynamic study at 18 months post-RT were decrease in bladder capacity and bladder volume at first sensation in both the supine and upright position, and reduction in bladder volume at desire to void in the supine position. In our cohort, the mean reduction in bladder capacity was 100 mL in the supine position and 54 mL in the upright position. No statistically significant change was observed with regard to pressure, maximum flow rate, voided volume, or postvoid residual volume. Furthermore, there was no statistically significant change in bladder compliance, bladder instability, or bladder outlet obstruction. No statistically significant change in self-assessed qualitative urological function was observed between baseline and 18 months post-RT, measured by the 3 parameters (IPSS, QoL, and urinary frequency over 24 h). CONCLUSIONS: This is the first quantitative study that prospectively evaluated the effect of RT on urodynamics in prostate cancer patients receiving definitive RT. The statistically significant changes at 18 months post-RT were reduction in bladder capacity, reduction in bladder volume at first sensation, and decrease in bladder volume at desire to void. Despite the decrease in these parameters, there was no statistically significant adverse effect of RT on bladder compliance, bladder stability, or bladder outlet flow. This observation corresponded well with no significant change in IPSS, QoL, or urinary frequency over 24 h. Furthermore, these results confirm the notion that most prostate cancer patients generally tolerate RT very well.

Aged↗
PubMed1999

Urinary tract infection after urodynamic studies in women: incidence and natural history.

OBJECTIVE: To study the incidence, natural history and symptomatic effects of bacteriuria after urodynamic studies in women. PATIENTS AND METHODS: In a prospective study in the urogynaecology clinic of a large District General Hospital, 214 women (mean age 52.3 years, range 23-81) underwent urodynamic studies. Bacteriuria was detected by semiquantitative culture at 2 and 7 days after the test. Women completed a 7-day diary of symptoms and events. RESULTS: The incidence of bacteriuria after urodynamic studies was 7.9%. Bacteriuria was transient in four of 17 women but persisted in nine and developed late in four; only one of 17 infections gave rise to symptoms. Irritative bladder symptoms after the test occurred in 34% of women, but only three went to their doctors because of concern about a possible urinary tract infection. Advancing age was the only variable associated with bacteriuria after urodynamic studies (P= 0.05). Menopausal status, past history of urinary tract infection, number of urethral instrumentations required, order number in a session, peak urinary flow rate and urodynamic diagnosis were not associated variables. CONCLUSIONS: In a large series of women presenting to a urogynaecology clinic, urodynamic investigations were associated with a high incidence of transient irritative symptoms but a low incidence of bacteriuria (8%). Infection was asymptomatic in most patients, but its natural history was unpredictable. Transient, persistent and late cases of bacteriuria all occurred. In this population, urodynamic studies are associated with a low level of morbidity.

Adult↗
PubMed1998

The urodynamic effects of intravenous opioids and ketoprofen in humans.

UNLABELLED: We used a double-blind design to study urodynamic changes induced by mu-agonists (fentanyl, morphine), a partial mu-agonist antagonist (buprenorphine), a putative mu-antagonist, kappa-agonist (nalbuphine), and ketoprofen, an injectable nonsteroidal antiinflammatory drug. Men (20-55 yr old) were randomly assigned to receive one of the following i.v. before anesthesia for endoscopic extraction of a ureteral stone: 10 mg of morphine, 0.3 mg of buprenorphine, 0.35 mg of fentanyl, 20 mg of nalbuphine, 100 mg of ketoprofen, or 10 mL of 0.9% sodium chloride. The urodynamic study consisted of cystometry followed by urethral pressure profile. Measurements were taken before the i.v. infusion of drugs and 15 min thereafter. Statistical comparisons were performed by using analysis of variance with repeated measurements (P < 0.05). Ketoprofen and saline did not induce any urodynamic changes. Opioids altered bladder sensations, and the residual volume after voiding increased, except after morphine. Detrusor contraction decreased only after the administration of fentanyl and buprenorphine. Some patients could not micturate after receiving morphine, fentanyl, and buprenorphine. Compliance and urethral pressures did not change with any drug. This study suggests that ketoprofen and nalbuphine are useful analgesics in terms of their urodynamics. IMPLICATIONS: We compared the urodynamic effects of opioids and ketoprofen used as analgesics in surgical patients. In contrast to ketoprofen, opioids altered urodynamics. The opioid nalbuphine had no effect on detrusor contraction. This study suggests that ketoprofen and nalbuphine are useful analgesics in terms of their urodynamics.

