URODYNAMICS PRES

1. PRINCIPLES OF URODYNAMICS
URODYNAMICS consists of a group of diagnostic
procedures that are performed to evaluate the voiding
and storage functions of the lower urinary tract.
It has two basic aims:
1. To reproduce the patient’s symptoms
2. To provide an explanation of the symptoms

2. MALE LOWER URINARY TRACT
MALE URINARY TRACT
2

3. FEMALE LOWER URINARY TRACT
3

4. BLADDER:
MUSCULAR "SACK" THAT
RELAXES TO ACCOMODATE URINE (FILLING PHASE)
AND CONTRACS TO EXPELL URINE THROUGH THE URETHRA
(VOIDING PHASE)
URETHRA:
TUBE THAT CLOSES TO HOLD URINE IN BLADDER AND OPENS
TO RELEASE URINE (MICTURITION)
PHYSIOLOGY

5. BLADDER has a wall of smooth muscle fibres, called DETRUSOR.
The bladder is capable of accepting large volumes of urine with little
change in intravesical pressure.
The detrusor is the source of mechanical power that pushes urine to flow
through the urethra.
URETHRA, i.e. the outlet of the bladder, is surrounded by muscle
fibres from the wall of the bladder (bladder neck) which form the
INTERNAL SPHINCTER.
Then the urethra passes through the striated muscles of the Pelvic Floor
which form the EXTERNAL SPHINCTER under conscious control.
Normally, continence is obtained by the combined action of the sphincter
and pelvic floor muscle which maintain urethral pressure greater than
vesical pressure unless a detrusor contraction results in voluntary or
involuntary micturition.

6. URODYNAMIC TECHNIQUES
Urodynamic investigations must be carried out in a safe and
scientific manner.
Attention must be paid to :
• Environment, i.e. privacy
• Standardisation of the techniques according to ICS
directives

7. URODYNAMIC MACHINE

8. URODYNAMIC INVESTIGATION
• UROFLOWMETRY
• CYSTOMETRY and PRESSURE FLOW STUDY
( CMG & PFS )
•URETHRAL PRESSURE PROFILE (UPP )
• LEAK POINT PRESSURE (LPP)
Combined investigations:
• ELECTROMYOGRAPHY of the PELVIC FLOOR
•VIDEO URODYNAMICS

9. UROFLOWMETRY
It is performed when the patient arrives at the lab with a full bladder and voids into a
beaker that is placed on a weight transducer , called load cell.
The uroflowmetry is a screening test only. An abnormal UROFLOW indicates a
voiding dysfunction and should be followed by for further testing.
The following parameters must be computed:
•Delay time
•Time to maximum flow
•Maximum Flow Rate
•Volume Voided
•Flow time
•Voiding Time
•Average Flow Rate
Maximum
flow rate
Delay
time
Time to maximum flow

10. Voiding time is defined as the total time from the on-set to the end of
micturition.
Flow time is defined as the total time when urine is actually flowing.
VOIDING TIME and FLOW TIME

11. CYSTOMETRY
It is performed by filling the bladder with saline ( CO2is rarely used )
by means of a peristaltic pump.
The test requires the use either of two catheters or a double-lumen
catheter.
One catheter (or one lumen) is used for filling the bladder and
the other one for recording the vesical pressure.
A water filled balloon catheter is inserted into the rectum in order
to record the abdominal pressure.
By subtracting abdominal pressure from vesical pressure,
the detrusor pressure is calculated.
The detrusor pressure is the expression of the detrusor muscle function.

13. DETRUSOR PRESSURE =
VESICAL PRESSURE – ABDOMINAL PRESSURE

14. CYSTOMETRY is basically performed to evaluate
the COMPLIANCE and STABILITY of the detrusor
muscle.
COMPLIANCE is the capability of the bladder to
accommodate urine inside. It must stretch" to
"normal" capacity while maintaining low pressures.
It is calculated dividing the volume by the pressure.
STABILITY is evaluated by observing the detrusor
while filling the bladder to normal capacity. The
evaluation determines the presence or absence of
DETRUSOR OVERACTIVITY
Cystometry doesn’t give information about outlet
function.

