Urodynamics

Preface

List of Abbreviations

Contents

Chapter 1 Principles of Urodynamics

The Urodynamic History

The Urodynamic Physical Examination

The Aims of Urodynamics

References

Chapter 2 Anatomy and Physiology

Introduction

Urethral Structure and Function

Anatomy

Innervation of Striated Muscle

Normal Urethral Function

Detrusor Function

Innervation

References

Chapter 3 Urodynamic Techniques

Introduction

Principles of Urodynamic Technique

Standardisation of Techniques

References

Uroflowmetry

Definitions

Urine Flow Clinic

Equipment

Normal Flow Patterns

Abnormal Flow Patterns – Classification and Interpretation

Uroflowmetry and the Recording of Residual Urine

Indications for Uroflowmetry

References

Cystometry

Introduction

Principles of Cystometry

Aims of Cystometry

Measurement of Pressure

Technique of Filling Cystometry

Voiding Cystometry

References

Complex Urodynamic Investigations

Videourodynamics

Ambulatory Urodynamics (AUDS)

Urethral Function Studies

Neurophysiological Testing

References

Chapter 4 Patient Assessment

Introduction

Frequency-Volume Charts

Alterations in Fluid Excretion

Psychogenic Voiding Patterns

Intravesical Pathology

Overactive Bladder and Detrusor Overactivity

Bladder Outlet Obstruction

Analysis of Symptoms

Storage Symptoms

Nocturia

Urgency

Bladder Pain

Urinary Incontinence

Voiding Symptoms

Post-Micturition Symptoms

Other Symptoms

Bowel Function

Medical History

Obstetric History

Gynaecological History

Urological History

Surgical History

Trauma History

Other Significant Conditions

Drug Therapy

Drugs Enhancing Bladder Emptying

Drugs Enhancing Bladder Storage

Other Drugs

General Patient Assessment

Physical Examination

Abdominal Examination

Examination of the External Genitalia

Vaginal Examination

Rectal Examination

Neurological Examination

Investigations

Urinalysis

Cytology

Radiology

References

Chapter 5 Urodynamics in Clinical Practice

Introduction

Urodynamics in Children

Children with Neurological Disorders

Children Born with Non-Neurological Defects

Normal Children with Vesico-Urethral Dysfunction

Modifications of Urodynamic Technique in Children

Indications for Urodynamic Investigation in Children

Urodynamics in Women

Symptom Presentation in Women

Stress Urinary Incontinence

The Overactive Bladder

“Bladder Hypersensitivity”

Painful Bladder Syndrome

Mixed Urgency and Stress Incontinence

Urinary Infections

Urodynamics in Men

Detrusor Overactivity

Bladder Outlet Obstruction

Detrusor Underactivity (DUA)

Urodynamics in the Younger Man

Postprostatectomy Problems

Urodynamics in the Elderly

Urodynamics in the Neurological Patient

Urodynamic Technique in the Neurogenic Patient

References

Chapter 6 Management of Lower Urinary Tract Dysfunction

Storage Phase Problems

Detrusor Overactivity

Intravesical Medical Management

Neuromodulation

Urethral Sphincter Incompetence

Management of Intractable Incontinence

Other Storage Phase Problems: Nocturia

Management of Voiding Problems

Bladder Outlet Obstruction

Treatment of Detrusor Underactivity

Management of Post-Micturition Symptoms

References

Chapter 7 Organisation of the Urodynamic Unit

Patient Referral

Making the Patient’s Appointment

The Patient’s Hospital Attendance

Urodynamic Studies

Urine Flow Clinic

Planning a New Urodynamic Service

The Investigating and Therapeutic Team

Summary of Equipment Needs

Basic Urodynamics

Pressure-Flow Studies

Advanced Urodynamics (Additional Requirements)

Complex Urodynamics (Additional Requirements)

Appendix 1, Part 1 List of ICS Standardisation Committee Reports 1973 to 2002

Appendix 1, Part 2 The Standardisation of Terminology of Female Pelvic Organ Prolapse and Pelvic Floor Dysfunction

Condensation

1. Introduction

2. Description of Pelvic Organ Prolapse

2.1. Conditions of the Examination

2.2. Quantitative Description of Pelvic Organ Position

2.3. Ordinal Stages of Pelvic Organ Prolapse

3. Ancillary Techniques for Describing Pelvic Organ Prolapse

3.1. Supplementary Physical Examination Techniques

3.2. Endoscopy

3.3. Photography

3.4. Imaging Procedures

3.5. Surgical Assessment

4. Pelvic Floor Muscle Testing

4.1. Inspection

4.2. Palpation

4.3. Electromyography

4.4. Pressure Recording

5. Description of Functional Symptoms

5.1. Urinary Symptoms

5.2. Bowel Symptoms

5.3. Sexual Symptoms

5.4. Other Local Symptoms

Acknowledgements

References

Appendix 1, Part 3 The Standardisation of Terminology of Lower Urinary Tract Function: Pressure-Flow Studies of Voiding, Urethral Resistance and Urethral Obstruction

