1. A URODYNAMIC STUDY The Whole Works Wendy McArthur

2. 2 Components Of Test Homework Free Flow Transperineal Scan Peritron Test Cystometry Leak Point Pressure Pressure Flow

3. 3 Urodynamics Examination of the lower urinary tract Test the bladder pressures during filling and emptying Helps determine the cause of bladder symptoms

4. 4 Aim Of Urodynamics To reproduce the symptoms under controlled and measured conditions Need technically reliable measurements Experience so technique is second nature –put patient at ease –reproduce their usual behaviour

5. 5 Homework Uro Kit includes Questionnaire Bladder Diary Pad Test MSU Form

6. 6 Questionnaire Relating to bladder symptoms Relevant medical history Obstetric history Medications

7. 7 Bladder Diary Recordings over 24hours Fluid intake Fluid output Guage output volumes Frequency Nocturia

8. 8 Pad Test Pre weighed pad Drink 1 litre of water Wait 1 hour Do set exercises with pad in pants Remove pad Measure urine Weigh pad when returned

9. 9 Laboratory Tests Mid stream Urine Urine Cytology for pts over 60

10. 10 Free Flow Full bladder Privacy, normal as possible Measures –voiding time –flow rate –time to maximum flow –volume passed

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13. 13 Transperineal Scan Measure descent of bladder neck Push into bottom

14. 14 Peritron Measures strength of pelvic floor muscles Probe in vagina Connect to abdominal pressure line Squeeze and hold - try for 40 seconds Normal strength = 30-40 cm H2O

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16. 16 Cystometogram Recording of bladder pressure as filled Sensory catheter in bladder = Pves Balloon catheter in rectum = Pabd Computer calculation of detrussor pressure Pdet = Pves - Pabd

17. 17 Assessment of Cystometogram Note first sensation in bladder First urge - about 50% capacity Normal desire - able to hold on Strong desire - persistant with no leakage Does the bladder relax and accommodate the fluid Does the detrussor pressure stay even

18. 18 Leak Point Pressure Valsalva movement sitting Full bladder Cough standing Measure leak point pressure

19. 19 Pressure Flow Pressure lines recording Detrussor pressure Abdomonal pressure

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