15. PRESSURE FLOW STUDY
PRESSURE FLOW STUDY INVESTIGATES THE VOIDING
PHASE
A PRESSURE FLOW STUDY comprises simultaneous recording of
bladder pressure and urinary flow rate.
It usually includes recording of the abdominal pressure and often also
sphincter EMG.
The study is the golden standard of the urodynamics procedure since
permits a complete evaluation of infravesical obstruction, detrusor
contraction and a wide range of neurogenic bladder dysfunctions.

16. Catheter setting for Cystometry and Pressure Flow study

17. PFS parameters
Qmax
Pdet.Qmax Pdet.max
Pdet.open
Pdet.clos

19. SCHAEFER NOMOGRAM
Q on the y-axis and Pdet on the x-axis
The screen is divided in:
 Seven sectors from left to right, named 0, I, II, ... VI. They show
increasing obstruction degree. On these sectors lies the LinPURR line
that represent the patient’s results.
 Six sectors, from the bottom to the top, marked VW, W-, W+, N-,
N+, ST. They show the detrusor power that can vary from Very Weak
to Strong.
 Three sectors from left to right named Unobstructed, Equivocal e
Obstructed. They give a rough estimate about the presence or absence
of urethral obstructions.

20. URETHRAL PRESSURES PROFILE ( UPP)
It studies the Urethral function i.e. the competence of the urethra to
hold on urine and to let it
pass when required
Two ways to perform UPP
• - Static
• -Dynamic or stress
STATIC UPP
It records the intraluminal pressure along the length of the urethra with
the bladder at rest.
It is performed with a catheter being pulled out at a constant rate by
the mechanical withdrawer

21. UPP SETTING

22. PARAMETERS OF STATIC UPP

23. Maximum urethral pressure
Maximum urethral closure pressure is the
difference between the maximum urethral pressure
and the intravesical pressure
Functional profile length is the length of the urethra
along which the pressure exceeds intravesical
pressure

24. DYNAMIC UPP
It assesses the efficiency of the pressure transmission to
the urethra from the abdominal cavity
A simultaneous measurement of the bladder pressure
and urethral pressure is made by means of a suitable
dual lumen catheter .
This is withdrawn at a slow rate ( 1mm/s) with the patient
coughing at regular interval

26. PARAMETERS OF DYNAMIC UPP
•Trasmission coefficient =
100 x Urethral pressure increment/Bladder pressure
increment
• Pura at the onset of the peak

27. LEAK POINT PRESSURE LPP
LPP is the bladder pressure at which urine leaks from the
bladder.
LPP is done during cystometry and PFS when the bladder is
filled with 250 ml of saline.
The patient is invited to strain slowly and increasingly i.e.
to perform the so called Valsalva maneuver. (VLPP)
Alternately the patient is invited to cough repeatedly . This is
called Cough Leak Point Pressure CLPP
.

28. VIDEO URODYNAMICS
The urodynamic system is connected to a video output of an X-ray unit
or image intensifier and captures images while performing a urodynamic
test
This feature allows the physician to visualize events in the lower urinary
tract along with pressure, flow and EMG data.

30. UROLOGISTS
GYNECOLOGISTS
PEDIATRICIANS (SURGEONS)
REHABILITATION SPECIALISTS
WHO IS INTERESTED IN URODYNAMICS

31. MENFIS’ PRODUCT RANGE
Pico Flow2
FlowZig
Pico Bright
Pico Compact
Pico Smart
Urodynamic catheters and lines

32. PICO FLOW2
• two channels: Uroflow and EMG
• touch screen user interface
•Large display 5” 1/4
• tests stored on a MC
•tests can be reviewed
•Wireless or cabled uroflowmeter

33. FLOWZIG
Wireless trasmission to a PC by
Zig Bee technologies
Stand-alone or combined with
Pico urodyanmic system
Competitive price

34. PICO BRIGHT
• Basic Urodynamic system
• Full range of urodynamic tests (except
Video-urodynamics)
• 15” touch screen user interface
• Up to 8 channels
• Portable
• Designed for small clinics