Adult↗
PubMed1998

Renal deterioration in myelodysplastic children: urodynamic evaluation and clinical correlates.

PURPOSE: We determined which factors portend a higher risk of renal deterioration in the myelodysplastic child, and evaluated the sensitivity and predictive value. MATERIALS AND METHODS: We retrospectively reviewed the medical history, imaging studies and urodynamics of 90 children with spinal dysraphism. Median patient age at initial evaluation was 3 months and average followup ranged between 2 and 25 years (average 11). We evaluated the relation of urodynamic parameters and sex to upper tract changes and the resolution of these changes. RESULTS: Statistically significant relationships were identified between the urodynamic parameters of leak point pressure, compliance and detrusor-sphincter dyssynergia, and renal deterioration but not with resolution of deterioration. Boys and girls did not demonstrate a significant difference among urodynamic parameters. Female patients had a higher incidence of reflux and parenchymal loss. CONCLUSIONS: With knowledge of the inherent sensitivity, specificity and predictive value of urodynamic parameters, selective use of urodynamics will assist in identifying patients at risk of renal deterioration. Female patients with reflux are at greatest risk of parenchymal loss. We advocate early institution of intermittent catheterization in patients identified as high risk for deterioration by urodynamics.

Adolescent↗
PubMed2001

Evaluating ambulatory urodynamics: a prospective study in asymptomatic women.

OBJECTIVE: To identify abnormal detrusor contractions in asymptomatic women undergoing ambulatory urodynamics, to standardise the investigation technique for women with urinary symptoms for clinical practice. DESIGN: Prospective observational study. SETTING: Two tertiary referral urogynaecology units: one in London, UK and one in Varese, Italy. METHODS: Women without urinary symptoms were recruited into the study. Ambulatory urodynamics was performed according to the King's College Hospital protocol. All the traces were analysed in four different ways: 1. without the second bladder transducer measurements displayed on the screen and without the diary; 2. as in 1. but with the diary; 3. with the second bladder sensor displayed on the screen but without the diary; 4. as in 3. but with the diary. The diary was always interpreted at the end of the test with the woman present. For each method we reported the total number of detrusor contractions and whether the woman would have been diagnosed as having abnormal detrusor contraction. Cochran's Q test was used for statistical analysis. RESULTS: Twenty-six women (mean age 31.7 years) were recruited. Ambulatory urodynamic testing lasted an average of 3.57 hour. The diagnosis of abnormal detrusor contraction varied by 65.4% depending on the method of analysis used. The diary and the women's symptoms during the test were the most discriminating factors. A significant difference between the diagnoses was obtained when comparing the four different ways of analysis. According to our protocol only three women (11.5%) had abnormal detrusor contractions. CONCLUSIONS: Using our protocol almost 90% of asymptomatic women have a stable bladder on ambulatory urodynamics. This is similar to the results of labouratory urodynamic testing of asymptomatic women but is in contrast to previous reports of ambulatory urodynamics of asymptomatic women. The technique used during ambulatory urodynamics determines the tests ability to detect detrusor instability with an accurate symptom diary being the most important.

Adult↗
PubMed2006

Urethral retro-resistance pressure and urodynamic diagnoses in women with lower urinary tract symptoms.

