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Key Components in Urodynamic Testing of Overactive Bladder

  • - Female Urology & Urogynecology - Urodynamic Assessment of Overactive Bladder
  • Jul 09, 2010
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Tags: | bladder dysfunction | cystourethrography | external sphincter dyssynergia | lower urinary tract |

After the decision is made to proceed with urodynamic testing, the next consideration is the type of testing to be conducted. Most current urodynamic machines offer only multiple-channel testing because single-channel testing is prone to considerable artifacts.

In general, because it is difficult to predict for the presence of specific voiding dysfunction in women based on urinary symptoms alone (9), it is good urodynamic practice always to perform a pressure flow study at the end of filling to assess for voiding disturbance. Although controversial, the use of patch or needle electromyographic perineal electrodes can assess for lack of pelvic floor relaxation or external sphincter dyssynergia in patients at risk. 

The addition of simultaneous cystourethrography (videourodynamics), although clearly not always mandated, does allow further evaluation of the outlet during voiding,  which can aid in determining the level of obstruction and evaluating the bladder for foreign bodies, vesicoureteral reflux, and diverticula. Although it may not be universally available, the addition of imaging of the lower urinary tract during urodynamic testing may be most useful when evaluating patients with known neurological conditions, young men with severe LUTS, and women with possible pelvic floor dysfunction.

Typically, a 6- or 7-French dual-lumen urethral urodynamic catheter is used, along with either a rectal or vaginal catheter to assess extravesical pressure fluctuations.

Patients are typically standing for the study, particularly if they are also complaining of stress incontinence, or they sit in a urodynamics chair. 

Urodynamic Assessment of Overactive Bladder

Urodynamic Assessment of Overactive Bladder

Fluid (room temperature sterile water or radiographic contrast) is instilled at 25–100 mL/min, keeping in mind that OAB contractions can be elicited by more rapid rates of filling, by utilizing a cold filling solution, and by performing certain provocative maneuvers during filling (such as heel bouncing). The threshold volume for OAB contractions should be noted in addition to the amplitude of the overactive contraction because there are some data to suggest that the severity of the contraction may correlate with the nature of the disease process responsible for detrusor overactivity (DO) (13).

Many patients will attempt to suppress leakage that may accompany the contraction, and if leakage still ensues, it should be recorded, as should the maximum bladder capacity. Compliance should also be assessed because altered compliance may be responsible for upper tract deterioration, particularly in neuropathic bladders. Although widely accepted cutoff values for outlet obstruction in women are still lacking, a number of strategies have been proposed (14–16), and a properly conducted voiding study (adjust transducers as the patient sits to void) is imperative after the conclusion of filling.

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Gary E. Lemack, MD
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REFERENCES

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  7. De Muylder X, Clae H, Neven P, De Jaegher K. Usefulness of urodynamic investigation in female incontinence. Eur J Obstet Gynecol Reprod Biol 1992;44:205-208.
  8. Colli E, Artibani W, Goka J, Parazzini F, Wein A. Are urodynamic tests useful tools for the initial conservative management of non-neurogenic urinary incontinence? A review of the literature. Eur Urol 2003;43:63-69.
  9. Lemack GE, Zimmern PE. Predictability of urodynamic findings based on the Urogenital Distress Inventory Questionnaire. Urology 1999;54:461-466.
  10. Giannitsas K, Perimenis P, Athanasopoulos A, Gyftopoulos K, Nikiforidis G, Barbalias G. Comparison of the efficacy of tolterodine and oxybutynin in different severity grades of idiopathic detrusor overactivity. Eur Urol 2004;46:776-783.
  11. Wagg A, Bayliss M, Ingham NJ, Arnold K, Malone-Lee J. Urodynamic variables cannot be used to classify the severity of detrusor instability. BJU 1998;82:499-502.
  12. Holtedahl K, Verelst M, Schiefloe A, Hunskaar S. Usefulness of urodynamic examination in female urinary incontinence—lessons from a population-based, randomized, controlled study of conservative treatment. Scand J Urol Nephrol 2000;34:169-174.
  13. Lemack GE, Zimmern PE, Frohman E, Hawker K, Ramnarayan P. Urodynamic distinctions between idiopathic detrusor overactivity and detrusor overactivity secondary to multiple sclerosis. Urology 2006; 67:960-964.
  14. Lemack GE, Zimmern PE. Pressure flow analysis may aid in identifying women with outflow obstruction. J Urol 2000;163:1823-1828.
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  17. Defreitas GA, Lemack GE, Zimmern PE, Roehrborn CG, Dewey RB. A urodynamic comparison of patients with Parkinson's disease and males with lower urinary tract symptoms: distinguishing neurogenic from non-neurogenic detrusor overactivity. J Urol 2003;169:1506-1509.
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  21. Kirby RS, Fowler CJ, Gosling J, et al. Urethro-vesical dysfunction in progressive autonomic failure in multiple systems atrophy. J Neurol Neurosurg Psychiatry 1986;49:554-562.

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