Urinary Incontinence
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Urodynamics
Urodynamics is a group of tests that will enable your physician to obtain objective information relating to complaints of incontinence, urgency, frequency and urinary retention. It may be useful in both men and women. The goal is to recreate the same sensations and voiding pattern that the patient experiences in daily life. In the setting of Urodynamics, however, there are monitoring devices in place that may help to make an accurate diagnosis.
On the day of the procedure, you may partake in your usual diet, and should take all of your medications, unless otherwise advised by your physician.
The Urodynamics study consists of multiple parts. The only real preparation on the part of the patient, is to arrive in the office, with a full bladder, so that a flow study can be done.
The flow study is a simple study that requires the patient to void into a special receptacle that records the voided volume and the time in which it takes for the patient to empty (Qavg and Qmax), as completely as possible.
Once the flow study is completed, the monitoring devices will be placed. These devices include a tiny catheter that is placed into the bladder, through the urethra, as well as small pressure sensing balloon that is placed in the rectum, or the vagina. The catheter allows for measurements of the pressure generated within the bladder (Pves), during the filling as well as the emptying phase of the study. The rectal or vaginal device measures the pressure in the abdomen (Pabd) which may identify individuals who use abdominal straining in order to empty their bladder.
Lastly, 3 sticky EMG (electromyogram) patches will be placed. Two will be placed near the rectum while one will be placed on one upper thigh as a grounding electrode. These recording electrodes will provide information relating to the functionality of the sphincter muscle.
Positioning of the patient for the test is the next step. Depending on the problem to be investigated, the patient will be asked to stand for the study, sit on a special commode, or remain lying on the table either flat, or with his or her feet in the stirrups (lithotomy position).
The test is accomplished by filling the bladder via the small catheter, while measuring activity within the bladder and rectum. At the same time the patient's subjective sense of the process of bladder filling and emptying is also recorded. Typically we will ask you to first to cough, and then to squeeze your sphincter muscle. You will be asked to let us know when you note the first sensation, that the bladder is being filled. At a point in the filling phase we may ask patients to cough hard, or to bear down and strain, so that we can measure the abdominal pressure required to force urine out of the bladder. Next we will ask that you let us know when you have a bad urge to void, and when your bladder is absolutely full. You may then be asked to void again, so that the flow can be measured once more. This generally completes the test.
Finally, depending on the clinical situation, cystoscopy, which is an endoscopic examination of the inside of the bladder may be recommended in order to help your physician identify anatomic issues that relate to the voiding problem.
At the end of the test, you will be advised of the findings. You will also be given an antibiotic pill to help decrease the likelihood infection.
There are no major risks involved in this procedure. Minor risks include infection, discomfort, burning on urination after the procedure and on rare occasions blood in the urine. Once in a while we will encounter difficulty passing the catheter in men, but this is rare.
While we recognize that this is a difficult procedure for many patients, we ask for your patience and cooperation, so that we may be able to help you with your urinary complaints. Your physician will be happy to answer any questions that you may have at the time of the procedure.