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PubMed2002

Good urodynamic practices: uroflowmetry, filling cystometry, and pressure-flow studies.

This is the first report of the International Continence Society (ICS) on the development of comprehensive guidelines for Good Urodynamic Practice for the measurement, quality control, and documentation of urodynamic investigations in both clinical and research environments. This report focuses on the most common urodynamics examinations; uroflowmetry, pressure recording during filling cystometry, and combined pressure-flow studies. The basic aspects of good urodynamic practice are discussed and a strategy for urodynamic measurement, equipment set-up and configuration, signal testing, plausibility controls, pattern recognition, and artifact correction are proposed. The problems of data analysis are mentioned only when they are relevant in the judgment of data quality. In general, recommendations are made for one specific technique. This does not imply that this technique is the only one possible. Rather, it means that this technique is well-established, and gives good results when used with the suggested standards of good urodynamic practice.

Diagnostic Techniques, Urological↗

PubMed2004

Impact of radical hysterectomy for cervical cancer on urodynamic findings.

To elucidate the impact of radical hysterectomy upon the urodynamic findings of patients with cervical cancer, 20 patients with cervical cancer at stage IB to IIA who underwent radical hysterectomy were recruited. Each patient underwent a 20-min pad test and urodynamic study prior to and 3 months after radical hysterectomy. ANOVA, Bonferroni test and paired t -test were utilized for analysis. The mean age of the 20 patients was 50.2+/-8.7 years with a mean parity of 3.5+/-1.5. Four (20%) of the 20 cases revealed normal urodynamic findings preoperatively, and the urodynamic findings became abnormal after surgery. Comparing the urodynamic parameters of both bladder voiding and storage functions pre- and post-surgery, we found significant impairments postoperatively in all 20 cases. Our data demonstrate that abnormal urodynamic findings may pre-exist for some patients with cervical cancer prior to surgical treatment. These findings may worsen, and/or additional abnormal states may arise subsequent to radical hysterectomy.

Adult↗

PubMed1998

Urodynamics and transurethral microwave thermotherapy.

In this paper the role and value of urodynamic measurements in symptomatic benign prostatic hyperplasia (BPH) patients selected for transurethral microwave thermotherapy (TUMT) reviewed. Although pressure-flow studies alone can diagnose benign prostatic obstruction, the level of acceptance of urodynamic investigations in BPH remains low, reportedly due to their cost and to their invasive and time-consuming nature. Furthermore, the observation that extremely different treatment modalities in BPH have nearly the same symptomatic outcome, independently of their influence on obstruction, has played a part in raising doubt as to the value of baseline urodynamics as a predictor of clinical success. Pre- and posttherapy urodynamic investigations in TUMT-treated patients have shown that urodynamic algorithms must be capable of distinguishing between compressive and constrictive types of obstruction to document the limited effects of low-energy TUMT on obstruction. Furthermore, it has been shown that urodynamics evaluated in this way seems to be the only predictor of the clinical success of TUMT when improvements in the objective parameters Qmax (peak uroflow) and residual urine are included in the definition of outcome.

Diathermy↗

PubMed2005

The relationship between the perineal length measurements and the urodynamic stress incontinence.

