Introduction
Urodynamic testing is a diagnostic group of exams studying the function of bladder and urethra during the filling and voiding phases of the micturition circle.
The test can be performed to investigate the origin of one of the following conditions:
- Urinary incontinence;
- Frequency or frequent urination (during the night is called nocturia);
- Urinary urgency (sudden, strong need to urinate);
- Painful urination;
- Difficulty in bladder emptying
- Recurrent urinary tract infections
The main contraindication is the presence of a urinary tract infection at the time of the exam.
Procedures
Urodynamic studies may include some or all of the following tests:
- Uroflowmetry and Post void urinary residual measurement
- Cystomanometry
- Pressure-flow study (voiding cystometry)
- Video-urodynamics
- Electromyography (EMG)
- Urethral pressure profile
The selection of one or more of these tests is made by the treating doctor according to the clinical signs and symptoms of the patient.
Uroflowmetry and Post void urinary residual measurement
Uroflowmetry is a non-invasive test studying the urinary flow during the urination: the patient simply urinates into a special funnel/toilet connected to a uroflowmeter, a device able to record information about urine flow (voided volume, flow time, flow rate over the time). Right after voiding the volume of urine remaining in the bladder is measured by either bladder ultrasonography or drainage by a urethral catheter.
Cystomanometry and Pressure-flow study
The patient is usually seated during the exam. Two thin catheters connected to a special urodynamic device are placed in the bladder and in the rectum with the purpose to measure respectively the vesical pressure (inside the bladder) and abdominal pressure during the micturition.
In the first phase (filling cystometry) of the exam, the bladder is filled with a saline solution through the catheter, simulating a faster physiologic bladder filling, till the patient refers an appropriate desire to urinate. In the second phase (pressure-flow study or voiding cystometry), the doctor asks the patient to urinate sitting or standing up. During the two steps it is possible to analysing the trend of pressures that reflects the functioning of the lower urinary tract.
In selected cases, it is possible to use x-rays and iodine-based radiocontrast agents to take pictures and/or videos during the exam, adding further information (video-urodynamic test). Pregnancy is a contraindication to the use of x-rays.
Electromyography (EMG)
It is the analysis of the electrical activity of the pelvic floor muscles during the filling and voiding phases of a urodynamic study and it is performed using special surface (patch) electrodes. Abnormalities in this test could refer to a nerve and/or muscular damage that affect the micturition.
Urethral pressure profile
It is the study of the urethral pressure along its length usually at rest (not during voiding) with the use of a special urethral catheter.
After the exam the patient may complaint of frequent or burning urination or the presence of blood in the urine that, in most of the cases, are temporary, ending 1-3days after the procedure.
If these symptoms persist or worsen with the onset of fever or the severe difficulty in micturition (e.g. for a urinary tract infection or retention), a medical consultation is recommended in order to start promptly a treatment, when indicated.
What is cystoscopy and why is it done?
Cystoscopy is a medical procedure applied by the urologist for diagnostic reasons and more specifically, for endoscopic examination of the mucosa of the urethra and bladder. The method is carried out using cystoscope, a special tool inserted from the urethra and gradually promoted in the bladder and performed under local anesthesia or mild sedation, depending on the method (flexible or rigid cystoscopy) and the patient’s tolerance. Indications for cystoscopy are the investigation of hematuria, the exclusion of findings such as urolithiasis or bladder tumors as well as the postoperative monitoring of the outcome of an operation.
How is cystoscopy done?
In the case of cystoscopy, the procedure begins as follows: After the doctor cleans well with local antiseptic solution the external genitalia of the man or woman examined, a sterile local anaesthetic fluid such as xylocaine is applied into the urethral lumen. The cystoscope is then inserted into the urethra which is dilated by the simultaneous flow of normal serum allowing the endoscope to enter the bladder. The cystoscope has a special lens that endoscopically records the picture of the area of the urethra and bladder. The method is from completely painless to slightly annoying and after the examination the patient can leave immediately. Usually a dose of prophylactic antibiotic is given during the operation. The results of the cystoscopy come out in real time, i.e. at the time of the examination, and the average duration of a cystoscopy does not exceed 15 minutes. In case of sedation use, the examination is carried out in a clinic and the patient will need to stop eating and taking fluids a few hours before the examination. He will remain in hospital for a few hours for resuscitation and then avoid driving for 24 hours.
Usually, no clinically significant side effects or complications are reported after a cystoscopy. Mild dysuria (pain when urinating) or hematuria (especially in cases of anticoagulant medication) may be observed in the first hours after the examination. Also, as after any endoscopic intervention, the risk of bacterial infection, which is usually prevented by the prophylactic antibiotic administered during the examination, may be increased.
In any case, the attending physician should be informed if anything unusual or a symptom persists more than two days after the examination.
What should you watch out for before and after cystoscopy?
Before the examination the patient must have urinated and cleaned the genital area well. Also, before the appointment is made to the doctor, he must have been informed of the medical history, the reason for the examination and the medication taken. After cystoscopy, fluid consumption should be increased for a few days in order to quicker rinse and clean the lower urinary tract.
