14 - UDS Flashcards
situations where UDS would be helpful - 5
- failed TURP/ refractory luts, 2. failed incontinence procedure, 3. SUI and prolapse, 4. NGB, 5. post prostatectomy incontinence
what part of UDS evaluates detrussor function - 2
- CMG, 2. DLPP
what parts of UDS evaluates SUI - 3
- valsalva LPP, 2. flouro UDS, 3. urethral Pressure Profile
what parts of UDS evaluate outlet obstruction - 3
- uroflow, 2. pressure flow, 3. flouro UDS
what parts of UDS eval neurogenic conditions - 3
- CMG, 2. DLPP, 3. EMG
what is abrams griffiths nomogram
classification for BOO based on Qmax
Q max assd w/ BOO
< 10 ml/sec
Q max ruling out BOO
> 15 ml/sec
bladder vol and urine flow rate
max flow rate is volume dependent
what does nl PVR tell u
nl PVR = nl neurologic function and nl detrusor/ outlet relationship
what is nl pvr
< 50
def of “ bladder voiding efficiency”
measures degree of bladder emptying aka measures bladder contractility vs outlet resistance
“bladder voiding efficiency” formula
voided volume/total bladder volume x 100
what # is abnormal for BE
< 75% correlates with detrussor failure
where is normal first sensation during CMG
75-150cc
nl bladder capacity
350-450 cc
2 phases of bladder filling
accommodation is flat curve, elastic phase is steep curve
main strength of CMG
allows measurement of compliance
% patients with nl CMG with DO
50%
compliance formula
change in vol over change in pressure
def pseudodyssenergia
voluntary contraction of external sphincter to prevent leakage in neurologically normal patient. True DSD only happens if neurologically abnormal
what type of LPP measures sphincteric incontinence
ALPP/VLPP (valsalva)
what does ALPP/ VLPP measure
measure bladder neck/ urethral competence with increased abdominal pressure - ability of sphincter to resist leakage
caveat of ALPP/VLPP
only measurable in ppl with SUI as nl people will not leak at any physiologic abdominal pressure
what LPP measures ability to store at low pressure
DLPP and BLPP (bladder)
DLPP def
intravesical pressure at the moment when fluid is first seen leaking from urethra around catheter. measures the “injured” bladder response to higher outlet resistance
what does DLPP tell you
> 40 cm H2O = risk of upper tract deterioration
ALPP/VLPP interpretation - 3
- < 60 cm H2O assd w ISD, 2. 60-100 cm H2O - grey area, 3. > 100 cm H2O urethral hypermobility. the lower the ALPP, the weaker the sphincter
relationship of ALPP, ISD and urethral hypermobility
if there is no hypermobility, SUI must be caused by ISD regardless of ALPP
how to measure ALPP
- insert catheter and measure PVR, 2. add/remove to 150-200 ml total, 3. have pt STAND then slow valsalva until leakage, 4. cough test ONLY if valsalva doesn’t work, 5. if still no leakage, remove catheter repeat valsalva/ cough
what is appropriate fill rate
50-75 ml/min
ALPP and full bladder
will maintain sphincter closed and give false negative
what is stress induced urge incontinence
stress incontinence with valsalva forces internal sphincter open which then causes contraction of external sphincter. Open bladder neck induces voiding response.
tx for stress induced urge incontinence
continence procedure - sling
anticholinergics and LPP
no effect on LPP
prolapse and UDS
have to reduce prolapse during uds
why do u have to reduce prolapse during uds
obtain accurate LPP because when treating prolapse may unmask SUI.
2 types of urethral leak point pressure
static and dynamic UPP
problem with static UPP
ISD is a dynamic problem
what is dynamic UPP
pull catheter as pt coughs
normal dynamic UPP
urethral pressure (prox 3/4 urethra) should exceed Pves
what is the abrams griffiths number on AG nomogram
Pdet at Q max
eq for bladder outlet obstruction index
BOOI = PdetQmax - 2*Qmax
BOOI interpretation
> 40 is obstructed, < 20 unobstructed
eq for bladder contractility index
PdetQmax + 5*Qmax
what BCI is nl
100-150= nl
what does BCI tell you
bladder strength
who needs UDS - 5
- < 45 yo and failed meds, 2. no relief after TURP, 3. hx neurologic disease. 4. sx out of proportion to flow rate, 5. low-nl flow rate and high PVR
nomograms and women
nomograms only apply to men
common causes of obstruction in women
- iatrogenic after SUI surgery, 2. dysfunctional voiding, 3. pelvic prolapse
uds caveat in women with obstruction
flouro is important to locate site of obstruction
first step in voiding
relaxation of striated sphincter
steps in voiding - 4
- striated sphincter relaxation, 2. detrussor contraction, 3. vesical neck opening, 4. urine flow
compliance in BOO and TURP
reduced compliance may improve after turp
BOOI and women
cant be used b/c will grossly underestimate BOO as women void at much lower pressure
involuntary detrussor contraction and EMG
EMG signal may increase due to guarding reflex
DESD problem
can lead to impaired compliance and lead to upper tract deterioration.
mgmt of DESD - 2
if learned - can be unlearned. if not learned, requires bypassing nl voiding with CIC or sphincterotomy
situations where video uds would be useful - 3
- eval bladder neck (internal sphincter), 2. neuro diseases w/ assd VUR, 3. female BOO
uds findings requiring intervention - 6
- impaired compliance, 2. DESD, 3. DISD, 4. high pressure DO present throughout filling, 5. elevated DLPP (>40 cm H2O), 6. poor emptying with high pressure storage
characteristics of DO
- involuntary detrussor contraction seen on UDS 2. assd w sx urgency/UUI, 3. can be provoked by cough/valsalva, 4. not same as OAB which describes a sx