OBJECTIVE: The purpose of this study was to assess the relationship between the length of perineal body, the anal position index, the total fourchette-coccyx distance and the anal-coccyx length and female urodynamic stress urinary incontinence (USUI). PATIENTS AND METHODS: The study included 57 women with USUI (group A) and 45 women without USUI as control (group B). All patients underwent a urodynamic evaluation and measurement of the length of perineal body (PB) and the distance between the fourchette and the inferior margin of coccyx (FC). PB is the distance between the fourchette and the center of anal orifice. The ratio PB/FC is the anal position index. Subtracting the PB length from FC distance equals the anal-coccyx (AC) length. RESULTS: The student's t-test showed no significant statistical difference between any of the measured lengths in the two groups. Moreover, in the USUI group, ANOVA did not show any significant relationship between the urodynamic parameters and the measured lengths. Regarding to the investigated urodynamic parameters only the maximum urethral pressure (Pura max) presented a significant statistical difference between the two groups (P = 0.009). CONCLUSION: Theoretically, a differentiation of perineal distances probably brings to the surface a laxity of the pelvic floor, a factor predisposing to USUI. Furthermore, the anterior position of anus can be a cause of constipation which also contributes to USUI. However, our study did not reveal any relationship between the perineal length measurements and USUI. Further investigation with longer series of patients is needed to show if this simple, inexpensive and non-invasive test could be added in the armamentarium of the diagnostic and prognostic investigation of USUI. Regarding to the urodynamic parameters, our results emphasize the importance of the Pura max parameter in the urodynamic evaluation of USUI.

Adult↗

PubMed1979

Patient costs for urodynamic testing.

Urodynamic investigations are not completely standardized. However, the number of exhibits of urodynamic equipment at urologic meetings by commercial firms suggests that these studies have considerable applicability and relevance to everyday practice. Investment by a urologist in equipment for urodynamic testing should be cautious in the light of the costs for these investigations reported from centers in Canada, the United States, and Western Europe. The figures suggest that sophisticated urodynamic testing is not a screening test -- it is too expensive, but large urodynamic laboratories appear to charge only for a portion of the actual cost of such testing. Since urodynamic testing is much more expensive than actual patient charges, it is probably not yet cost effective in its present state of development.

Canada↗

PubMed1992

The value of urodynamic studies in infants less than 1 year old with congenital spinal dysraphism.

The role and timing of urodynamic studies in infants with congenital spinal dysraphism are controversial. We reviewed 64 consecutive infants with a mean followup of 28 months who underwent video urodynamic study when they were less than 1 year old (50 of the 64 patients were less than 3 months old). A previously reported video urodynamic "hostility score" from 0 (best) to 10 (worst) was given to each study and compared with the outcome of the upper urinary tract and subsequent urodynamic studies. A larger fraction of these children with high hostility scores (5 or greater) had upper tract deterioration (39%) compared to those with low hostility scores (9%). Moreover, 6 of 14 patients in the low hostility group who underwent repeat video urodynamic studies after age 1 year had high hostility lower urinary tracts. We conclude that urodynamic studies during and after the first year of life are useful in the appropriate urological evaluation and management of infants with spinal dysraphism.

Female↗

PubMed1984

Computer-assisted urodynamics.

We have assembled a computer hardware system and have written software programs that convert analogue urodynamic input to digital data. This has allowed for 1) extremely accurate recording of urodynamic events with a higher frequency response than existing units, 2) data storage of urodynamic events in digital form on floppy disks, 3) retrieval and plotting of urodynamic studies during and at times remote from the study performance, and 4) manipulation of the parameters in the urodynamic study for patient care and research purposes. Software is now available for the performance of cystometrograms (volume, total pressure, intravesical pressure and dP/dt), electromyograms, flow studies and dynamic renal pelvic pressure testing. Programs are in the development phase for computer analysis of urodynamic studies.

Analog-Digital Conversion↗

PubMed1999

Lack of morbidity from urodynamic studies in children with asymptomatic bacteriuria.

