Outline Of Urodynamic

Nadia gantri

Risk factors of spontaneous preterm births

in Libyan women in Tripoli medical center.

Abstract

Aims

1. Find out relation ship between preterm birth and known risk

factors.

2. To reveal relation ship between pregnancy out come and preterm

births.

Urodynamic is generally defined as all the investigation used by gynaecologist to assess the function of the lower urinary tract.

Initial assessment

All urinary tract assessment must begin with thorough history and examination to ascertain, nature , severity of symptom.

URODYNAMIC MEASUREMENTS

Bladder pressure - storage and voiding

Abdominal pressure

Urethral pressure

Urine flow

Bladder capacity

Volume voided

Residual

FILLING CYSTOMETRY First desire to micturate

Capacity

Detrusor activity

WHEN TO DO A CYSTOSCOPY? Microscopic hematuria

Abnormal cytology

Periurethral abnormality

For reassurance

UROFLOWMETRY

Patient voids into a flow meter Flow rate Volume voided Residual - catheter

- ultrasound

URINE FLOW RATESWOMEN

Under 50 years - 25 ml/sec Over 50 years - 18 ml/sec

Basic tests

Mid stream urine specimen. Urinary diary-is a simple record of

the patients fluid intake and output . It should be complete by all patient for one week.

Flow studies (uroflowmeter).Simple investigation.

Basic tests

Indicated in women with complaints of hesitancy or difficulty in voiding .To evaluate patient before incontinence surgery .Rate of 15 ml/s is normal.Pad test weight of > 1 gram is considered a significant loss.

Basic tests

Cystometry – involve the measurement of the pressure/volume relationship of the bladder during filling and voiding.Simple & accurate investigation.Easy to perform.Take 15-20 minute per patient.

Indication

Multiple symptoms. Voiding disorder. Prior to any bladder neck surgery. Neuropathic bladder disorder.

Intravenous Urography

Neuropathic baldder. Suspected ureterovaginal fistula.

Video Cystourethrography

Radiology screening of the bladder synchronized with pressure study of the bladder ,it is not a routine.

Neuropathic bladder. Post micturation dribble. Suspicion of ureteric reflux.

Ultrasound

Bladder morphology. Residual urine volumes. TV scan help in studying bladder

neck anatomy . Urethral pressure measurement.

Cystourethroscopy

Not a routine.

Indicated in

Reduced bladder capacity. A suspected urethrovaginal or

vesicovaginal fistula. Suspicion of interstitial cystitis. A need to exclude neoplasm

Electromyogarphy (EMG)

To investigate neuropathy & myopathy

Key points

Clinical history is often not a good predictor of urodynamic finding .

Urinary infection must be excluded before any urodynamic study.

Stress incontinence diagnosed on cystometry is a diagnosis of exclusion.

All patient undergoing repeat continence surgery must have urodynamic studies performed.