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Urodynamic Tests (urodynamic + test)
Selected AbstractsIncreased postvoid residual volume after measuring the isovolumetric bladder pressure using the noninvasive condom catheter methodBJU INTERNATIONAL, Issue 6 2007Sandra De Zeeuw The papers in this section cover a variety of topics, from urodynamics using a noninvasive method, the morbidity associated with long-term urinary catheters and attempts being made to lower this, the use of botulinum toxin in refractory idiopathic detrusor overactivity, and finally, a study into the effect of chronic prostatitis-like symptoms on the quality of life in a relatively large patient sample. OBJECTIVE To test, in an ongoing noninvasive longitudinal study in healthy men, whether the condom catheter method (a noninvasive urodynamic test to assess bladder function and bladder outlet obstruction) inhibits bladder function and whether this affects the reliability of the measured isovolumetric bladder pressure (Pves.iso). SUBJECTS AND METHODS Subjects (754, aged 40,79 years) voided three times, i.e. one free void and two condom measurements. The postvoid residual volume (PVR) was measured after each void using transabdominal ultrasonography. The statistical significance of differences was tested using Wilcoxon rank test and the Mann,Whitney U -test. RESULTS After free voiding the median (interquartile range) PVR was 18 (37) mL, and independent of the amount of fluid intake. In a subgroup of volunteers, when the free void was done last, the PVR was no different (P = 0.25), suggesting that the bladder did not become exhausted during the protocol. The PVR after two subsequent condom measurements was significantly higher than after free voiding, at 45 (78) and 57 (88) (both P < 0.05), independent of the number of interruptions in voiding. After supplementary fluid intake before the condom measurements, the PVR was double that with a normal fluid intake (P = 0.03). The median Pves.iso was 3 cmH2O higher in the second condom measurement than in the first (P < 0.05), although this small difference was not clinically relevant. CONCLUSIONS The condom measurement is associated with a significantly higher PVR, partly caused by supplementary fluid intake. This effect was only temporary and did not affect the measured Pves.iso. [source] The influence of bladder filling on anorectal functionCOLORECTAL DISEASE, Issue 3 2003J. J. Crosbie Abstract Objective The aim of this study was to develop a technique to simultaneously evaluate bladder and anorectal function. In particular, this study was designed to determine if anal sphincter resting pressure, anal sphincter squeeze pressure and rectal sensation change with bladder filling. Patient and methods A pilot study of ten female patients who presented to the pelvic physiology unit for assessment of urinary symptoms was performed. All patients completed a symptom questionnaire and quality of life assessment form. Following informed consent a baseline urodynamic test was performed with the bladder empty and subsequently followed by an anorectal manometric test. Changes in anal sphincter resting pressure, squeeze pressure and rectal pressure were recorded over a ten-minute period. With the patient lying in the left lateral position, the bladder was then filled with isotonic saline at room temperature at a constant rate of 30ml/min. A continuous assessment of changes in anal sphincter resting pressure during bladder filling was made. Anal sphincter squeeze pressure and rectal sensation were measured at fixed intervals during bladder filling (50, 100, 150 ml etc.) and at fixed intervals relative to bladder capacity (25, 50, 75 and 100% capacity) by stopping bladder filling at the appropriate level. Results , There was no significant change in anal sphincter resting pressure (Mean difference(s.d.) between bladder full and empty = 2.7(5.6) P = 0.92*), squeeze pressure (Mean(s.d.) difference = 9.5(26.3) P = 0.86*) and rectal sensation (Mean difference(s.d.) first sensation 10(15.2) P = 0.958; Mean difference(s.d.) urgency = 10(17.8) P = 0.07*) on bladder filling. Conclusion , Under normal physiological circumstances, bladder filling does not influence anorectal function. *Stastistical analysis: Wilcoxon signed rank sum test. P < 0.05 considered significant. Units = mmHg [source] Clinical, urodynamic and endoscopic characteristics of the Stanford pouch ileal neobladder constructed with absorbable staplesINTERNATIONAL JOURNAL OF UROLOGY, Issue 12 2000M Cemil Uygur Abstract Purpose The clinical, urodynamic and endoscopic aspects of the Stanford pouch ileal neobladder formed with absorbable staples were investigated. Methods A Stanford pouch ileal neobladder was formed using absorbable staples after radical cystoprostatectomy in 30 male patients with the diagnosis of muscle invasive carcinoma of the bladder between 1995 and 1998. The mean age of the patients was 62 (range 41,70) years. Patients were followed with arterial blood gas, serum biochemistry, pouch cystography, urodynamic tests and endoscopy. Results Five (16.7%) patients had early postoperative