OBJECTIVE: This study determines whether the retrograde urethral retro-resistance pressure (URP) measurement discriminates between urodynamic diagnoses in a group of women. DESIGN: A prospective observational study. SETTING: Urogynaecology units of three tertiary referral teaching hospitals. POPULATION: Women with lower urinary tract symptoms. METHODS: Consecutive women attending the urodynamic clinics of three tertiary referral teaching hospitals were studied using a validated urinary symptom questionnaire, URP measurement and urodynamic evaluation between February and July 2004. The URP mean values were compared with urinary symptoms and urodynamic diagnoses, using the independent t test correction for multiple measurements. MAIN OUTCOME MEASURES: Retrograde URP, urodynamic diagnoses and urinary symptoms. RESULTS: One hundred and eighty-five women were recruited. Women with urodynamic stress incontinence (USI) have significantly lower URP than women with competent urethral sphincters (P < 0.05, independent t test). Women with mixed urodynamic incontinence had values of URP intermediate between women with detrusor overactivity (DOA) and those with USI. In the mixed group, URP mean values were not significantly different from those with DOA and competent sphincters or USI (P > 0.05, independent t test). There was no significant difference between mean URP values and different urinary symptoms (P > 0.05, independent t test). CONCLUSIONS: There are significantly different URP measurements between women with DOA and those with USI. However, the URP is not a diagnostic tool.

Adult↗
PubMed2002

Bladder dysfunction in acute transverse myelitis: magnetic resonance imaging and neurophysiological and urodynamic correlations.

AIMS: To evaluate micturition abnormalities in acute transverse myelitis and correlate these with evoked potentials, magnetic resonance imaging (MRI), and urodynamic findings. SETTING: Tertiary care teaching hospital. PATIENTS: 18 patients with acute transverse myelitis, aged 4-50 years; 15 had paraparesis and three quadriparesis. METHODS: Patients with acute transverse myelitis had a neurological evaluation and tibial somatosensory and motor evoked potential studies in the lower limbs. Spinal MRI was carried out using a 1.5 T scanner. Urodynamic studies were done using Dantec UD 5500 equipment. Neurological outcome was determined on the basis of Barthel index score at six months as poor, partial, or complete. In some patients, urodynamic studies were repeated at six and 12 months. RESULTS: Spinal MRI in 14 of the 18 patients revealed T2 hyperintense signal changes extending for at least three spinal segments in 13; one patient had normal MRI. In the acute stage, 17 patients had a history of urinary retention and one had urge incontinence. On follow up at six months two patients regained normal voiding, retention persisted in six, and storage symptoms developed in 10, of whom five also had emptying difficulties. Urodynamic studies showed an areflexic or hypocontractile bladder in 10, detrusor hyperreflexia with poor compliance in two, and detrusor sphincter dyssynergia in three. Early abnormal urodynamic findings commonly persisted at the six and 12 months examinations. Persistent abnormalities included detrusor hyperreflexia, dyssynergia, and areflexic bladder. The urodynamic abnormalities correlated with muscle tone and reflex changes but not with sensory or motor evoked potentials, muscle power, MRI signal changes, sensory level, or six months outcome. CONCLUSIONS: Bladder dysfunction is common in acute transverse myelitis and may be the only sequel. Urodynamic study is helpful in evaluating the bladder dysfunction and also in its management.

Adolescent↗
PubMed2002

Voiding dysfunction in children: role of urodynamic studies.

