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Weider's Urology > Urodynamics > Flashcards

Urodynamics Flashcards

(48 cards)

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1
Q

What are the two phases of bladder function?

A

Filling (storage)

Emptying (voiding)

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2
Q

What three things are required for bladder filling?

A

Absence of involuntary contractions
Accommodation
Closed bladder outlet

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3
Q

What are the three components of bladder accommodation?

A 
Compliance
SNS stimulation (reduces detrusor tone)
PNS inhibition (reduces detrusor tone)
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4
Q

What two things are required to keep the bladder outlet closed during the filling stage?

A 
SNS stimulation (increases smooth sphincter tone)
Onuf's nucleus stimulation (increases striated tone)
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5
Q

What 3 factors are required for normal emptying?

A

Absence of obstruction
Open bladder outlet
coordinated detrusor contraction

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6
Q

What two factors are involved in opening the bladder outlet during the emptying phase?

A 
SNS inhibition (decreases smooth sphincter tone)
Onuf's nucleus inhibition (decreases striated tone)
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7
Q

What two factors are involved in coordinated detrusor contraction?

A 
PNS stimulation (Increases detrusor tone)
SNS inhibition (decreases detrusor inhibition)
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8
Q

What are the two major determinants of urine flow rate?

A

Detrusor function

Outlet resistance

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9
Q

What is the guarding reflex?

A

Inhibition of PNS
Stimulation by SNS
Activation of Onuf’s nucleus

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10
Q

What is the voiding reflex?

A

Bladder volume reaches critical level leading to:
Activation of PNS
Inhibition of SNS
Inhibition of Onuf’s nucleus

Can be suppressed and controlled by the cerebral cortex.

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11
Q

What structure allows the CNS to allow voluntary voiding?

A

Barrington’s nucleus in the Pons.

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12
Q

What are the seven components of a urodynamic study?

A 
Cystometry
Uroflowmetry
Pressure flow studies
Electromyography
Urethral pressure profilometry
Cystogram 
Post void residual
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13
Q

What does uroflowmetry measure?

A

Flow rate
voided volume
voiding duration

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14
Q

What is required for an adequate uroflometry study?

A

At least 150ml

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15
Q

What does the graph of a normal flow profile look like?

A

Bell shaped curve

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16
Q

What are the normal peak flow rates for men and women?

A

Men: 20-25 ml/sec
Female: 25-30 ml/sec

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17
Q

What flow rates suggest obstruction?

A

Suspected obstruction: 10-15 ml/sec

Probable obstruction: < 10 ml/sec

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18
Q

What is a normal PVR?

A

< 50-100cc

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19
Q

What does an increased PVR indicate?

A

Bladder outlet obstruction
Decreased detrusor function
Both of the above.

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20
Q

What 5 things does a CMG measure?

Study These Flashcards
A 
Detrusor pressure
Bladder capacity
Bladder compliance
Voluntary sphincter function
Leak point pressure
21
Q

What is a normal bladder compliance?

Study These Flashcards
A

< 6 cm water rise in detrusor pressure with filling

22
Q

What is a normal volume for first sensation of filling?

23
Q

What is a normal volume for sensation of fullness?

24
Q

What is a normal volume for first desire to void?

25
What is volume of imminent void?
Unable to inhibit voiding any longer
26
What else should the patient be asked to do during a cystometrogram?
cough or valsalva
27
What is abdominal leak point pressure/valsalva leak point pressue?
The lowest intravesical pressure at which urine leaks around the catheter with an increase in abdominal pressure but no detrusor contraction.
28
What values are diagnostic for ALPP/VLPP?
ALPP < 60 indicates SUI caused by ISD ALPP 60-100 is indeterminant ALPP > 100 indicates that SUI is not from ISD
29
What is detrusor leak point pressure?
The lowest pressure at which urine leaks around the catheter without detrusor contraction and with no increase in abdominal pressure.
30
What values are important for detrusor leak point pressure?
DLPP > 40cm water can cause ureteral obstruction, hydronephrosis, and renal damage.
31
In what order should the phases of the UDS be read?
1. Filling phase 2. Voiding phase 3. Flow 4. Video cystogram
32
What should be evaluated when reading the filling phase?
``` Compliance Capacity Sensation Detrusor overactivity Urine leak ```
33
What is the equation of bladder capacity in kids?
(Age in years + 2) x 30 = bladder capacity in ml
34
What indicates significant detrusor overactivity?
If they are sensed If they cause leakage If they increase pressure > 15ml of water
35
What should be evaluated in the voiding phase?
``` Max flow Voided volume Max detrusor pressure (Pdet max) PVR EMG ```
36
What is normal Pdet max?
40-60cm water | Less for females
37
What is the impact of a suprapontine lesion on voiding?
Detrusor overactivity Bladder sphincter synergy Normal sensation Adequate emptying
38
What is the impact of a lesion in the pons to the spinal cord above S2?
Detrusor overactivity Spastic sphincter Detrusor sphincter dyssynergia Spastic paresis of lower limbs
39
What is the impact of a lesion from S2-S4?
Acontractile flaccid detrusor Flaccid striated sphincter Flaccid paralysis of the lower limbs
40
What is the impact of a lesion to the peripheral pelvic nerves?
Acontractile detrusor | Absent bladder sensation
41
What are the typical UDS findings of Multiple sclerosis?
Detrusor overactivity
42
What are the typical UDS findings of normal pressure hydrocephalus?
Detrusor overactivity Dementia (wacky) Gait disturbances (wobbly) Urge incontinence (wet)
43
What are the typical UDS findings for stroke patients?
Detrusor overactivity | Synergic sphincter
44
What are the typical UDS findings for Parkinson's disease?
Detrusor overactivity | Usually no DSD but sometimes cogwheeling can cause DSD.
45
What are the typical UDS findings associated with Cauda equina syndrome?
Acontractile detrusor | Flaccid sphincter
46
What are the typical findings for a patient with spinal shock from a suprasacral spinal cord injury?
Acontractile detrusor Increased tone in urethral sphincter and bladder neck Absent bulbocavernosus and deep tendon reflexes
47
How long does spinal shock usually last?
6-12 weeks
48
What are the typical UDS findings for a patient with tethered cord?
Detrusor underactivity

Weider's Urology (2 decks)

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