1. Introduction

2. Evaluation of Micturition

2.1. Pressure-Flow Studies

2.2. Urethral Resistance and Bladder Outlet Obstruction

2.3. The Detrusor During Micturition

3. Additional Symbols

References

Appendix: ICS Standard for Digital Exchange of Pressure-Flow Study Data

A1. Introduction

A2. General Description of Signal Storage

A3.Variable Values and Types

A4. General Structure of File and Records

A5. Definitions of Record Types

A6. Signals and Information to be Stored: Minimal Specification and Optional Extensions

A7. Typical File Structure

A8. Acknowledgements

A9. Addendum: Signal IDs

Appendix 1, Part 4Standardisation of Ambulatory Urodynamic Monitoring

1. Introduction

2. Indications for AUM

3. Terminology

3.1. Definitions

4. Methodology

4.1. Signals

4.2. Signal Quality

4.3. Intravesical and Abdominal Pressure Measurement

4.4. Urethral Pressure and Conductance

4.5. Catheter Fixation

4.6. Recording of Urinary Leakage

4.7. Instructions to the Patient

5. Analysis

5.1. Quality Assessment

5.2. Phase Identification

5.3. Events

6. Clinical Report

7. Scientific Presentation

8. Explanatory Examples

References

Appendix 1, Part 5The Standardisation of Terminology in Lower Urinary Tract Function

1. Lower Urinary Tract Symptoms (LUTS)

1.1. Storage Symptoms

1.2.Voiding Symptoms

1.3. Post Micturition Symptoms

1.4. Symptoms Associated with Sexual Intercourse

1.5. Symptoms Associated with Pelvic Organ Prolapse

1.6. Genital and Lower Urinary Tract Pain

1.7. Genito-Urinary Pain Syndromes and Symptom Syndromes Suggestive of LUTD

2. Signs Suggestive of Lower Urinary Tract Dysfunction (LUTD)

2.1. Measuring the Frequency, Severity and Impact of Lower Urinary Tract Symptoms

2.2. Physical Examination

2.3. Pad Testing

3. Urodynamic Observations and Conditions

3.1. Urodynamic Techniques

3.2. Filling Cystometry

3.3. Pressure Flow Studies

4. Conditions

5. Treatment

5.1. Lower Urinary Tract Rehabilitation

5.2. Electrical Stimulation

5.3. Catheterization

5.4.Bladder Reflex Triggering

5.5. Bladder Expression

References

Appendix 1, Part 6Good Urodynamic Practices: Uroflowmetry, Filling Cystometry and Pressure-Flow Studies

Introduction

Recording Micturitions and Symptoms

Uroflowmetry

Normal Uroflow

Accuracy of Uroflowmeters

Problems in Urine Flow Rate Measurement

Recommendations for Uroflowmetry

Invasive Urodynamics: Filling Cystometry, Pressure-flow Study of Voiding

ntroduction

Measurement of Urine Flow Rate During Pressure–Flow Studies

Measurement of Intravesical and Abdominal Pressure

Pressure Transducers

Urodynamic Catheters

Equipment: Minimum Requirements for Filling Cystometry and Pressure–Flow Studies of Voiding

Calibration of Equipment

Pressure Signal Quality Control: Qualitative and Quantitative Plausibility

Problem Solving

Retrospective Artifact Correction

Urodynamic Computer Software

Strategy for Repetition of Urodynamic Tests

Conclusions

Acknowledgements

References

Appendix 1, Part 7 The Standardisation of Terminology in Nocturia: Report from the Standardisation Sub-committee of the International Continence Society

1. Introduction

2. Clinical Assessment

2.1. Nocturia

2.2. Night

2.3. Screen

2.4. Advice

2.5. Further Evaluation

2.6. Polyuria

2.7. Nocturnal Polyuria

2.8. Bladder Storage Problems

References

Appendix 2, Part 1 Frequency-Volume Chart

Appendix 2, Part 2 Patient Information Sheet

Appendix 3, Part 1 Urodynamics Data Sheet: Full Version

Appendix 3, Part 2 Urodynamics Data Sheet: Shortened Version

Appendix 4, Part 1 ICIQ Modular Questionnaire

Introduction

References

Appendix 4, Part 2 ICIQ UISF (Urinary Incontinence Short Form)

Index