Understanding of Urodynamics
Testing
Mrs. Malar
Kodi Aathi1, Ms. Akoijam
Sangita Devi2, Mr. Gaurav
Kohli3
1Assistant Professor, Dept of Child Health
Nursing, M.M Institute of Nursing, M.M University Mullana,
Ambala Haryana.133207
2Dept of Medical Surgical Nursing, M.M Institute of Nursing, M.M
University Mullana, Ambala
Haryana.133207
3Dept of Community Health Nursing, M.M Institute of Nursing, M.M
University Mullana, Ambala
Haryana.133207
*Corresponding
Author Email: malargeethu@gmail.com
ABSTRACT:
A systematic investigation of urodynamics will
provide an explanation and comprehension of various invasive and non invasive
investigations involved in urodynamics such as uroflowmetry, post void residual measurement, cystometric test, leak point pressure measurement, pressure
flow study, electromyography, video Urodynamic tests.
This simple, painless study is a
series of tests that allows your physician to evaluate any problems your bladder
may have storing or emptying urine. Reasons for these tests may include incontinent (leak
urine), bladder may not empty completely, uncomfortable symptoms, such as the
frequent need to urinate or a constant urgent need to urinate, urine stream may
be intermittent or weak, Client may have persistent urinary tract infections.
Bladder and abdominal pressure is measured during filling and voiding. Urodynamic equipment calculates detrusor
pressure by subtracting abdominal from pelvic. This pressure measures during
filling and voiding of urine. The terminology in this abstract has comply with cooper measure guide, International
Continence Society and department of urodynamics
standard and quality control.
KEY WORDS: Comprehension,
Urodynamics, Uroflowmetry, post void residual measurement, cystometry, leak point pressure measurement, pressure flow
study, electromyography, video Urodynamic tests,
incontinence.
INTRODUCTION:
In recent years, researchers have learned much about the causes
and treatment of lower urinary tract problems. Researchers are looking into
ways to more accurately assess LUTS and diagnose lower urinary tract problems.
Research focuses on designing and developing more accurate and reliable
diagnostic tests and tools.2
The National Institute of Diabetes and Digestive and Kidney
Diseases (NIDDK) sponsors studies of diagnostic Urodynamic methods and devices. The NIDDK also sponsors
programs aimed at understanding, diagnosing, and treating lower urinary tract
problems. NIDDK-funded studies have shown associations between (LUTS)
Lower Urinary Tract Symptoms and no neurologic diseases and
conditions. These findings have important diagnostic and management
implications. Continued improvement in Urodynamic
testing will help support advancements in understanding these associations.
Participants in clinical trials can play a more active role in our own health
care, gain access to new research treatments before they are widely available,
and help others by contributing to health research.1
Urodynamics Urodynamics is
the term that encompasses a number of tests used in the investigation of women
with lower urinary tract symptoms (LUTS). Some are non invasive, such as flows
studies, but the majority are non invasive, requiring urethral catherization and placement of an abdominal pressure
catheter in the vagina, rectum or stoma. The International Continence Society
(ICS) sets definitions and standards for urodynamics
investigation. It publishes standardization reports that are available online
and should be adhered to. Non invasive urodynamics
tests, such as Uroflowmetry, do not have any
associated morbidity. Invasive tests involving urethral catherization
have a recognized risk of urinary tract infections of between 1 and 10%. Most
centers do not advocate the prophylactic use of antibiotics for cystometry apart from in specific indication, for example
renal transplant patients.6
What is urodynamics?
Urodynamic tests range from simple observation to
precise measurements using sophisticated instruments.
Most Urodynamic tests focus on the
bladder’s ability to hold urine and empty steadily and completely. Urodynamic tests can also show whether the bladder is
having involuntary contractions that cause urine leakage.7 Urodynamic tests range from simple observation to precise
measurements using sophisticated instruments. For simple observation, a health
care provider may record the length of time it takes a person to produce a
urinary stream, note the volume of urine produced, and record the ability or
inability to stop the urine flow in midstream. For precise measurements,
imaging equipment takes pictures of the bladder filling and emptying, pressure
monitors record the pressures inside the bladder, and sensors record muscle and
nerve activity. The health care provider will decide the type of Urodynamic test based on the person’s health information,
physical exam, and LUTS (lower urinary tract symptoms). The Urodynamic
tests results help diagnose the cause and nature of a lower urinary tract
problem. Urodynamic tests include Uroflowmetry,
post void residual measurement, cystometric test,
leak point pressure measurement, pressure flow study, electromyography, video Urodynamic tests.5
Types of Urodynamic tests
Uroflowmetry
Purpose:
Uroflowmetry is the measurement of urine speed and
volume. Special equipment automatically measures the amount of urine and the
flow rate how fast the urine comes out.
