Practical urodynamics What PA s need to know. Gary E. Lemack, MD Professor of Urology and Neurology
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1 Practical urodynamics What PA s need to know Gary E. Lemack, MD Professor of Urology and Neurology
2 Urodynamics essential elements Urethral catheter Fill rate Catheter size Intravesical pressure measurements Rectal catheter or vaginal catheter Intraabdominal pressure measurements EMG monitoring Patch versus needle
3 Pressures determined during urodynamics P vesical P abdominal P detrusor P vesical = P detrusor + P abdominal Only Pves and Pabd measured, Pdet calculated
4 Urodynamics what is learned Capacity total capacity, first sensation Compliance change in vol/change in pres. Contractility Unstable during filling BOO versus hypocontractile during voiding Completeness ie. PVR Communication synergy vs. dyssynergia
5 Urodynamics what is normal First sensation less than 100 cc Compliance ( v/ p) - less than cm water Capacity cc No unstable contractions during filling But what about ambulatory CMG? Voiding Pressure flow: Abrams Griffith, AG Number, Schafer method (linear passive urethral resistance LPURR)
6 Which incontinent women need UDS? (my opinion level 1 evidence lacking) Mixed incontinence Large PVR H/O previous repairs Neurological history Failure to demonstrate incontinence Cystocele (grade 2 or larger) Considering surgical intervention (?)
7 Which men with LUTS need UDS? (my opinion level 1 evidence lacking) History of neurological impairment Patients with LUTS and normal flow (>12) Younger men with severe LUTS Little endoscopic evidence of prostatic occlusion Symptoms are primarily irritative LUTS don t improve following surgery
8 53 year old with incontinence
9 Urge 53 year old female with urgency and frequency
10 Diagnosis: Idiopathic detrusor overactivity Detrusor Overactivity
11 Leak 62 year old female s/p BNS with incontinence
12 VLPP 30 Stable bladder Normal void Diagnosis: ISD
13 Leak Leak 30 year old female leaks with cough
14 Cough Induced DO Valsalva Induced DO Diagnosis: Stress induced overactivity
15 Urge Urge 44 y.o. female with MS
16 Phasic unstable contractions Leak; Urge UI Diagnosis: Neurogenic Detrusor Overactivity
17 32 year old female with T5 SCI, incontinence
18 Unstable contraction Dyssnergic sphincter Diagnosis: NDO with DSD
19
20 No leak 68 year old with vaginal bulge
21 Pressure flow Parameters c/w obstr. Poor emptying Diagnosis: BOO secondary to prolapse
22 Pves Pabd Pdet Flow Void EMG 24 year old neurologically intact female with LUTS
23 Pves Pabd Pdet Flow Void Staccato voiding pattern Abnormal sphincteric activity EMG Diagnosis: dysfunctional voiding, dyssnergia
24 73 year old male with long history of LUTS
25 No detrusor contraction increased vesical pressure due to abdominal strain Low flow interrupted Large capacity Poor emptying Diagnosis: Detrusor areflexia
26 Pves Pabd Pdet Flow Vol. EMG 72 year old male with nocturia
27 Pves Pabd Pdet Flow Strong detrusor contraction Poor flow Vol. EMG Diagnosis: Bladder outlet obstruction
28 52 year old female needs to stand to void following SUI procedure
29 Diagnosis: BOO secondary to obstructing sling Pressure flow c/w obstruction
30 Urge 53 year old with severe urge UI following bone anchored sling
31 Unstable contraction Voluntary sphincteric activity attempting to inhibit void Diagnosis: Obstruction following sling; dec. capacity, DO
32 Leak 54 year old male with SCI, long term indwelling catheter
33 Large increase in detrusor pressure with filling Detrusor leak point pressure 50 cm water Diagnosis: Poorly compliant bladder
34
35
36 Leak 54 year old female with history of XRT for cervical cancer
37 Poor compliance Drop in pressure represents either leak or presence of simultaneous unstable contraction DLPP 85 cm water Diagnosis: Poor compliance with NDO
38 No leak Leak 43 year old nurse with incontinence, what s your recommendation?
39 VLPP 60 (differential) Valsalva voids Is this a contraindication to MUS?
40
41 With Pack Pack Removed
42
43
44
45 Conclusions Urodynamics, though not critically evaluated in multiple areas, often helpful at evaluating complex voiding dysfunction Clearest roles: Neurogenic bladder, LUTS refractory to meds, mixed incontinence
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Ben Herbert Alex Wojtowicz 54 year old female presenting with: Dragging sensation Urinary incontinence Some faecal incontinence HPC Since May 14 had noticed a mass protruding from the vagina when going
Anatomical and Functional Results of Pelvic Organ Prolapse Mesh Repair: A Prospective Study of 105 Cases
International Journal of Clinical Urology 2018; 2(1): 20-24 http://www.sciencepublishinggroup.com/j/ijcu doi: 10.11648/j.ijcu.20180201.14 Anatomical and Functional Results of Pelvic Organ Prolapse Mesh
April Clinical Focus Topic URINARY FREQUENCY
April Clinical Focus Topic URINARY FREQUENCY This month I am focusing on a topic that may seem a little boring. But I would like to look at it from a less common perspective.urinary Frequency and its relationship