Urodynamics

Question 1

In which patients is urodynamics indicated?

a) patients with a history consistent with stress incontinence
b) patients with SUI who are considering a trial of conservative mgmt with pessary
c) a patient with symptoms of stress incontinence who does not improve with conservative treatment
d) patients with symptoms of urge incontinence who are considering a trial of medical management

Answer 1

c

Question 2

Name the five components necessary for normal bladder filling and emptying.

Answer 2

1. normal bladder compliance
2. bladder stability
3. competence of ureterovesical junctions
4. competent vesical outlet at rest and during period of inc intra-abdominal pressure
5. appropriate bladder sensation

Question 3

Choose correct responses regarding urodynamics:

a) detrusor overactivity is defined as inappropriate detrusor activity measured during filling phase of cystogram
b) a normal PVR is less than 200cc
c) compliance is defined as change in volume divided by change in pressure
d) normal feeling of first sensation on filling cystogram is around 400cc
e) a normal bladder changes its volume with minimal change in its intravesical pressure

Answer 3

a) true
b) false -debatable but guideline says 100cc
c) true
d) false 100-200cc
e) true

Question 4

Choose all correct answers:

a) Intrinsic sphincter deficiency cannot be diagnosed using urodynamics
b) ISD is diagnosed based on measuring the leak pressure point
c) patients with ISD are at greater risk of sling failure than patients with SUI due to lack of external sphincter support
d) a valsalva leak point pressure of <60cmH20 is suggestive of ISD

Answer 4

a) false
b) true
c) true
d) true

Question 5

Which of these patients should have urodynamics performed?

a) a patient with SUI symptoms in whom you are planning a TVT
b) a patient with a cystocele and no SUI symptoms to see if reducing the prolapse surgically will “unmask” SUI
c) a patient with a previous TVT considering a repeat procedure 5 years later
d) a patient with mixed incontinence symptoms not responding to anti-cholinergic medications

Answer 5

a) false -controversial but not technically recommended
b) false -negative cough test with prolapse reduced is enough
c) true
d) true