OBJECTIVES: Patients on clean intermittent catheterization (CIC) have a high rate of asymptomatic bacteriuria. Although prophylactic antibiotics for routine surgical procedures in patients with bacteriuria is common practice, the role of prophylaxis for invasive diagnostic procedures remains unclear. The aim of this study was to investigate the morbidity associated with urodynamic evaluation in patients with asymptomatic bacteriuria. METHODS: Routine urodynamic evaluation was performed in 69 pediatric patients (mean age 10 years). Ninety-six percent had a neurogenic bladder, and most were on CIC. Routine urine cultures were obtained at the time of the cystometrogram. Forty-six patients had positive urine cultures, and 23 patients with sterile urine served as a comparison. Patients were evaluated subjectively for symptoms of a urinary tract infection (UTI) within 1 week of the procedure. The results of the cystometrograms were compared between the patients with and without bacteriuria. RESULTS: No patient developed symptomatic UTI after the urodynamic studies. Overall, 65% of the patients with and 52% of the patients without bacteriuria had adequate capacity and compliance, and there was no difference in the urodynamic findings between the patients with and without bacteriuria (P = 0.4). CONCLUSIONS: Urodynamic studies were performed safely in the presence of asymptomatic bacteriuria in the present study. Therefore, routine use of urine cultures or prophylactic antibiotics before urodynamic studies in pediatric patients with a neurogenic bladder does not appear to be indicated.

Bacteriuria↗

PubMed1998

Neuromodulation: urodynamic effects of sacral (S3) spinal nerve stimulation in patients with detrusor instability or detrusor hyperflexia.

The aim of this study was to determine the urodynamic effects of sacral (S3) nerve stimulation in patients with urge incontinence due to detrusor overactivity which has been refractory to conservative treatment. A total of 24 patients with idiopathic detrusor instability and five with neurogenic hyperreflexia were studied urodynamically before and 6 months after a permanent S3 foramen electrode implant. The urodynamic studies at follow-up were done with the stimulus on. Clinically, the average voiding frequency, the number of leakage episodes and pad use per 24 h decreased significantly. Improvement in several urodynamic parameters was noted. In the idiopathic as well as in the neurogenic group, the correlation between symptomatic and urodynamic improvement was incomplete. Neuromodulation leads to improvement of several urodynamic parameters in patients with urge incontinence due to detrusor overactivity which has been refractory to conservative treatment and appears to be a valuable treatment option in these patients.

Adult↗

PubMed1999

Effects of doxazosin in men with benign prostatic hyperplasia: urodynamic assessment.

OBJECTIVE: In this study, a randomized and placebo controlled trial, we aimed to study the effectiveness and safety of doxazosin based upon urodynamic parameters, especially pressure/flow studies, in men with benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: A total of 57 men (29 doxazosin, 28 placebo) 48-82 years of age with BPH were enrolled. Yet, 8 of 29 in the doxazosin group and 10 of 28 in the placebo group were excluded due to side effects of doxazosin and intolerability of urodynamic assessment of free uroflow, postvoiding residual urine volume (PVR) and pressure/flow studies. RESULTS: There were improvements in all urodynamic parameters (Free Qmax: 30.4% and 28%, PVR: 14 ml and 12 ml, invasive Qmax: 29.3% and 26.2%, Pdet at Qmax: -32.7% and -30%, Pdet-max: -29% and -27.7% at end of the 1st and 6th months whereas placebo effects were worsening in all urodynamic parameters. CONCLUSIONS: We suggest that doxazosin is an important treatment option for patients with BPH, and efficacy of doxazosin should be evaluated with objective, quantitative urodynamic studies not with subjective symptom scores. But additional costs and invasiveness of urodynamic studies restrict their common usefulness.

Adrenergic alpha-Antagonists↗

PubMed1984

Urodynamic practice in neuro-urological patients: techniques and clinical value.

During the last decade a variety of urodynamic techniques have been developed. Despite this there is a tendency to be somewhat inflexible in the application of urodynamics; as soon as the investigator becomes familiar with one method he tends to use it for all his urodynamic evaluations. A short survey gives information about the most popular urodynamic methods with their combinations, as well as their clinical value for paraplegics. The type and number of urodynamic techniques used at the Rehabilitation Centre Bad Häring during the last 6 years demonstrate that extensive facilities are desirable. This gives the flexibility to choose the proper technique, giving maximal information for the individual patient with minimal costs. The combination of cystometry with X-ray videography (the simplest form of videourodynamics), is the most frequent method used, whereas the time consuming combined pressure-flow-EMG-X-ray-video-studies are only used for special indications (approximately 10 per cent of all our urodynamic studies). In order to obtain information of clinical value sometimes a compromise is necessary in order to find the method somewhere between what we would like to measure and the disturbance caused to the patient.