Procedure:
Uroflowmetry equipment includes a device for catching
and measuring urine and a computer to record the data. During a Uroflowmetry test, the person
urinates privately into a special toilet or funnel that has a container for
collecting the urine and a scale. The equipment creates a graph that shows
changes in flow rate from second to second so the health care provider can see
when the flow rate is the highest and how many seconds it takes to get there.
Results of this test will be abnormal if the bladder muscles are weak or urine
flow is blocked. Another approach to measuring flow rate is to record the time
it takes to urinate into a special container that accurately measures the volume
of urine.4 Uroflowmetry
measurements are performed in a health care provider’s office; no anesthesia is
needed. Figure: 1.
Time required:
1-2 minutes
Fig.
1. Normal Uroflowmetry
study demonstrating a normal bell-shaped pattern ( A) and an abnormal screening Uroflowmetry
study ( B) in a Valsalva voider with an
interrupted, intermittent flow pattern
Posts void Residual Measurement:
Purpose:
This Urodynamic test measures the amount
of urine left in the bladder after urination. The remaining urine is called the
post void residual.
Procedure:
Post void residual can be measured with ultrasound equipment that
uses harmless sound waves to create a picture of the bladder. Bladder
ultrasounds are performed in a health care provider’s office, radiology center,
or hospital by a specially trained technician and interpreted by a doctor,
usually a radiologist. Anesthesia is not needed. Post void residual can also be
measured using a catheter a thin flexible tube. A health care provider inserts
the catheter through the urethra up into the bladder to remove and measure the
amount of remaining urine. A post void residual of 100 milliliters or more is a
sign that the bladder is not emptying completely. Catheter measurements are
performed in a health care provider’s office, clinic, or hospital with local
anesthesia. (Figure: 2)
Time required: Will
take up to 30 minutes
Figure: 2 Posts void Residual Measurement
Cystometric Test:
Purpose:
A cystometric test measures how much
urine the bladder can hold, how much pressure builds up inside the bladder as
it stores urine, and how full it is when the urge to urinate begins.
Procedure:
A catheter is used to empty the bladder completely. Then a
special, smaller catheter is placed in the bladder. This catheter has a
pressure-measuring device called a manometer. Another catheter may be placed in
the rectum to record pressure there.
Once the bladder is emptied completely, the bladder is filled
slowly with warm water. During this time, the person is asked to describe how
the bladder feels and indicate when the need to urinate arises. When the urge
to urinate occurs, the volume of water and the bladder pressure are recorded.
The person may be asked to cough or strain during this procedure to see if the
bladder pressure changes. A cystometric test can also
identify involuntary bladder contractions. Cystometric
tests are performed in a health care provider’s office, clinic, or hospital
with local anesthesia.(figure:3)
Time required: 10-20
minutes
Figure:3 Cystometry
Leak Point Pressure Measurement:
Purpose:
This Urodynamic test measures pressure
at the point of leakage during a cystometric test.
Procedure:
While the bladder is being filled for the cystometric
test, it may suddenly contract and squeeze some water out without warning. The
manometer measures the pressure inside the bladder when this leakage occurs.
This reading may provide information about the kind of bladder problem that
exists. The person may be asked to apply abdominal pressure to the bladder by
coughing, shifting position, or trying to exhale while holding the nose and
mouth. These actions help the health care provider evaluate the sphincters.
Time required: 30
minutes
Pressure Flow Study:
Purpose:
A pressure flow study measures the bladder pressure required to
urinate and the flow rate a given pressure generates.
Procedure:
After the cystometric test, the person
empties the bladder, during which time a manometer is used to measure bladder
pressure and flow rate. This pressure flow study helps identify bladder outlet
blockage that men may experience with prostate enlargement. Bladder outlet
blockage is less common in women but can occur with a cystocele
or, rarely, after a surgical procedure for urinary incontinence. Pressure flow
studies are performed in a health care provider’s office, clinic, or hospital
with local anesthesia. (Figure:4)
Time required:
1-5 minutes
Electromyography:
Purpose: Electromyography
uses special sensors to measure the electrical activity of the muscles and
nerves in and around the bladder and the sphincters. If the health care
provider thinks the urinary problem is related to nerve or muscle damage, the
person may be given an electromyography.
Procedure: The
sensors are placed on the skin near the urethra and rectum or on a urethral or
rectal catheter. Muscle and nerve activity is recorded on a machine. The
patterns of the nerve impulses show whether the messages sent to the bladder
and sphincters are coordinated correctly. Electromyography is performed by a
specially trained technician in a health care provider’s office, outpatient
clinic, or hospital. Anesthesia is not needed if sensors are placed on the
skin. Local anesthesia is needed if sensors are placed on a urethral or rectal
catheter.
