Urodynamic Testing: Simple

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Chapter 253 Urodynamic Testing: Simple

DESCRIPTION

Simple urodynamic testing involves measurement of bladder function carried out with the use of simple equipment readily found in the office setting.

INDICATIONS

Urinary incontinence (stress, urge, mixed, overflow). May be used as an adjunct to the evaluation of interstitial cystitis or other urinary complaints.

CONTRAINDICATIONS

Active bladder infection. Known or suspected allergy to cleansing solutions or local anesthetics to be used.

TECHNIQUE

Immediately before the procedure is started, the patient is asked to empty her bladder (in private and in her usual manner). The patient is placed in the dorsal lithotomy position, and the external urinary meatus and surrounding vulvar vestibule are cleansed with antiseptic solution. One to three milliliters of topical anesthetic, such as 2% lidocaine, are introduced into the urethra.

With sterile technique, the patient is catheterized by use of a straight catheter, and any residual urine is caught, measured for volume, and sent for culture (if appropriate). The catheter-tip or irrigation syringe is attached to the catheter to act as a funnel to fill the bladder with sterile water or saline. With the syringe held no more than 15 cm above the level of the symphysis and the catheter pinched off, fluid is poured into the syringe. The fluid is allowed to flow by gravity into the bladder at a rate not to exceed 1 to 3 mL per second. This is often best accomplished in aliquots of 50 mL. The patient is asked to report her first sensation of bladder fullness, and the volume infused at that point is noted. Filling continues in 25-mL aliquots until the patient is unable to tolerate more, and this volume is recorded as the maximal bladder capacity. Any upward movement of the fluid column, intense sensation of urgency, or leakage around the catheter is abnormal, suggests detrusor instability, and should be noted.

For more exact measurements of bladder function, intravenous tubing, a spinal manometer (or limb of extra tubing), and a three-way connector may be connected to form a water-column manometer. In this configuration, filling proceeds as described with the exception that pressure inside the fluid column may be directly monitored, and the presence of bladder contractions may be more easily detected. When this greater degree of accuracy is required, many prefer to proceed to formal urodynamics testing rather than commit to the additional preparation and time necessary to assemble this configuration.

Once the bladder has been filled and bladder compliance has been noted, the catheter is next removed and the patient is asked to cough several times. Urinary leakage at the time of cough should be noted. Leakage that occurs immediately after, is prolonged, or is of large volume suggests detrusor instability.

Filling the bladder with 200 mL of fluid and listening to the patient’s voiding from outside a bathroom door or while the patient voids behind a screen can provide a simple assessment of voiding. The duration of flow may be timed with a stopwatch.

COMPLICATIONS

Urinary tract infection, dysuria, urinary retention.

FOLLOW-UP

Based on indications and findings.

CPT CODE(S)

51725 Simple cystometrogram

51736 Simple uroflowmetry

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