(Video) urodynamics
The urodynamic examination (bladder pressure measurement) is an important diagnostic method in urology and urogynecology. It provides helpful information about the patient’s urinary tract and is the only method that can objectively assess the function and dysfunction of the lower urinary tract. It is of particular importance in patients with neurogenic detrusor overactivity (NDO), for example. According to the EAU guideline, urodynamics is recommended for all NDO patients at the start of treatment and during treatment. The guidelines also recommend early urodynamic testing (video urodynamics if necessary) and consistent monitoring in children. This examination is also essential for the treatment of bladder dysfunction.
Urodynamics examines bladder activity and the pelvic floor by mimicking the processes of bladder filling and emptying. In the special video variant of urodynamics, brief synchronous X-rays are taken repeatedly to visualize the shape of the bladder and urethra the bladder, urethra and any reflux to the kidney. This examination is particularly useful for suspected neurological disorders of bladder or pelvic floor function.
One of the functions of the urinary tract is to filter the blood in the kidneys and excrete it as urine. Urine flows into the bladder via the ureters. The bladder stores the urine and is emptied voluntarily, completely and promptly, usually at a filling volume of 150-500 ml, without high bladder pressure and without abdominal pressure at the “appropriate place and in an appropriate situation”. In healthy people, this happens about 4-7 times during the day and 0-1 times at night. These processes are controlled by the spinal cord and the brain. However, disturbances can occur at various points between the bladder and the brain. In the case of bladder dysfunction, such as urinary incontinence, the reason for the dysfunction can only be determined by visualizing bladder activity and the pelvic floor using urodynamics.
Urodynamic examination procedure
Preparation: Immediately before the examination, the patient is asked to empty the bladder.
Positioning: In the examination room or X-ray room, the patient must undress “down below” and cover himself with a cloth. The patient then sits on a special examination chair.
Catheterization and electrode placement: A thin catheter is inserted to empty the bladder completely. A very thin measuring catheter is inserted into the bladder and rectum. Adhesive electrodes are attached to the perineum.
Filling phase: Despite the measuring probe being in place, the bladder may empty voluntarily or involuntarily. This state is desired and should not cause any irritation or embarrassment. The bladder is now filled very slowly (with X-ray contrast medium during video urodynamics). In the meantime, the patient is asked to cough, strain or describe the feeling during filling. The patient should also indicate when they feel the first slight urge to urinate or needs to urinate.
Summary
The urodynamic examination is an essential diagnostic method that provides important information about the function and dysfunction of the lower urinary tract. It is necessary for the classification and treatment of bladder dysfunction and according to the guidelines, it is recommended for various patient groups, including children. The examination procedure includes preparation, catheterization, filling and emptying phases, with the patient actively involved in the process. This comprehensive diagnostic investigation can provide a basis for treatment customized to produce a sustained improvement in the patient’s quality of life.