INTRODUCTION: Urodynamic examination is said to be the most reliable, but also a rather invasive tool for the diagnosis of dysfunctional voiding in children. We compared the usefulness of baseline diagnostics to urodynamics. MATERIALS AND METHODS: 60 children, mean age 9 years, admitted for further evaluation of voiding dysfunctions (monosymptomatic nocturnal enuresis, 17; recurrent urinary tract infection, 12; reflux, 2; urgency, incontinence or residual urine, 29) underwent clinical examination, ultrasound, uroflowmetry, endoscopy and urodynamics. RESULTS: Urodynamic evaluation revealed pathologic findings in 37 patients. Detrusor instability was found in 26 children, 11 children (18%) demonstrated signs of pelvic floor overactivity. Treatment decision was based on baseline diagnostics exclusively in 14 children, mainly on baseline diagnostics in 56 patients, and on urodynamics exclusively in 4 children (7%). CONCLUSION: In children with idiopathic dysfunction, urodynamics did not have a significant additional value compared to baseline diagnostics. Therefore, noninvasive methods should be the first-line diagnostic tools. Only in patients with unsuccessful initial treatment should a urodynamic examination be performed to rule out severe bladder dysfunction.

Child↗
PubMed2005

[Upper urinary tract video-urodynamics. Current indications].

OBJECTIVES: Upper urinary tract videourodynamic studies were first described in the second half of the 20th century (years 60-70). The antegrade pyelogram with constant pressure and controlled flow received the name of its author, "Vela Navarrete test" (1982), who currently refers to it as video-urodynamic study of the upper urinary tract. It is the simultaneous study of pressure, flow, and dynamic x-ray of the upper urinary tract and it keeps same indications than the original design, in spite of the appearance of new dynamic and static imaging techniques (ultrasound, CT scan, MRI, radioisotope studies). The continued practice of video urodynamic study of the upper urinary tract in the FJD prompted an update of the procedure reviewing its current indications. METHODS: Patient is positioned in the prone decubitus on an x-ray table with video. After punctioning renal cavities with fine needle, video urodynamic tests are performed: pyelomanometry, basal pyelic pressure (basic urodynamics study), pressure changes after induced diuresis, and pressure-flow studies. 10-20 ml of urine are obtained for biochemical tests (creatinine, electrolytes, osmolarity,...), which give information about the functional viability of the renal unit, cytology or microbiological tests. Finally, the study concludes with an antegrade pyelogram, a fluoroscopic study of the radiological anatomy which provides morphologic and dynamic data of the upper urinary tract. In the Urodynamics Unit of the FJD, urologists perform 30-40 studies per year. We analyzed retrospectively all studies performed over the last five years (1999-2005) for various pathological entities of kidney dilation. (Table I). RESULTS: Structural and dynamic data obtained by the studies offered conclusive information in most of them facilitating the decision for surgery or observation (Table II). CONCLUSIONS: The interpretation of the upper urinary tract video-urodynamic study is based on radiological and dynamic findings. Flow-controlled pyelogram enables determining the existence of obstruction, dilation volume, and ureteral peristaltic behaviour. Constant pressure enables quantification of obstruction. The video urodynamic study of the upper urinary tract is easy to perform, well tolerated and may be repeated as many times as required, mainly if nephrostomy tube is placed for more prolonged evaluations. It offers excellent anatomical, dynamic, and etiological information about the upper urinary tract, and furthermore conclusive, with minimal risk.

Humans↗
PubMed1999

Comparison of urodynamic and free voiding pattern in infants with dilating reflux.

PURPOSE: We compared simultaneous investigations of free voiding pattern and urodynamic assessment in infants with dilating reflux to obtain further information on previously suspected bladder dysfunction based on abnormal urodynamic findings. MATERIAL AND METHODS: A total of 33 male and 8 female infants with dilating reflux were included in the study. Free voiding pattern was determined by 4-hour voiding observation compared to previously described voiding pattern studies of healthy infants. Simultaneous invasive urodynamic assessments were performed. RESULTS: The patients were grouped according to urodynamic bladder capacity. Half of the male patients had low bladder capacity with high voiding pressure levels (hypercontractile) and the other half had either normal or high capacity bladders. The low capacity group had frequent small voids and a high rate of interrupted voiding, the high capacity group had infrequent voids of high volumes with high residual urine, and the pattern of the normal capacity group differed only from that of healthy infants by an increase in residual urine. All female infants had the typical characteristics of high capacity bladder on free voiding and urodynamic assessments. CONCLUSIONS: Infants with abnormal invasive urodynamic investigations, including those with a small capacity hypercontractile bladder and those with a high capacity bladder, could be identified on free voiding studies, indicating that an abnormal urodynamic pattern represents bladder dysfunction.

