Urodynamics (eBook)

Paul Abrams is Honorary Secretary of the International Continence Society, consultant urologist and Chairman of Research at the Bristol Urological Institute based at Southmead Hospital in Bristol. He is also the author of several books in the field.

Preface 5
List of Abbreviations 7
Contents 9
Chapter 1 Principles of Urodynamics 11
The Urodynamic History 12
The Urodynamic Physical Examination 13
The Aims of Urodynamics 13
References 16
Chapter 2 Anatomy and Physiology 17
Introduction 17
Urethral Structure and Function 17
Anatomy 17
Innervation of Striated Muscle 20
Normal Urethral Function 22
Detrusor Function 24
Innervation 24
References 25
Chapter 3 Urodynamic Techniques 27
Introduction 27
Principles of Urodynamic Technique 28
Standardisation of Techniques 28
References 29
Uroflowmetry 30
Definitions 30
Urine Flow Clinic 31
Equipment 33
Normal Flow Patterns 34
Abnormal Flow Patterns – Classification and Interpretation 39
Uroflowmetry and the Recording of Residual Urine 46
Indications for Uroflowmetry 46
References 48
Cystometry 49
Introduction 49
Principles of Cystometry 50
Aims of Cystometry 51
Measurement of Pressure 51
Technique of Filling Cystometry 61
Voiding Cystometry 85
References 94
Complex Urodynamic Investigations 98
Videourodynamics 98
Ambulatory Urodynamics (AUDS) 104
Urethral Function Studies 109
Neurophysiological Testing 124
References 124
Chapter 4 Patient Assessment 127
Introduction 127
Frequency-Volume Charts 128
Alterations in Fluid Excretion 130
Psychogenic Voiding Patterns 131
Intravesical Pathology 131
Overactive Bladder and Detrusor Overactivity 133
Bladder Outlet Obstruction 133
Analysis of Symptoms 133
Storage Symptoms 133
Nocturia 135
Urgency 136
Bladder Pain 137
Urinary Incontinence 137
Voiding Symptoms 141
Post-Micturition Symptoms 144
Other Symptoms 145
Bowel Function 147
Medical History 147
Obstetric History 147
Gynaecological History 147
Urological History 148
Surgical History 148
Trauma History 148
Other Significant Conditions 148
Drug Therapy 148
Drugs Enhancing Bladder Emptying 149
Drugs Enhancing Bladder Storage 149
Other Drugs 149
General Patient Assessment 150
Physical Examination 150
Abdominal Examination 150
Examination of the External Genitalia 151
Vaginal Examination 151
Rectal Examination 152
Neurological Examination 152
Investigations 153
Urinalysis 153
Cytology 153
Radiology 154
References 155
Chapter 5 Urodynamics in Clinical Practice 157
Introduction 157
Urodynamics in Children 158
Children with Neurological Disorders 158
Children Born with Non-Neurological Defects 159
Normal Children with Vesico-Urethral Dysfunction 160
Modifications of Urodynamic Technique in Children 161
Indications for Urodynamic Investigation in Children 162
Urodynamics in Women 162
Symptom Presentation in Women 163
Stress Urinary Incontinence 164
The Overactive Bladder 165
“Bladder Hypersensitivity” 166
Painful Bladder Syndrome 166
Mixed Urgency and Stress Incontinence 167
Urinary Infections 168
Urodynamics in Men 169
Detrusor Overactivity 169
Bladder Outlet Obstruction 169
Detrusor Underactivity (DUA) 172
Urodynamics in the Younger Man 173
Postprostatectomy Problems 173
Urodynamics in the Elderly 176
Urodynamics in the Neurological Patient 176
Urodynamic Technique in the Neurogenic Patient 177
References 179
Chapter 6 Management of Lower Urinary Tract Dysfunction 180
Storage Phase Problems 180
Detrusor Overactivity 180
Intravesical Medical Management 182
Neuromodulation 182
Urethral Sphincter Incompetence 183
Management of Intractable Incontinence 188
Other Storage Phase Problems: Nocturia 188
Management of Voiding Problems 189
Bladder Outlet Obstruction 189
Treatment of Detrusor Underactivity 192
Management of Post-Micturition Symptoms 192
References 193
Chapter 7 Organisation of the Urodynamic Unit 194
Patient Referral 194
Making the Patient’s Appointment 195
The Patient’s Hospital Attendance 195
Urodynamic Studies 195
Urine Flow Clinic 196
Planning a New Urodynamic Service 198
The Investigating and Therapeutic Team 203
Summary of Equipment Needs 204
Basic Urodynamics 204
Pressure-Flow Studies 204
Advanced Urodynamics (Additional Requirements) 204
Complex Urodynamics (Additional Requirements) 205
Appendix 1, Part 1 List of ICS Standardisation Committee Reports 1973 to 2002 206
Appendix 1, Part 2 The Standardisation of Terminology of Female Pelvic Organ Prolapse and Pelvic Floor Dysfunction 208
Condensation 209
1. Introduction 209
2. Description of Pelvic Organ Prolapse 209
2.1. Conditions of the Examination 210
2.2. Quantitative Description of Pelvic Organ Position 210
2.3. Ordinal Stages of Pelvic Organ Prolapse 214
