Springer-Verlag London Ltd.

Transcription

1 Urodynamics

2 Springer-Verlag London Ltd.

3 Paul Abrams Urodynamics Second edition With 145 Figures Including 3 Colour plates, Springer

4 Paul Abrams, MD, FRCS Bristol Urological Institute, Southmead Hospital, Westbury-on-Trym, Bristol BS10 SNB, UK ISBN British Library Cataloguing in Publication Data Abrams, Paul, Urodynamics. - 2nd ed. 1. Urodynamics 1. Title 616.6'2'0754 ISBN Library of Congress Cataloging-in-Publication Data Abrams, Paul, Urodynamics / Paul Abrams. - 2nd ed. p. cm. Includes bibliographical references and index. ISBN ISBN (ebook) DOI / Urodynamics. 1. Title. [DNLM: 1. Urodynamics. 2. Urologic Diseases - diagnosis. A161u 1997] RC901.9.A '07-dc21 DNLM/DLC for Library of Congress WJ CIP Apart from any fair dealing for the purposes of research or private study, or criticism or review, as permitted under the Copyright, Designs and Patents Act 1988, this publication may only be reproduced, stored or transmitted, in any form or by any means, with the prior permission in writing of the publishers, or in the case of reprographic reproduction in accordance with the terms of licences issued by the Copyright Licensing Agency. Enquiries concerning reproduction outside those terms should be sent to the publishers. Springer-Verlag London 1997 OriginaIIy published by Springer-Verlag London Limited in 1997 Softcover reprint of the hardcover 2nd edition 1997 First published 1983 Second edition 1997 The use of registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant laws and regulations and therefore free for general use. Product liability: The publisher can give no guarantee for information about drug dosage and application thereof contained in this book. In every individual case the respective user must check its accuracy by consulting other pharmaceutical literature. Typeset by EXPO Holdings, Malaysia Printed at the University Press, Cambridge 28/ Printed on acid-free paper

5 Preface Lower urinary tract dysfunction produces a huge burden on sufferers in particular and on society in general. Lower urinary tract symptoms have a high prevalence in the community: 5% of children aged 10 wet the bed, while 15% of women and 7% of men have troublesome incontinence; and in elderly men of 75, benign prostatic hyperplasia occurs in more than 80% of individuals, with benign prostatic enlargement coexisting in up to half this group and half of these having bladder outlet obstruction. The confusion felt in many people's minds as to the role of urodynamics has receded for the most part. The need to support the clinical assessment with objective measurement has become accepted by most clinicians specialising in the care of patients with lower urinary tract symptoms (LUTS). Since the first edition of this book in 1983, urodynamics has become more widely accepted. In the last ten years the number of urodynamic units in Britain and Europe has increased rapidly and almost every hospital of any significance embraces urodynamic investigations as an essential part of the diagnostic armamentarium of the urology and gynaecology departments. Further, specialists in geriatrics, paediatrics and neurology recognise the importance of urodynamics in the investigation of a significant minority of their patients. Despite the technological innovations that have seen the introduction of computerised urodynamics, the development of neurophysiological testing and the introduction of new techniques such as ambulatory monitoring, the objectives of this book remain unchanged. Urodynamics may appear complicated, and one of the objectives of this book is to put the subject over simply but in enough detail to allow urodynamic investigation to be accepted, on its own merit, as a fundamental contribution to the management of many patients. To do this means not only describing the tests but also showing in which clinical areas they help management and in which they are pointless. It means concentrating on the common clinical problems and on the presenting symptom complexes, not the diagnosis; and it means pointing out any limitations and possible artifacts of investigation. We hope that a clinician with no previous experience in urodynamics will, after reading this book, appreciate the value and limitations of the subject, and will have obtained the necessary

6 vi Preface practical advice on the use of the appropriate equipment in the correct situations. Because this book is based on personal experience, references in the text are relatively few. Bristol Urological Institute April 1997 Paul Abrams References Brocklehurst JC (1993). Urinary incontinence in the community - analysis of a MORl poll. Br Med J 306: Burgio KL, Matthews KA, Engel BT (1991). Prevalence, incidence and correlates of urinary incontinence in healthy, middle-aged women. J UroI146: O'Brien J, Austin M, Sethi P, O'Boyle P (1991). Urinary incontinence: prevalence, need for treatment, and effectiveness ofintervention by nurse. Br Med J 303: Sandvik H, Hunskaar S, Seim A, Hermstad R, Vanvik A, Bratt H (1993). Validation of a severity index in female urinary incontinence and its implementation in an epidemiological survey. J Epidemiol Community Health 47: Torrens MJ (1974). The control of the hyperactive bladder by selective sacral denervation. ChM Thesis, Bristol University. Turner Warwick R, Milroy E (1979). A reappraisal of the value of routine urological procedures in the assessment of urodynamic function. Urol Clin N Am 6: Whiteside CG (1979). Symptoms of micturition disorders in relation to dynamic function. Urol Clin N Am 6:55-62.

7 Contents List of Abbreviations... ix Chapter 1 Principles ofurodynamics 1 Chapter 2 Anatomy and Physiology 7 Chapter 3 Urodynamic Techniques 17 Chapter 4 Patient Assessment Chapter 5 U rodynamics in Clinical Practice... Chapter 6 Management of Lower Urinary Tract Dysfunction Chapter 7 Organisation of the Urodynamic Unit Appendix 1, Part 1 Urodynamic Equipment: Technical Aspects Appendix 1, Part 2 The Standardisation of Terminology of Lower Urinary Tract Function Appendix 1, Part 3 Lower Urinary Tract Rehabilitation Techniques: Seventh Report on the Standardisation of Terminology of Lower Urinary Tract Function Appendix 1, Part 4 The Standardisation of Terminology of Female Pelvic Organ Prolapse and Pelvic Floor Dysfunction Appendix 1, Part 5 The Standardisation of Terminology and Assessment of Functional Characteristics of Intestinal Urinary Reservoirs Appendix 1, Part 6 The Standardisation of Terminology of Lower Urinary Tract Function: Pressure-Flow Studies of Voiding, Urethral Resistance and Urethral Obstruction

8 viii Contents 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 Drugs Active on the Lower Urinary Tract Index

9 List of Abbreviations AUDS BOO BPE BPH BPO DFV DHR DI DSD DUA GP GSI ICS IDSO ISC LUTD LUTS MUCG MUCP Pabd Pde! pqs Pves PVR Qave Qmax TURP UDS UFS UPP VUDS VUR ambulatory urodynamic studies bladder outlet obstruction benign prostatic enlargement benign prostatic hyperplasia benign prostatic obstruction dysfunctional voiding detrusor hyperreflexia detrusor instability detrusor sphincter dyssynergia detrusor underactivity general practitioner (family physician) genuine stress incontinence International Continence Society isolated distal sphincter obstruction intermittent self-catheterisation lower urinary tract dysfunction lower urinary tract symptoms micturating cystourethrography maximum urethral closure pressure intra-abdominal pressure detrusor pressure pressure-flow studies intravesical pressure post-void residual average flow rate maximum flow rate transurethral resection of the prostate urodynamic studies urine flow studies urethral pressure profile videourodynamic studies vesico-ureteric reflux

10 x List of Abbreviations Measurement Units Quantity volume time flow rate pressure Unit milli1itre (ml) second (s) milli1itres/second (m1!s) centimetres of water (cmh 2 0) Symbol V t Q p Urodynamic Qualifiers Intra vesical (bladder) Intra urethral Detrusor Intra abdominal (usually rectal) ves ura det abd