Cystometry and uroflowmetry
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Cystometry and uroflowmetry
- 6. FD = First Desire toVoid, ND = Normal desire to void, SD = Strong desire to void, U = Urgency, L = leakage, MCC = Maximum Cystometric Capacity.
- 9. Normal measurements: • Volume greater than 200 mL over 15 to 30 seconds • Maximum flow rate greater than 15 mL/sec • Continuous single curve (as opposed to short spikes) of flow
Notes de l'éditeur
- Urodynamic stress incontinence: insufficient strength of the pelvic floor muscles to prevent the passage of urine, especially during activities that increase intra-abdominal pressure, such as coughing, sneezing, or bearing down. (around 50% of all patients). Common causes are trauma and stretching during vaginal delivery, hysterectomy, menopause causing hormonal changes, pelvic denervation. It can also be caused by intrinsic sphincter dysfunction due to multiple previous operation, trauma, radiation and atrophic changes due to lack of estrogen Urge incontinence: involuntary loss of urine occurring for no apparent reason while suddenly feeling the need or urge to urinate, can be due to primary causes (detrusor hyperactivity) or secondary causes that leads to irritation of the bladder wall (e.g. UTI) – among 20% of all patients Mixed = ~30% Overflow incontinence: Patient doesn’t have the urge of urination but the urine flows out involuntarilty – causes include obstructive uropathies and DM causing neuropathy to the bladder – more common in men due to more diversity of causes of obstruction, comparatively less common in female
- Stress urinary incontinence is characterized by leakage that occurs with an increase in abdominal pressure, such as coughing or Valsalva, without a rise in true detrusor pressure.
- International continence society (ICS definitions) First desire to void – The patient would like to pass urine at the next convenient moment, but voiding can be delayed if necessary ●Strong desire to void – A persistent desire to void, but without fear of leakage ●Urgency – a sudden compelling desire to void ●Maximum cystometric capacity – The patient feels she can no longer delay micturition Detrusor overactivity (overactive bladder) can be diagnosed if there is urgency or leakage with a detrusor contraction that the patient cannot suppress. The involuntary detrusor contractions during the filling phase may be spontaneous or provoked by maneuvers such as posture change from prone to standing, toe raises, running water, or hand washing. In women with neurologic disease, uninhibited detrusor contractions are termed neurogenic detrusor overactivity. When there is no defined cause, detrusor overactivity is labeled as “idiopathic.” ●Phasic detrusor overactivity – A characteristic wave form which may or may not lead to urinary incontinence ●Terminal detrusor overactivity – A single, involuntary detrusor contraction, occurring at cystometric capacity, which cannot be suppressed and results in incontinence usually with bladder emptying (voiding) ●Detrusor overactivity incontinence – Incontinence due to an involuntary detrusor contraction
- Ensure patient is not stressed by: Explain the simple nature of the test to patient to let them have a normal urge to urinate Should be allowed to void in private – avoid tension to the patient Ask the patient is the test results are representative – if not, test should be repeated ●Frequency, urgency, and urgency incontinence as some of these patients have outlet obstruction. ●Voiding difficulty, hesitancy, or difficulty maintaining the urine stream, which can also be due to outlet obstruction (from previous pelvic surgery or urethral kinking with anterior vaginal wall prolapse) or weak detrusor (as in neurologic diseases). ●Planned pelvic surgery because poor uroflow may be a predictor of postoperative voiding difficulty after incontinence surgery or radical pelvic surgery.
- Flow rates less than 15 mL/sec may indicate outlet obstruction, detrusor weakness, or significant Valsalva effort during voiding. An acontractile detrusor is unable to initiate a contraction and will lead to overflow incontinence.
- Urinary diary - a record of volume and frequency of fluid intake and voiding over one to seven days Perineal pad test: to quantify leakage over a 1- to 24-hour period by measuring changes in pad weight Residual urine: important in all incontinent women and distinguish between true incontinence (<50mL) and overflow incontinence (>100mL) – done by ultrasound or straight catheterization Cystoscopy to rule out any organic lesions inside the bladder – do when suspicious