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Urodynamic testing is a diagnostic group of exams studying the function of bladder and urethra during the filling and voiding phases of the micturition circle.
The test can be performed to investigate the origin of one of the following conditions:
- Urinary incontinence;
- Frequency or frequent urination (during the night is called nocturia);
- Urinary urgency (sudden, strong need to urinate);
- Painful urination;
- Difficulty in bladder emptying
- Recurrent urinary tract infections
The main contraindication is the presence of a urinary tract infection at the time of the exam.
Procedures
Urodynamic studies may include some or all of the following tests:
- Uroflowmetry and Post void urinary residual measurement
- Cystomanometry
- Pressure-flow study (voiding cystometry)
- Video-urodynamics
- Electromyography (EMG)
- Urethral pressure profile
The selection of one or more of these tests is made by the treating doctor according to the clinical signs and symptoms of the patient.
Uroflowmetry and Post void urinary residual measurement
Uroflowmetry is a non-invasive test studying the urinary flow during the urination: the patient simply urinates into a special funnel/toilet connected to a uroflowmeter, a device able to record information about urine flow (voided volume, flow time, flow rate over the time). Right after voiding the volume of urine remaining in the bladder is measured by either bladder ultrasonography or drainage by a urethral catheter.
Cystomanometry and Pressure-flow study
The patient is usually seated during the exam. Two thin catheters connected to a special urodynamic device are placed in the bladder and in the rectum with the purpose to measure respectively the vesical pressure (inside the bladder) and abdominal pressure during the micturition.
In the first phase (filling cystometry) of the exam, the bladder is filled with a saline solution through the catheter, simulating a faster physiologic bladder filling, till the patient refers an appropriate desire to urinate. In the second phase (pressure-flow study or voiding cystometry), the doctor asks the patient to urinate sitting or standing up. During the two steps it is possible to analysing the trend of pressures that reflects the functioning of the lower urinary tract.
In selected cases, it is possible to use x-rays and iodine-based radiocontrast agents to take pictures and/or videos during the exam, adding further information (video-urodynamic test). Pregnancy is a contraindication to the use of x-rays.
Electromyography (EMG)
It is the analysis of the electrical activity of the pelvic floor muscles during the filling and voiding phases of a urodynamic study and it is performed using special surface (patch) electrodes. Abnormalities in this test could refer to a nerve and/or muscular damage that affect the micturition.
Urethral pressure profile
It is the study of the urethral pressure along its length usually at rest (not during voiding) with the use of a special urethral catheter.
After the exam the patient may complaint of frequent or burning urination or the presence of blood in the urine that, in most of the cases, are temporary, ending 1-3days after the procedure.
If these symptoms persist or worsen with the onset of fever or the severe difficulty in micturition (e.g. for a urinary tract infection or retention), a medical consultation is recommended in order to start promptly a treatment, when indicated.
What is cystoscopy and why is it done?
Cystoscopy is a medical procedure applied by the urologist for diagnostic reasons and more specifically, for endoscopic examination of the mucosa of the urethra and bladder. The method is carried out using cystoscope, a special tool inserted from the urethra and gradually promoted in the bladder and performed under local anesthesia or mild sedation, depending on the method (flexible or rigid cystoscopy) and the patient’s tolerance. Indications for cystoscopy are the investigation of hematuria, the exclusion of findings such as urolithiasis or bladder tumors as well as the postoperative monitoring of the outcome of an operation.
How is cystoscopy done?
In the case of cystoscopy, the procedure begins as follows: After the doctor cleans well with local antiseptic solution the external genitalia of the man or woman examined, a sterile local anaesthetic fluid such as xylocaine is applied into the urethral lumen. The cystoscope is then inserted into the urethra which is dilated by the simultaneous flow of normal serum allowing the endoscope to enter the bladder. The cystoscope has a special lens that endoscopically records the picture of the area of the urethra and bladder. The method is from completely painless to slightly annoying and after the examination the patient can leave immediately. Usually a dose of prophylactic antibiotic is given during the operation. The results of the cystoscopy come out in real time, i.e. at the time of the examination, and the average duration of a cystoscopy does not exceed 15 minutes. In case of sedation use, the examination is carried out in a clinic and the patient will need to stop eating and taking fluids a few hours before the examination. He will remain in hospital for a few hours for resuscitation and then avoid driving for 24 hours.
Usually, no clinically significant side effects or complications are reported after a cystoscopy. Mild dysuria (pain when urinating) or hematuria (especially in cases of anticoagulant medication) may be observed in the first hours after the examination. Also, as after any endoscopic intervention, the risk of bacterial infection, which is usually prevented by the prophylactic antibiotic administered during the examination, may be increased.
In any case, the attending physician should be informed if anything unusual or a symptom persists more than two days after the examination.
What should you watch out for before and after cystoscopy?
Before the examination the patient must have urinated and cleaned the genital area well. Also, before the appointment is made to the doctor, he must have been informed of the medical history, the reason for the examination and the medication taken. After cystoscopy, fluid consumption should be increased for a few days in order to quicker rinse and clean the lower urinary tract.