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Weider's Urology > Urodynamics > Flashcards

Urodynamics Flashcards

1
Q

What are the two phases of bladder function?

A

Filling (storage)

Emptying (voiding)

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2
Q

What three things are required for bladder filling?

A

Absence of involuntary contractions
Accommodation
Closed bladder outlet

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3
Q

What are the three components of bladder accommodation?

A 
Compliance
SNS stimulation (reduces detrusor tone)
PNS inhibition (reduces detrusor tone)
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4
Q

What two things are required to keep the bladder outlet closed during the filling stage?

A 
SNS stimulation (increases smooth sphincter tone)
Onuf's nucleus stimulation (increases striated tone)
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5
Q

What 3 factors are required for normal emptying?

A

Absence of obstruction
Open bladder outlet
coordinated detrusor contraction

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6
Q

What two factors are involved in opening the bladder outlet during the emptying phase?

A 
SNS inhibition (decreases smooth sphincter tone)
Onuf's nucleus inhibition (decreases striated tone)
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7
Q

What two factors are involved in coordinated detrusor contraction?

A 
PNS stimulation (Increases detrusor tone)
SNS inhibition (decreases detrusor inhibition)
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8
Q

What are the two major determinants of urine flow rate?

A

Detrusor function

Outlet resistance

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9
Q

What is the guarding reflex?

A

Inhibition of PNS
Stimulation by SNS
Activation of Onuf’s nucleus

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10
Q

What is the voiding reflex?

A

Bladder volume reaches critical level leading to:
Activation of PNS
Inhibition of SNS
Inhibition of Onuf’s nucleus

Can be suppressed and controlled by the cerebral cortex.

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11
Q

What structure allows the CNS to allow voluntary voiding?

A

Barrington’s nucleus in the Pons.

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12
Q

What are the seven components of a urodynamic study?

A 
Cystometry
Uroflowmetry
Pressure flow studies
Electromyography
Urethral pressure profilometry
Cystogram 
Post void residual
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13
Q

What does uroflowmetry measure?

A

Flow rate
voided volume
voiding duration

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14
Q

What is required for an adequate uroflometry study?

A

At least 150ml

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15
Q

What does the graph of a normal flow profile look like?

A

Bell shaped curve

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16
Q

What are the normal peak flow rates for men and women?

A

Men: 20-25 ml/sec
Female: 25-30 ml/sec

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17
Q

What flow rates suggest obstruction?

A

Suspected obstruction: 10-15 ml/sec

Probable obstruction: < 10 ml/sec

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18
Q

What is a normal PVR?

A

< 50-100cc

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19
Q

What does an increased PVR indicate?

A

Bladder outlet obstruction
Decreased detrusor function
Both of the above.

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20
Q

What 5 things does a CMG measure?

A 
Detrusor pressure
Bladder capacity
Bladder compliance
Voluntary sphincter function
Leak point pressure
21
Q

What is a normal bladder compliance?

A

< 6 cm water rise in detrusor pressure with filling

22
Q

What is a normal volume for first sensation of filling?

A

100-200ml

23
Q

What is a normal volume for sensation of fullness?

A

350-450ml

24
Q

What is a normal volume for first desire to void?

A

350-450ml

25
Q

What is volume of imminent void?

A

Unable to inhibit voiding any longer

26
Q

What else should the patient be asked to do during a cystometrogram?

A

cough or valsalva

27
Q

What is abdominal leak point pressure/valsalva leak point pressue?

A

The lowest intravesical pressure at which urine leaks around the catheter with an increase in abdominal pressure but no detrusor contraction.

28
Q

What values are diagnostic for ALPP/VLPP?

A

ALPP < 60 indicates SUI caused by ISD
ALPP 60-100 is indeterminant
ALPP > 100 indicates that SUI is not from ISD

29
Q

What is detrusor leak point pressure?

A

The lowest pressure at which urine leaks around the catheter without detrusor contraction and with no increase in abdominal pressure.

30
Q

What values are important for detrusor leak point pressure?

A

DLPP > 40cm water can cause ureteral obstruction, hydronephrosis, and renal damage.

31
Q

In what order should the phases of the UDS be read?

A
  1. Filling phase
  2. Voiding phase
  3. Flow
  4. Video cystogram
32
Q

What should be evaluated when reading the filling phase?

A 
Compliance
Capacity
Sensation
Detrusor overactivity
Urine leak
33
Q

What is the equation of bladder capacity in kids?

A

(Age in years + 2) x 30 = bladder capacity in ml

34
Q

What indicates significant detrusor overactivity?

A

If they are sensed
If they cause leakage
If they increase pressure > 15ml of water

35
Q

What should be evaluated in the voiding phase?

A 
Max flow
Voided volume
Max detrusor pressure (Pdet max)
PVR
EMG
36
Q

What is normal Pdet max?

A

40-60cm water

Less for females

37
Q

What is the impact of a suprapontine lesion on voiding?

A

Detrusor overactivity
Bladder sphincter synergy
Normal sensation
Adequate emptying

38
Q

What is the impact of a lesion in the pons to the spinal cord above S2?

A

Detrusor overactivity
Spastic sphincter
Detrusor sphincter dyssynergia
Spastic paresis of lower limbs

39
Q

What is the impact of a lesion from S2-S4?

A

Acontractile flaccid detrusor
Flaccid striated sphincter
Flaccid paralysis of the lower limbs

40
Q

What is the impact of a lesion to the peripheral pelvic nerves?

A

Acontractile detrusor

Absent bladder sensation

41
Q

What are the typical UDS findings of Multiple sclerosis?

A

Detrusor overactivity

42
Q

What are the typical UDS findings of normal pressure hydrocephalus?

A

Detrusor overactivity
Dementia (wacky)
Gait disturbances (wobbly)
Urge incontinence (wet)

43
Q

What are the typical UDS findings for stroke patients?

A

Detrusor overactivity

Synergic sphincter

44
Q

What are the typical UDS findings for Parkinson’s disease?

A

Detrusor overactivity

Usually no DSD but sometimes cogwheeling can cause DSD.

45
Q

What are the typical UDS findings associated with Cauda equina syndrome?

A

Acontractile detrusor

Flaccid sphincter

46
Q

What are the typical findings for a patient with spinal shock from a suprasacral spinal cord injury?

A

Acontractile detrusor
Increased tone in urethral sphincter and bladder neck
Absent bulbocavernosus and deep tendon reflexes

47
Q

How long does spinal shock usually last?

A

6-12 weeks

48
Q

What are the typical UDS findings for a patient with tethered cord?

A

Detrusor underactivity

Weider's Urology (2 decks)

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