Electromyography↗

PubMed2006

Effect of the intravesical resiniferatoxin instillation evaluated by the ice provocative urodynamic study.

STUDY DESIGN: Prospective urodynamic investigation before and after intravesical resiniferatoxin instillation treatment. OBJECTIVE: To evaluate the effectiveness of intravesical resiniferatoxin instillation for the treatment of neurogenic detrusor overactivity (NDO), using conventional and ice provocative urodynamic studies to monitor the activity of the unmyelinated C-fiber. SETTING: Spinal Cord Injury Unit, Yonsei Rehabilitation Hospital, Seoul, Korea. METHODS: A measure of 100 ml of resiniferatoxin solution, at a concentration of 100 nM diluted in 10% ethanol, was intravesically instilled into the bladder of 15 spinal cord injury patients with NDO. Conventional and ice provocative urodynamic studies were performed to evaluate the change in the involuntary detrusor activity, reflex volume, maximal bladder capacity, compliance, maximal detrusor pressure and reflex volume ratio 7 days before and 30 days after the instillation. RESULTS: Before the intravesical resiniferatoxin instillation, all patients exhibited NDO in both the conventional and ice provocative urodynamic studies, with a mean reflex volume ratio of 0.45+/-0.22. There was no significant change in the maximal bladder capacity, compliance and maximal detrusor pressure at the follow-up urodynamic study, but the reflex volume ratio was significantly increased (P<0.05) after the intravesical resiniferatoxin instillation. Among the 15 patients, three (20%) showed complete and nine (60%) partial suppression of the unmyelinated C-fiber activities. CONCLUSION: Intravesical resiniferatoxin instillation was partially controlled by the unmyelinated C-fiber activities, which were estimated by an ice provocative urodynamic study. Therefore, further studies on the optimal dosage and accurate indications for resiniferatoxin instillation are required.

Administration, Intravesical↗

PubMed2003

Experimental and clinical trial of measuring urinary velocity with the pitot tube and a transrectal ultrasound guided video urodynamic system.

BACKGROUND: The pitot tube is a common device to measure flow velocity. If the pitot tube is used as an urodynamic catheter, urinary velocity and urethral pressure may be measured simultaneously. However, to our knowledge, urodynamic studies with the pitot tube have not been reported. We experimentally and clinically evaluated the feasibility of the pitot tube to measure urinary velocity with a transrectal ultrasound guided video urodynamic system. METHODS: We carried out a basal experiment measuring flow velocity in model urethras of 4.5-8.0 mm in inner diameter with a 12-Fr pitot tube. In a clinical trial, 79 patients underwent transrectal ultrasound guided video urodynamic studies with the 12-Fr pitot tube. Urinary velocity was calculated from dynamic pressure (Pd) with the pitot tube formula and the correcting equation according to the results of the basal experiment. RESULTS: Velocity measured by the pitot tube was proportional to the average velocity in model urethras and the coefficients were determined by diameters of model urethras. We obtained a formula to calculate urinary velocity from the basal experiment. The urinary velocity could be obtained in 32 of 79 patients. Qmax was 8.1 +/- 4.3 mL/s (mean +/- SD; range, 18.4-1.3 mL/s), urethral diameter was 7.3 +/- 3.0 mm (mean +/- SD; range, 18.7-4.3 mm) and urinary velocity was 69.4 +/- 43.6 (mean +/- SD; range, 181.3-0 cm/s) at maximum flow rate. The correlation coefficient of Qmax measured by a flowmeter versus Qdv flow rate calculated with urethral diameter and velocity was 0.41 without significant difference. CONCLUSION: The use of the pitot tube as an urodynamic catheter to a transrectal ultrasound-guided video urodynamic system can measure urethral pressure, diameter and urinary velocity simultaneously. However, a thinner pitot tube and further clinical trials are needed to obtain more accurate results.

