Adult Urodynamics Flashcards
What should you do to make the diagnosis of urodynamic stress incontinence?
Clinicians who are making the diagnosis of urodynamic stress incontinence should assess urethral function.
If you are considering invasive therapy in patient with stress urinary incontinence, what basic test should you do in the office?
Surgeons considering invasive therapy in patients with SUI should assess post- void residual (PVR) urine volume.
When is urodynamics indicated for stress incontinence?
Clinicians may perform multi-channel urodynamics in patients with both symptoms and physical findings of stress incontinence who are considering invasive, potentially morbid or irreversible treatments.
If you cannot demonstrate stress incontinence with the urethral catheter in place during urodynamics, what is the next step?
Clinicians should perform repeat stress testing with the urethral catheter removed in patients suspected of having SUI who do not demonstrate this finding with the catheter in place during urodynamic testing.
When should urodynamics be performed in patients with pelvic organ prolapse?
How should this be done?
Clinicians should perform stress testing with reduction of the prolapse in women with high grade pelvic organ prolapse (POP) but without the symptom of SUI.
Multi-channel urodynamics with prolapse reduction may be used to assess for occult stress incontinence and detrusor dysfunction in these women with associated LUTS.
– HIGH GRADE POP without SUI
– REDUCE prolapse
– Look for occult stress incontinence and detrusor dysfunction
What are the indications for urodynamics in patients with OAB?
Clinicians may perform multi-channel filling cystometry when it is important to determine if:
–Altered compliance
–Detrusor overactivity
–Or other urodynamic abnormalities are present (or not) in patients with urgency incontinence in whom invasive, potentially morbid or irreversible treatments are considered.
May perform pressure flow studies (PFS) in patients with urgency incontinence after bladder outlet procedures to evaluate for bladder outlet obstruction.
What are the indications for urodynamics in patients with urge urinary incontinence?
Clinicians may perform multi-channel filling cystometry when it is important to determine if:
–Altered compliance
–Detrusor overactivity
–Or other urodynamic abnormalities are present (or not) in patients with urgency incontinence in whom invasive, potentially morbid or irreversible treatments are considered.
May perform pressure flow studies (PFS) in patients with urgency incontinence after bladder outlet procedures to evaluate for bladder outlet obstruction.
What are the indications for urodynamics in mixed incontinence?
Clinicians may perform multi-channel filling cystometry when it is important to determine if:
–Altered compliance
–Detrusor overactivity
–Or other urodynamic abnormalities are present (or not) in patients with urgency incontinence in whom invasive, potentially morbid or irreversible treatments are considered.
May perform pressure flow studies (PFS) in patients with urgency incontinence after bladder outlet procedures to evaluate for bladder outlet obstruction.
In a patient with clinically suspected detrusor overactivity but no DO on urodynamics, what should the patient be told?
Clinicians should counsel patients with urgency incontinence and mixed incontinence that the absence of detrusor overactivity (DO) on a single urodynamic study does not exclude it as a causative agent for their symptoms.
When evaluating a patient with neurogenic bladder (including spinal cord injury and myelominingocele), what should a clinician obtain?
–PVR
–CMG
–Pressure Flow Analysis
–Videourodynamics (may)
–EMG in combination with CMG with or without PFS
Clinicians should perform PVR assessment, either as part of a complete urodynamic study or separately, during the initial urological evaluation of patients with relevant neurological conditions (e.g., spinal cord injury and myelomeningocele) and as part of ongoing follow-up when appropriate.
Clinicians should perform a complex cystometrogram (CMG) during initial urological evaluation of patients with relevant neurological conditions with or without symptoms and as part of ongoing follow-up when appropriate. In patients with other neurological diseases, physicians may consider CMG as an option in the urological evaluation of patients with LUTS.
Clinicians should perform pressure flow analysis during the initial urological evaluation of patients with relevant neurological conditions with or without symptoms and as part of ongoing follow-up when appropriate, in patients with other neurologic disease and elevated PVR or in patients with persistent symptoms.
When available, clinicians may perform fluoroscopy at the time of urodynamics (videourodynamics) in patients with relevant neurologic disease at risk for neurogenic bladder, in patients with other neurologic disease and elevated PVR or in patients with urinary symptoms.
Clinicians should perform electromyography (EMG) in combination with CMG with or without PFS in patients with relevant neurologic disease at risk for neurogenic bladder, in patients with other neurologic disease and elevated PVR or in patients with urinary symptoms.
Should a physician perform a PVR in patient with LUTS?
Clinicians may perform PVR in patients with LUTS as a safety measure to rule out significant urinary retention
both initially and during follow up.
Should clinicians perform a uroflow in patients with LUTS?
Uroflow may be used by clinicians in the initial and ongoing evaluation of male patients with LUTS when an
abnormality of voiding/emptying is suggested.
Should clinicians perform urodynamics in patients with DO and LUTS?
Clinicians may perform multi-channel filling cystometry when it is important to determine if DO or other abnormalities of bladder filling/urine storage are present in patients with LUTS, particularly when invasive, potentially morbid or irreversible treatments are considered.
Should clinicians perform pressure flow studies in men with LUTS?
Clinicians should perform PFS in men when it is important to determine if urodynamic obstruction is present in men with LUTS, particularly when invasive, potentially morbid or irreversible treatments are considered.
Should clinicians perform pressure flow studies in women?
Clinicians may perform PFS in women when it is important to determine if obstruction is present.