complications and three were related to the neobladder. One year postoperatively, low grade (I, II) vesicoureteral reflux was present in five (16.7%) cases. The mean preoperative and 6 months postoperative serum creatinine levels were 1.07 ± 0.3 mg/dL and 1.2 ± 0.4 mg/dL, respectively, but the difference was not statistically significant (P = 0.1). Six months postoperatively the mean serum chloride level was 109 ± 4.5 (range 100,113) mmol/L and the mean arterial blood pH was 7.37 ± 0.2 (range 7.3,7.4). Two (6.7%) patients required oral alkaline supplementation because of high chloride levels. All the patients except one were continent throughout the day after 1 year. However, nocturnal enuresis was present in 25 (83.3%) cases. The pouch capacity was increased gradually up to 12 months postoperatively and the mean pouch capacity 12 months postoperatively was 460 ± 95.8 mL. Micturition occurred spontaneously in most patients while some needed abdominal straining. None of the patients had a residual urine of more than 60 mL. The mean maximum flow rate 6 months postoperatively was 9.8 (range 5.4,15.0) mL/s. After 6 months the stapled edge was noticed as a nodular line. One year postoperatively only a white scar could be observed at the suture line. Conclusion The Stanford pouch ileal neobladder constructed using absorbable staples was able to provide a good capacity,low pressure reservoir with a low rate of complications. [source] Reproducibility of same session repeated cystometry and pressure-flow studies in women with symptoms of urinary incontinence,,NEUROUROLOGY AND URODYNAMICS, Issue 3 2010Suzan R. Broekhuis Abstract Aim The aim of this study was to determine the reproducibility of same session repeated urodynamic measurements in women with symptoms of urinary incontinence. Methods Women presenting with symptoms of urinary incontinence underwent standardized urodynamic examination, which consisted of free uroflowmetry and two filling cystometries and pressure-flow studies. Intra-class Correlation Coefficient (ICC) and McNemar tests were used to describe the same session reproducibility. Results Two evaluable urodynamic tests were available in 152 patients. Overall, reproducibility of the urodynamic parameters were good to excellent (ICC range: 0.72,0.93), except for the bladder volume at first sensation of bladder filling (ICC,=,0.46) and the maximum Watt's factor (ICC,=,0.68). The bladder volume at first sensation and the maximum cystometric capacity were systematically higher in the second run (mean difference (95% CI),=,,45 (,73; ,37) and ,3 (,15; 10), respectively). Reproducibility of the diagnosis stress urinary incontinence and/or detrusor overactivity were good to excellent (median ICC,=,0.76, P,=,0.68 and P,=,1.00, respectively). Reproducibility of the volume and amplitude at involuntary detrusor contractions, however, were only poor (ICC,=,0.18 and 0.25, respectively). Conclusions The reproducibility of same session repeated urodynamic measurements in women with symptoms of urinary incontinence was good to excellent. Our results provide the scientific support for guidelines that recommend the omission of repeated filling cystometries and pressure-flow studies in cases where the first test confirms the pathology expected. Neurourol. Urodynam. 29:428,431, 2010. © 2009 Wiley-Liss, Inc. [source] Quality control in urodynamics: a review of urodynamic traces from one centreBJU INTERNATIONAL, Issue 3 2003J. Sullivan OBJECTIVE To investigate quality control in our unit and to enable other units to compare their results, as experience from central reviews of urodynamic traces for multicentre trials has suggested that poor quality control is common. PATIENTS AND METHODS All consecutive male urodynamic tests conducted over 1 year were reviewed. A list of criteria to assess the quality of the records was devised, based upon International Continence Society guidelines on ,good urodynamic practice', and on other sources. Eligible traces were analysed for aspects of quality control, e.g. baseline pressures and coughs to test pressure transmission. The data were analysed to establish how often quality criteria were met, and identify areas for improvement. RESULTS In 100 eligible traces, the baseline detrusor pressure was 0,10 cmH2O in 86, and , 5 to +10 cmH2O in 94%. Baseline intravesical and abdominal pressure were 30,50 cmH2O in 68% and 73% of cases, respectively. Coughs were present before filling in 94%, during filling in 95%, before voiding in 72% and after voiding in 87% of cases. The cough-test frequency was sufficient in 30% of traces. In 11 the intravesical pressure line fell out during voiding. CONCLUSION Most of the traces assessed met the quality criteria defined, but significant defects were not uncommon. Some of the problems identified suggest areas of urodynamic technique which should be studied in more detail. We intend to modify our quality control practices, and hope to show an improvement on re-audit. We hope that other urodynamic departments will be encouraged to review their practice, and we aim to improve our results. [source] | ||||||||||