Female↗
PubMed2000

Urodynamic assessment of the bashful bladder.

PURPOSE: We prospectively studied the potential contribution of ambulatory urodynamic monitoring in men with urinary symptoms unable to initiate a void on conventional video cystometrography. MATERIALS AND METHODS: A total of 40 consecutive symptomatic men with a median International Prostate Symptom Score of 19 (range 1 to 29) and median age of 51.9 years (range 30 to 75) who were unable to void during video cystometrography underwent ambulatory urodynamic monitoring. Solid-state transducers mounted on silicone coated catheters were inserted urethrally and rectally, and connected to a portable recorder. Subjects voided in private into a specially designed flow meter, which they connected to the recording device. RESULTS: Of the patients 2 (5%) failed to attend ambulatory urodynamic monitoring, despite multiple reminders, and in 1 (2.5%) the trace was uninterpretable. Pressure flow data were available for the remaining 37 patients with mean plus or minus standard deviation 2.72+/-0.1 storage void cycles recorded per patient. All 6 patients (15%) with obstruction were older than 40 years. In 6 cases (15%) obstruction was equivocal and the remainder were unobstructed. Transurethral prostatic resection in 2 and urethrotomy in 1 of 6 patients with obstruction resulted in subjective and objective improvement. CONCLUSIONS: The bashful bladder syndrome was not associated with any specific urodynamic diagnosis. Ambulatory urodynamic monitoring will yield a urodynamic diagnosis in more than 90% of cases after failure to record void data on video cystometrography. A surgically correctable cause of symptoms can be found in about 20% of men older than 40 years. The contribution of ambulatory urodynamic monitoring compared to more conventional evaluation in men younger than 40 years is negligible.

Adult↗
PubMed2003

[Diagnosis of overactive bladder influenced by methods of clinical assessment--micturition diary vs. urodynamics].

INTRODUCTION: Most characteristic symptom of overactive bladder is urgent, possibly painful, desire to void. This complaint is caused by autonomous bladder contractions. The increased activity of detrusor muscle is not only responsible for the urgency but also is the direct reason for the development of urge urinary incontinence. THE AIM OF THE STUDY: The comparison of the subjective (micturition diary) and objective (urodynamic investigation) mode of diagnosis of overactive bladder. MATERIAL AND METHOD: Twenty one women complaining of symptoms of the overactive bladder were included into the study. The infection of lower urinary tract was ruled out based on the results of urinalysis. Each patient reported urinary symptoms (number of urgency episodes and urge urinary leakages) in micturition diary for seven days. Thereafter, all participants underwent the urodynamic investigation that included uroflowmetry and cystometry. RESULTS: Data obtained from micturition diaries proved that all patients had subjective symptoms of overactive bladder (n = 21). However, only 8 subjects met overactive bladder diagnostic criteria on urodynamic investigation. The data obtained from micturition diaries and urodynamics were compared between group with objectively (urodynamic investigation) and subjectively (micturition diary) diagnosed overactive bladder. CONCLUSIONS: 1. There is marked discrepancy between data obtained from micturition diary and the results of urodynamic investigation. 2. It was shown that the diagnosis of overactive bladder cannot be made solely on the basis of maturation diary. 3. Volume of voided urine measured at uroflowmetry and volume of infused fluid causing strong desire to void are best markers of urodynamically proven diagnosis of overactive bladder.

Diagnosis, Differential↗
PubMed2004

Characteristics of North American urodynamic centers: measuring lower urinary tract filling and storage function.