Time required: 30
minute
Eyeball Cystometrogram:
A simple "eyeball Cystometrogram
(CMG)" can be performed at the bedside or in the office. The patient is
placed in the supine position and catheterized with an 18 Fr catheter.
Post-void residual urine is measured. The plunger is removed from a 50-60 mL catheter tip syringe and the barrel of the syringe is
connected directly to the end of the catheter. Water or saline is infused into
the bladder by pouring into the open end of the syringe. The height of the
barrel is raised or lowered until there is steady flow. The patient is
instructed to neither try to void nor to inhibit micturition,
but rather to report their sensations to the clinician. If the rate of infusion
begins to slow down or if the fluid begins to back up, the barrel of the
syringe is raised or lowered until flow just stops. The height of the meniscus,
above the symphysis, is a measure of vesical pressure. If the pressure does rise, it may be due
to an involuntary detrusor contraction, to an
increase in abdominal pressure or to low bladder compliance. Increases in
intra-abdominal pressure are usually detectable by visual observation or
palpation of the abdomen, but low bladder compliance may be difficult to distinguish
from an involuntary detrusor contraction. An
involuntary detrusor contraction is characterized by
a sudden increase in pressure which is not volitional. In most neurologically
normal patients the involuntary detrusor contraction
is perceived by the patient as an urge to void, but some patient may be
completely unaware of it. If involuntary detrusor
contractions are suspected, but not demonstrated, the examination is repeated
in the upright position. The patient is asked to cough or strain and the pressure
response observed to see if this stimulates an involuntary detrusor
contraction, which will be apparent as a sustained increase in pressure that
persists long after the increase in abdominal pressure has abated.3
Video Urodynamic Tests:
Purpose: Video
Urodynamic tests take pictures and videos of the
bladder during filling and emptying.
Procedure: The
imaging equipment may use x rays or ultrasound. If x-ray equipment is used, the
bladder will be filled with a special fluid, called contrast medium, that shows
up on x rays. X rays are performed by an x-ray
technician in a health care provider’s office, outpatient facility, or
hospital; anesthesia is not needed. If ultrasound equipment is used, the
bladder is filled with warm water and harmless sound waves are used to create a
picture of the bladder. The pictures and videos show the size and shape of the
bladder and help the health care provider understand the problem. Bladder
ultrasounds are performed in a health care provider’s office, radiology center,
or hospital by a specially trained technician and interpreted by a doctor,
usually a radiologist. Although anesthesia is not needed for the ultrasound,
local anesthesia is needed to insert the catheter to fill the bladder.
Time required: Approximately
one half to three-quarters of an hour
Nursing responsibilities:
- A careful history, examination and completion of frequency
volume chart should be maintained firstly
- Relevant past medical history, including surgery and
neurological disease should be include as well as parity and obstetric history
- Client’s drug history should b taken prior to urodynamics investigation as some medication, for example,
diuretics can affect urinary symptoms such as urine frequency.
- Frequency/volume chart will contain information about voiding
frequency, as well as voiding volumes. On its own it can be used as diagnosing
tool
- Its nurses responsibility to give an
information leaflet about what to expect during testing and any questions
should be answered
- Before embarking on urodynamics
question should be identified, i.e. what are the symptoms required to provide
diagnosis will be determined by the urodynamics
questions
- Degree of incontinence and the number of pads should be noted,
as should any co existing difficulties8
SUMMARY:
Urodynamic as an essential part of the investigation
and its measures nerve and muscle function, pressures around and in the
bladder, flow rates and other factors which might help to explain a person's
incontinence. Some people find these tests embarrassing and uncomfortable. Urodynamic studies are a set of investigation that define
underlying pathophysiology and facilitates better
treatment of symptoms. Urodynamic studies are the
best diagnostic tool in the management of patients with LUTS. Being invasive
and time consuming, it is unnecessary to perform Urodynamic
tests in each and every patient with LUTS. However, in patients undergoing any
surgical procedure designed to modify the function of the lower urinary tract,
an objective assessment by Urodynamic evaluation is
mandatory. Patients with recurrent LUTS after initial medical treatment or
patients with persistent symptoms after adequate treatment should be referred
for Urodynamic studies before undertaking further
treatment.
ACKNOWLEDGEMENTS:
With profound gratitude we express my heartfelt veneration toward
my esteemed; the keen and invaluable family members and friends for
enlightening guidance, interest, valuable suggestions and consistent
encouragement at all stages of work. We deeply appreciate their untiring and
outstanding contribution, encouraging words for compiling the narrative review
paper.
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6. Latthe, Foon and Toozs. (2008)
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Abrass. (1982) Urinary incontinence
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Received on 04.04.2013 Modified on 25.04.2013
Accepted on 01.05.2013 © A&V Publication all right reserved
Asian
J. Nur. Edu. and Research 3(3): July-Sept.,
2013; Page 171-176