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review course > 14 - UDS > Flashcards

14 - UDS Flashcards

1
Q

situations where UDS would be helpful - 5

A
  1. failed TURP/ refractory luts, 2. failed incontinence procedure, 3. SUI and prolapse, 4. NGB, 5. post prostatectomy incontinence
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2
Q

what part of UDS evaluates detrussor function - 2

A
  1. CMG, 2. DLPP
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3
Q

what parts of UDS evaluates SUI - 3

A
  1. valsalva LPP, 2. flouro UDS, 3. urethral Pressure Profile
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4
Q

what parts of UDS evaluate outlet obstruction - 3

A
  1. uroflow, 2. pressure flow, 3. flouro UDS
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5
Q

what parts of UDS eval neurogenic conditions - 3

A
  1. CMG, 2. DLPP, 3. EMG
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6
Q

what is abrams griffiths nomogram

A

classification for BOO based on Qmax

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7
Q

Q max assd w/ BOO

A

< 10 ml/sec

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8
Q

Q max ruling out BOO

A

> 15 ml/sec

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9
Q

bladder vol and urine flow rate

A

max flow rate is volume dependent

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10
Q

what does nl PVR tell u

A

nl PVR = nl neurologic function and nl detrusor/ outlet relationship

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11
Q

what is nl pvr

A

< 50

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12
Q

def of “ bladder voiding efficiency”

A

measures degree of bladder emptying aka measures bladder contractility vs outlet resistance

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13
Q

“bladder voiding efficiency” formula

A

voided volume/total bladder volume x 100

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14
Q

what # is abnormal for BE

A

< 75% correlates with detrussor failure

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15
Q

where is normal first sensation during CMG

A

75-150cc

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16
Q

nl bladder capacity

A

350-450 cc

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17
Q

2 phases of bladder filling

A

accommodation is flat curve, elastic phase is steep curve

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18
Q

main strength of CMG

A

allows measurement of compliance

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19
Q

% patients with nl CMG with DO

A

50%

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20
Q

compliance formula

A

change in vol over change in pressure

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21
Q

def pseudodyssenergia

A

voluntary contraction of external sphincter to prevent leakage in neurologically normal patient. True DSD only happens if neurologically abnormal

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22
Q

what type of LPP measures sphincteric incontinence

A

ALPP/VLPP (valsalva)

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23
Q

what does ALPP/ VLPP measure

A

measure bladder neck/ urethral competence with increased abdominal pressure - ability of sphincter to resist leakage

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24
Q

caveat of ALPP/VLPP

A

only measurable in ppl with SUI as nl people will not leak at any physiologic abdominal pressure

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25
Q

what LPP measures ability to store at low pressure

A

DLPP and BLPP (bladder)

26
Q

DLPP def

A

intravesical pressure at the moment when fluid is first seen leaking from urethra around catheter. measures the “injured” bladder response to higher outlet resistance

27
Q

what does DLPP tell you

A

> 40 cm H2O = risk of upper tract deterioration

28
Q

ALPP/VLPP interpretation - 3

A
  1. < 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
29
Q

relationship of ALPP, ISD and urethral hypermobility

A

if there is no hypermobility, SUI must be caused by ISD regardless of ALPP

30
Q

how to measure ALPP

A
  1. 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
31
Q

what is appropriate fill rate

A

50-75 ml/min

32
Q

ALPP and full bladder

A

will maintain sphincter closed and give false negative

33
Q

what is stress induced urge incontinence

A

stress incontinence with valsalva forces internal sphincter open which then causes contraction of external sphincter. Open bladder neck induces voiding response.

34
Q

tx for stress induced urge incontinence

A

continence procedure - sling

35
Q

anticholinergics and LPP

A

no effect on LPP

36
Q

prolapse and UDS

A

have to reduce prolapse during uds

37
Q

why do u have to reduce prolapse during uds

A

obtain accurate LPP because when treating prolapse may unmask SUI.

38
Q

2 types of urethral leak point pressure

A

static and dynamic UPP

39
Q

problem with static UPP

A

ISD is a dynamic problem

40
Q

what is dynamic UPP

A

pull catheter as pt coughs

41
Q

normal dynamic UPP

A

urethral pressure (prox 3/4 urethra) should exceed Pves

42
Q

what is the abrams griffiths number on AG nomogram

A

Pdet at Q max

43
Q

eq for bladder outlet obstruction index

A

BOOI = PdetQmax - 2*Qmax

44
Q

BOOI interpretation

A

> 40 is obstructed, < 20 unobstructed

45
Q

eq for bladder contractility index

A

PdetQmax + 5*Qmax

46
Q

what BCI is nl

A

100-150= nl

47
Q

what does BCI tell you

A

bladder strength

48
Q

who needs UDS - 5

A
  1. < 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
49
Q

nomograms and women

A

nomograms only apply to men

50
Q

common causes of obstruction in women

A
  1. iatrogenic after SUI surgery, 2. dysfunctional voiding, 3. pelvic prolapse
51
Q

uds caveat in women with obstruction

A

flouro is important to locate site of obstruction

52
Q

first step in voiding

A

relaxation of striated sphincter

53
Q

steps in voiding - 4

A
  1. striated sphincter relaxation, 2. detrussor contraction, 3. vesical neck opening, 4. urine flow
54
Q

compliance in BOO and TURP

A

reduced compliance may improve after turp

55
Q

BOOI and women

A

cant be used b/c will grossly underestimate BOO as women void at much lower pressure

56
Q

involuntary detrussor contraction and EMG

A

EMG signal may increase due to guarding reflex

57
Q

DESD problem

A

can lead to impaired compliance and lead to upper tract deterioration.

58
Q

mgmt of DESD - 2

A

if learned - can be unlearned. if not learned, requires bypassing nl voiding with CIC or sphincterotomy

59
Q

situations where video uds would be useful - 3

A
  1. eval bladder neck (internal sphincter), 2. neuro diseases w/ assd VUR, 3. female BOO
60
Q

uds findings requiring intervention - 6

A
  1. 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
61
Q

characteristics of DO

A
  1. 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

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