In this second article reviewing the characteristics of urodynamic evaluations in North American urodynamic centers, selected techniques used when measuring lower urinary tract function are discussed. Previously reported were the characteristics of clinicians and equipment of urodynamic centers in North America (Krissovich & Gray, 2002). A subsequent article will focus on current practices used to assess pelvic floor muscle function via electromyography and urethral pressure studies. The results of this study show that while most clinicians adhere to the guidelines for good urodynamic practices, there is a significant variability related to critical issues such as calibration, zeroing, and measurement of the Abd LPP. There is need for a comprehensive evaluation of the research base evaluating various urodynamic technologies and techniques combined with production of best practice guidelines from interested professional societies. Research into multiple areas of urodynamic testing is recommended, possibly beginning with critical comparisons of calibration and zeroing procedures and progressing to issues of quality assurance with each step of a comprehensive urodynamic evaluation.

Calibration↗
PubMed1992

Prevalence of abnormal urodynamic test results in continent women with severe genitourinary prolapse.

Twenty-two clinically continent women with severe genitourinary prolapse were evaluated urodynamically to determine the prevalence of urodynamic abnormalities that could lead to potential urinary incontinence. Urodynamic testing found an occult incontinence disorder in 13 women (59%), of whom four had urine loss during cough pressure profiles after pessary placement, four had uninhibited detrusor contractions during retrograde medium-fill water cystometry, and five had both stress urinary incontinence and an unstable bladder. Therefore, nine of the 22 patients (41%) had uninhibited detrusor contractions during urodynamic testing. However, uroflowmetry did not reveal voiding dysfunction in this group, although peak flow rates appeared to be lower in the subgroup of women manifesting uninhibited detrusor contractions. Associated symptoms of frequency, nocturia, and urgency occurred in 41% of the women in this study; four of nine (44%) who had normal urodynamic test results, five of 13 (38%) who had abnormal test results, and five of nine (56%) who had an unstable bladder. Therefore, associated symptoms could not be used to determine which women would have abnormal urodynamic test results. These preliminary results suggest that women with genitourinary prolapse may be at risk for an occult incontinence disorder that is masked by the prolapse and that could manifest after corrective surgery for prolapse. Urodynamic testing is suggested for women with genitourinary prolapse who present with or without symptoms of incontinence, so that more data can be obtained to determine the importance of abnormal test results.

Female↗
PubMed1996

Conventional urodynamics and ambulatory monitoring in the definition and management of bladder outflow obstruction.

PURPOSE: We determined whether ambulatory urodynamics and new objective methods of defining bladder outflow obstruction might improve the classification of bladder outflow obstruction over conventional urodynamics (cystometrography), and whether such measures might improve prediction of the outcome of prostatectomy. MATERIALS AND METHODS: A prospective study was performed of 122 men undergoing prostatectomy for symptoms and low flow rates. Cystometrography and ambulatory urodynamics were performed before and 6 months after prostatectomy but did not influence selection for operation. Methods of classifying obstruction included the Abrams-Griffiths nomogram, Schäfer linear passive urethral resistance relation and Griffiths urethral resistance factor. RESULTS: The proportion of cases defined as obstructed did not differ on ambulatory urodynamics or cystometrography or when the Abrams-Griffiths nomogram was compared to the linear passive urethral resistance relation or urethral resistance factor. Significant improvements after prostatectomy were noted in flow rates (p < 0.001), residual urine (p < 0.001), voiding pressure (p < 0.001) and symptom scores (p < 0.001). Ambulatory urodynamics were more sensitive than cystometrography in detection of detrusor instability but detrusor instability did not correlate with outcome. Voiding pressures were greater during ambulatory urodynamics (p < 0.02). The outcome of obstructed cases (on Abrams-Griffiths nomogram during ambulatory urodynamics) was better (79% good outcome) than that of nonobstructed or equivocally obstructed cases (55% good symptomatic outcome, p < 0.05). CONCLUSIONS: Men proved to have obstruction on the basis of pressure and flow measurements applied to a nomogram have better outcomes after transurethral resection of the prostate but sophisticated or computer derived methods of classification of obstruction did not improve prediction.