3. Ancillary Techniques for Describing Pelvic Organ Prolapse 215
3.1. Supplementary Physical Examination Techniques 215
3.2. Endoscopy 216
3.3. Photography 216
3.4. Imaging Procedures 216
3.5. Surgical Assessment 217
4. Pelvic Floor Muscle Testing 217
4.1. Inspection 218
4.2. Palpation 218
4.3. Electromyography 218
4.4. Pressure Recording 219
5. Description of Functional Symptoms 219
5.1. Urinary Symptoms 219
5.2. Bowel Symptoms 220
5.3. Sexual Symptoms 220
5.4. Other Local Symptoms 220
Acknowledgements 220
References 221
Appendix 1, Part 3 The Standardisation of Terminology of Lower Urinary Tract Function: Pressure-Flow Studies of Voiding, Urethral Resistance and Urethral Obstruction 222
1. Introduction 223
2. Evaluation of Micturition 223
2.1. Pressure-Flow Studies 223
2.2. Urethral Resistance and Bladder Outlet Obstruction 226
2.3. The Detrusor During Micturition 229
3. Additional Symbols 230
References 230
Appendix: ICS Standard for Digital Exchange of Pressure-Flow Study Data 231
A1. Introduction 231
A2. General Description of Signal Storage 231
A3.Variable Values and Types 232
A4. General Structure of File and Records 232
A5. Definitions of Record Types 232
A6. Signals and Information to be Stored: Minimal Specification and Optional Extensions 238
A7. Typical File Structure 239
A8. Acknowledgements 240
A9. Addendum: Signal IDs 240
Appendix 1, Part 4Standardisation of Ambulatory Urodynamic Monitoring 241
1. Introduction 242
2. Indications for AUM 242
3. Terminology 242
3.1. Definitions 242
4. Methodology 243
4.1. Signals 243
4.2. Signal Quality 243
4.3. Intravesical and Abdominal Pressure Measurement 243
4.4. Urethral Pressure and Conductance 245
4.5. Catheter Fixation 245
4.6. Recording of Urinary Leakage 246
4.7. Instructions to the Patient 246
5. Analysis 246
5.1. Quality Assessment 246
5.2. Phase Identification 246
5.3. Events 247
6. Clinical Report 247
7. Scientific Presentation 247
8. Explanatory Examples 248
References 254
Appendix 1, Part 5The Standardisation of Terminology in Lower Urinary Tract Function 255
1. Lower Urinary Tract Symptoms (LUTS) 256
1.1. Storage Symptoms 257
1.2.Voiding Symptoms 258
1.3. Post Micturition Symptoms 258
1.4. Symptoms Associated with Sexual Intercourse 259
1.5. Symptoms Associated with Pelvic Organ Prolapse 259
1.6. Genital and Lower Urinary Tract Pain 259
1.7. Genito-Urinary Pain Syndromes and Symptom Syndromes Suggestive of LUTD 260
2. Signs Suggestive of Lower Urinary Tract Dysfunction (LUTD) 261
2.1. Measuring the Frequency, Severity and Impact of Lower Urinary Tract Symptoms 261
2.2. Physical Examination 262
2.3. Pad Testing 264
3. Urodynamic Observations and Conditions 264
3.1. Urodynamic Techniques 264
3.2. Filling Cystometry 265
3.3. Pressure Flow Studies 269
4. Conditions 272
5. Treatment 272
5.1. Lower Urinary Tract Rehabilitation 273
5.2. Electrical Stimulation 273
5.3. Catheterization 273
5.4.Bladder Reflex Triggering 273
5.5. Bladder Expression 273
References 274
Appendix 1, Part 6Good Urodynamic Practices: Uroflowmetry, Filling Cystometry and Pressure-Flow Studies 276
Introduction 277
Recording Micturitions and Symptoms 277
Uroflowmetry 278
Normal Uroflow 278
Accuracy of Uroflowmeters 279
Problems in Urine Flow Rate Measurement 280
Recommendations for Uroflowmetry 281
Invasive Urodynamics: Filling Cystometry, Pressure-flow Study of Voiding 282
ntroduction 282
Measurement of Urine Flow Rate During Pressure–Flow Studies 287
Measurement of Intravesical and Abdominal Pressure 288
Pressure Transducers 288
Urodynamic Catheters 289
Equipment: Minimum Requirements for Filling Cystometry and Pressure–Flow Studies of Voiding 290
Calibration of Equipment 292
Pressure Signal Quality Control: Qualitative and Quantitative Plausibility 292
Problem Solving 293
Retrospective Artifact Correction 295
Urodynamic Computer Software 295
Strategy for Repetition of Urodynamic Tests 296
Conclusions 296
Acknowledgements 297
References 297
Appendix 1, Part 7 The Standardisation of Terminology in Nocturia: Report from the Standardisation Sub-committee of the International Continence Society 298
1. Introduction 299
2. Clinical Assessment 299
2.1. Nocturia 300
2.2. Night 301
2.3. Screen 301
2.4. Advice 302
2.5. Further Evaluation 302
2.6. Polyuria 302
2.7. Nocturnal Polyuria 302
2.8. Bladder Storage Problems 303
References 304
Appendix 2, Part 1 Frequency-Volume Chart 306
Appendix 2, Part 2 Patient Information Sheet 307
Appendix 3, Part 1 Urodynamics Data Sheet: Full Version 310
Appendix 3, Part 2 Urodynamics Data Sheet: Shortened Version 327
Appendix 4, Part 1 ICIQ Modular Questionnaire 332
Introduction 332
References 338
Appendix 4, Part 2 ICIQ UISF (Urinary Incontinence Short Form) 339
Index 341