Urogynae Flashcards
Indications for urodynamics
Failure of conservative management for urge urinary incontinence
Prior to any surgical procedure for urinary incontinence (unless clearly pure SUI with no symptoms of OAB or prolapse which is only 5% of urogynae population)
Any previous anterior compartment or incontinence surgery
Symptoms suggestive of voiding dysfunction
Symptoms suggestive of overflow incontinence
Neurological symptoms
Severe prolapse prior to surgery esp if pre- existing urinary incontinence
Definition of overactive bladder syndrome
Urgency + daytime frequency +/- nocturia +/- urinary incontinence
Urgency definition
A sudden compelling desire to void which is difficult to defer
Urge urinary incontinence
Incontinence accompanied by or immediately preceded by urgency
Urodynamic stress incontinence definition
Urodynamic diagnosis
Involuntary leakage provoked by increased intra- abdominal pressure and in the absence of increased detrusor contraction during filling cystometry
Detrusor overactivity definition
Urodynamic diagnosis
Involuntary detrusor contraction during filling cystometry which may be provoked or spontaneous
Things to do prior to urodynamics
Rule out UTI
Stop anticholinergics 10 days prior
Check compliance with conservative measures
Check bladder diary
Tell me about uroflowmetry
Measurement of flow rate over time
Woman voids in a commode that funnels urine into a device that measures flow rate over time
Looks at:
- max flow rate
- average flow rate
- total volume voided (must be >150ml to be interpretable)
This helps to diagnose or exclude voiding difficulties
You then look at post- void residuals with bladder scan or in + out catheter
Tell me about cystometry
Measure of the pressure- volume relationship of the bladder during filling and voiding.
Fluid (water/ saline) is infused into the bladder via a catheter.
Catheter in bladder measures intravesical pressure.
Catheter into rectum or vagina to measure IAP.
Detrusor pressure Pdet= Pves - Pabd
Assess:
- bladder sensation
- bladder capacity
- detrusor activity and compliance
- sphincter competence
- urine leakage
Do some provocative tests like coughing or wash hands
Aims to diagnose detrusor overactivity or urodynamic stress urinary incontinence
Voiding phase: pressure- flow study
- high pressure voiding= obstruction
- low pressure voiding = detrusor hypo- contractility
Pressure- flow studies
Pt voids while pressure transducer is still in
Relationship between pressure in the bladder and urine flow during emptying = detrusor contractility
Urethral pressure profile
Measures urethral closure pressure= bladder pressure- urethral pressure
Normally, urethra closure pressure is maintained during filling even with increased IAP.
Leakage occurs when bladder pressure exceeds urethral pressure
Clinical value is unknown
Leak point pressures
The bladder pressure at which leakage occurs.
Abdominal leak point pressure- the intravesicular pressure at which leakage occurs due to increased abdominal pressure in the absence of detrusor contraction. Provoked by coughing/ position change
Detrusor leak point pressure- the intravesicular pressure at which leakage occurs due to a detrusor contraction in the absence of increased abdo pressure. Provoked by running water/ visual cues.
A low abdo leak point pressure (<60) can be associated with intrinsic sphincter deficiency
Videocystourethrography
Combines cystometry with contrast as filling fluid, with radiological assessment of the bladder and urethra
Anatomical and functional features can be reviewed simultaneously.
Use in patients with neuro conditions or suspected bladder neck opening reflux or fistula
Normal post void residual
< 100ml
Intrinsic sphincter deficiency
Urodynamic diagnosis
ALPP < 60 cmH2O
MUCP < 20 cm H2O