Aged↗
PubMedDate not supplied

[Outpatient urodynamic monitoring in the diagnosis of subclinical forms of a urination disorder in women].

The authors studied potentialities of outpatient urodynamic monitoring in diagnosis of subclinical urination defects in females. The examination was made of 31 females aged 25-55 years (mean age 43.8 years) with complaints of pollakiuria, precipitant urination. Laboratory urodynamic investigation combined retrograde cystometry, profilometry and uroflowmetry (Jupiter 8000 Video produced by WIEST) and was followed by urodynamic monitoring (CAMSYS 6300 by WIEST). Standard combined urodynamic evaluation registered normal urodynamic parameters in 17 females, unstable urethra in 4, unstable detrusor in 7, unstable urethra and detrusor in 3 patients. The curves devised on the basis of the outpatient urodynamic monitoring data indicated that; normal urodynamics, unstable urethra, unstable detrusor, detrusor-sphincter dyssynergia, combined instability of urethra and detrusor, unstable detrusor plus detrusor-sphincter dyssynergia in 4, 10, 7, 3, 2, 2 females, respectively. 3 cases were ineligible. The above investigation promoted accurate diagnosis in 41.9% of cases. Outpatient monitoring is a method of choice in diagnosis of subclinical urination disorders.

Adult↗
PubMed1998

[Complete urodynamic office evaluation; a method for the delivery of health care].

INTRODUCTION: The goal of the study was to evaluate the usefulness of the complete urodynamic office evaluation. This assistance modality consists on the realisation in the same moment of the clinical chart, physical examination, urodynamic study, report, therapeutic indications, program of other complementary studies, hospitalisation or discharge from the outpatient office. PATIENTS AND METHODS: During 1 year complete urodynamic office evaluation was performed to 100 patients (87 female, 13 male) All patients were directed to our department to perform a urodynamic test, most of them due to incontinence. Different kinds of urodynamic tests were performed in 91 patients, with a medium of 2 studies per test. Abnormalities were detected in 59 cases. RESULTS: After the complete urodynamic office evaluation, 16 patients were programmed for surgery, 26 were discharged from outpatient office, 37 were directed to follow up in the outpatient setting, 2 were hospitalised, and 19 were lost of follow up. CONCLUSIONS: The complete urodynamic office evaluation allowed us to get the diagnostic and therapeutic approach in 98% of patients, employing a standard of 90 minutes. Twenty six percent of patients could be discharged from our center. Sixteen patients were operated on following this unique visit, that means an important reduction in the usual assistance delay.

Adult↗
PubMed2002

Urodynamic investigations for management of urinary incontinence in adults.

BACKGROUND: Urodynamic tests are used to investigate people who have urinary incontinence or other urinary symptoms in order to make a definitive objective diagnosis. The aim is to help to select the treatment most likely to be successful. The investigations are invasive and time consuming. OBJECTIVES: The objective of this review was to discover if treatment according to a urodynamic-based diagnosis led to clinical improvements in urinary incontinence, compared to treatment based on history and examination. SEARCH STRATEGY: We searched the Cochrane Incontinence Group trials register. Date of the most recent search: April 2002. SELECTION CRITERIA: Randomised and quasi-randomised trials comparing clinical outcomes in groups of people who were and were not investigated using urodynamics, or comparing one type of urodynamics against another. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial quality and extracted data. Authors of one study were contacted for more information, including adverse effects. MAIN RESULTS: Two small trials involving 128 women were included. In one small trial, women who were investigated with urodynamics were more likely to receive active treatment with drugs or surgery. However, the numbers in both trials were too small to determine if this affected clinical outcomes such as a reduction in incontinence. REVIEWER'S CONCLUSIONS: A larger definitive trial is needed, in which people are randomly allocated to management according to urodynamic findings or to standard management based on history and clinical examination.

Adult↗