Adult↗

PubMed1999

The incidence of detrusor instability before and after colposuspension: a study using conventional and ambulatory urodynamic monitoring.

OBJECTIVE: To determine the incidence of detrusor instability (DI) detected by conventional and ambulatory bladder pressure monitoring, any link between urodynamic findings before and after colposuspension, and between patients' symptoms and the urodynamic findings. PATIENTS AND METHODS: Sixty-five patients, scheduled to undergo colposuspension on the basis of pure genuine stress incontinence on conventional cystometrography (CMG), also underwent ambulatory monitoring (AM) before surgery. All were requested to return 3 months afterward for repeat CMG and AM in random order. In all, 56 patients completed all assessments before and after surgery. In addition to the urodynamic assessment, the patients' symptoms before and after surgery were compared using a detailed questionnaire. RESULTS: On AM before surgery, half the patients showed some DI; afterward, the incidence on AM was 70% and on CMG was 27%. However, on AM, 25% of patients who had DI before surgery showed no evidence of it afterward. Of the 19 women who complained of urgency preoperatively, 16 showed DI on preoperative AM. However, of the 37 women denying urgency preoperatively, 12 (32%) also showed evidence of DI on preoperative AM. CONCLUSIONS: There is a significant incidence of DI detected by CMG after colposuspension in patients who are stable before surgery. The incidence of DI on AM was significantly higher than on CMG both before and after surgery. However, the preoperative urodynamic finding of increased DI on AM does not exclusively predict its presence postoperatively on AM or CMG. In addition, a patient history of urgency does not correlate well with the urodynamic findings before or after surgery. Therefore, from this study it appears that the postoperative symptomatic or urodynamic state cannot be predicted reliably from those before surgery.

Adult↗

PubMed2003

Urodynamic verification of an overactive bladder is not a prerequisite for antimuscarinic treatment response.

OBJECTIVE: To investigate the place of urodynamics in the evaluation of patients with symptoms of the overactive bladder by comparing the response to antimuscarinic therapy in those with and with no urodynamically verified symptoms. PATIENTS AND METHODS: In a prospective observational study, 356 female patients with urinary frequency (> or = 8 voids/24 h) and urgency, with or without urge incontinence, underwent cystometry. Patients were diagnosed with detrusor instability if there were spontaneous, uninhibited increases in detrusor pressure during bladder filling. All patients, regardless of urodynamic findings, were subsequently treated with oxybutynin 2.5 mg twice daily and bladder retraining. The outcome was evaluated as the change in urinary frequency and incontinence episodes after 6-8 weeks of treatment. RESULTS: Among 352 evaluable patients, 266 (76%) had detrusor instability on cystometry and the remainder did not. There was no significant between-group difference in mean age, urinary frequency or the number of incontinence episodes at presentation. Both groups improved equally well during oxybutynin and bladder retraining therapy; after 6-8 weeks there was no significant between-group difference for the mean change from baseline in urinary frequency or incontinence episodes. Tolerability profiles were comparable for the two groups. CONCLUSION: Patients with symptoms of an overactive bladder, but apparently normal urodynamic findings, respond equally well to antimuscarinic therapy as those with urodynamically verified symptoms. Such findings cast further doubt on the clinical validity of using invasive urodynamic procedures to characterize patients with irritative lower urinary tract symptoms before starting antimuscarinic therapy.

Adult↗

PubMed2000

Cost-effectiveness of urodynamic testing before surgery for women with pelvic organ prolapse and stress urinary incontinence.

OBJECTIVE: This study was undertaken to compare cost-effectiveness between 2 preoperative testing strategies for women with pelvic organ prolapse and stress urinary incontinence symptoms. STUDY DESIGN: We developed decision-analytic models that evaluated the cost-effectiveness of basic office evaluation before surgery in women with prolapse and stress urinary incontinence symptoms and contrasted it with that of urodynamic testing. Costs were obtained from the Federal Register; effectiveness of treatment for urinary incontinence was based on the published literature. RESULTS: The strategies of basic office evaluation and urodynamic testing had the same cure rate of urinary incontinence (96%) after initial and secondary treatment. Under baseline assumptions incremental cost-effectiveness (cost for single extra cure of urinary incontinence) of urodynamic testing was $328,601. According to sensitivity analyses, basic office evaluation was more cost-effective than urodynamic testing when the prevalence of pure detrusor instability was <8% or when the cost of urodynamic testing was >$103. CONCLUSION: Urodynamic testing before surgery in women with prolapse and stress urinary incontinence symptoms is not cost-effective relative to basic office evaluation.

Cost-Benefit Analysis↗

PubMed2000

Usefulness of urodynamic examination in female urinary incontinence--lessons from a population-based, randomized, controlled study of conservative treatment.

OBJECTIVE: To test the usefulness of urodynamic examination in female urinary incontinence. MATERIAL AND METHODS: As part of a population-based, randomized, controlled treatment study in general practice, the control group was offered urodynamic examination before and after delayed treatment starting 6 months after inclusion in the study, i.e. after the first outcome evaluation comparing the initially treated group with the control group. The intervention group was offered urodynamic examination only after the final outcome evaluation at 12 months. Eighty-seven women, aged 50-74, from three Norwegian municipalities participated. RESULTS: There was no difference in treatment outcome whether the patients had urodynamic examination or not. Eleven patients (26% of 42 control patients) had their diagnosis revised after urodynamic examination, ten of them with a subsequent change in treatment. The outcome for this group was no different than for the other patients. As a subgroup, the 11 patients had more severe leakage (p = 0.048) and more previous gynecological operations (p = 0.038) than the other control group patients. CONCLUSIONS: Our study supports the idea that in general practice, or in rather unselected patients, women with urinary incontinence may be classified and treated without urodynamic examination. If there is little or no improvement during the first few months referral should be considered, and this should be done sooner for patients with severe incontinence or prior gynecological operations than for other patients.

Aged↗

PubMed1995

Urodynamic findings in patients with diabetic cystopathy.

To ascertain the relationship between voiding dysfunction associated with diabetes and bladder and sphincter behavior, the video urodynamic studies of 182 patients were retrospectively analyzed. Patients were classified based on urodynamic diagnosis and the presence or absence of signs of sacral cord involvement. Urodynamic findings were classified as either detrusor hyperreflexia, impaired detrusor contractility, detrusor areflexia, indeterminate and normal. The results indicate that mean bladder capacity was 485 +/- 89.3 ml. with a mean first sensation of filling of 298 +/- 67.4 ml. Of the 182 patients 100 (55%) had detrusor hyperreflexia, 42 (23%) had impaired detrusor contractility, 20 (11%) had indeterminate findings, 19 (10%) had detrusor areflexia and 1 (1%) was normal. Bladder outlet obstruction occurred in 66 patients (36%), all men (57%). The diagnosis was isolated in 24 patients (36%) or in combination with another diagnosis in 42 (74%). However, if one considers the presence of sacral cord signs (42 patients), the most common urodynamic diagnoses were either impaired detrusor contractility in 21 (50%) or detrusor areflexia in 10 (24%). These data suggest that classical diabetic cystopathy is not the most common urodynamic findings in patients with diabetes mellitus and voiding dysfunction, and in fact these patients present with variable pathophysiological findings. These findings demonstrate the importance of urodynamic studies in diagnosing voiding dysfunction in diabetics before initiation of therapy.

Aged↗