35. PICO COMPACT
•Entire spectrum of
urodynamic tests
•Modular configuration
•Fully expandable
• 8 pressure channels
•1 uroflow
•2 EMG
•1 volume
• Sampling rate: 50 Hz

36. PICO SMART
Same software with a state of art
Acquisition unit : ACQ3000
• 12 plug-and-play channels
• Sampling rate up to 1KHz per channel
• Wireless link with the PC

37. URODYNAMIC CATHETERS

38. Urodynamic catheters are made by MEDICA on
Menfis design
 Sterile and single use
• Wide range of single , double and triple lumen
catheters.
• Balloon catheter for abdominal pressure measurement.
• Cannula made mainly of PEBAX® .
It is a polyether-amide, biocompatible material with
smooth surface

39. Parameters Materials
Polyu
rethan
es
P.V.C. Silicones PEBAX®
Friction coefficient 1.35 2.0 3.0 0.95
Humidity
absorption
0.9 0.75 0.1 0.5
Max temperature
of sterilization
60 °C 60 °C 120 °C 60 °C
Steam sterilizing NO NO YES NO
Shape memory HIGH HIGH LOW HIGH
Inner diameter /
outer diameter
ratio
LOW LOW VERY
LOW
HIGH

40. SHAPE MEMORY
It is fitted with a stiletto in order to straighten the tip. Then
the catheter is passed transurethrally and the stiletto is
removed .The tip resumes the pigtail shape thus avoiding
expulsion of the catheter.

41. COMPETITORS
ALBYN
ANDROMEDA
LABORIE
LIFE-TECH
MEDIWATCH
MMS

42. ALBYN MEDICAL
http://web.albynmedical.com
•SmartFlow
•Phoenix Plus
•Hermes
•Catheters

43. PHOENIX PLUS
Standard system
• 3way foot pedal

44. HERMES
• New hardware
•Old software
•Fully expandable

45. ANDROMEDA
www.andromeda-ms.de
•CONUS
•ELIPSE
•ELIX
•Catheters

46. ELIPSE
• Small display
• Optional Computer link
• Nice system
•No manometry expansion

47. HELIX
 Small and Compact system
Fixed no of pressure channels
(max 3)
 Optional link with a PC
Very small display
No manometry expansion

48. LABORIE MEDICAL TECHNOLOGY
www.laborie.com
•Urocap III
•Aquarius
•Triton
•Delphis
•Dorado
•Catheters

49. TRITON
•Flexible system
•Many different configurations
• Very aggressive marketing

50. LIFE-TECH
www.life-tech.com
•MICROFLO
• UROLAB SYSTEM V
•Catheters

51. UROLAB
Life-Tech: long experience
•The system takes several
names: Novus, Opus, Primus,
Janus, Maximum
• Reliable system

52. MEDIWATCH
www.mediwatch.com
•Urodyn1000
•Logic G2
•Duet Encompass
•Catheters

53. LOGIC G2
Ex Medtronic , ex Dantec
Dedicated Keyboard
Flowmeter with Spinning disk

54. SPINNING DISK
• A DISK IS KEPT ROTATING AT A CONSTANT SPEED
• THE URINE JET STREAM DECELERATED THE DISK
• A FEEDBACK CONTROL INCREASES THE ENGINE POWER
TO KEEP THE ROTATION CONSTANT
•THE POWER CONSUMPTION IS A FUNCTION OF THE
FLOW RATE
• ADVANTAGE : THE URINE CAN BE DRAINED TO THE
SEWER
•DISADVENTAGE: MORE LIABLE TO TECHNICAL FAILURE

55. Sensicclinic
Ergonomic system
 Full set of Urodynamic tests
Wireless Uroflowmeter
 No Anorectal Manometry

56. MMS - Medical Measurements Systems
www.mmsinternational.com
•Flowmaster
•Flowstar
•Alpha & Alpha Plus
•Solar Blue
•Solar
• Catheters

57. SOLAR
• Fully upgradeable system
•DICOM and HL7
connectivity

58. SOLAR BLUE
 Fully wireless system
Uroflowmeter, PC, puller
linked by Bluetooth
 Portable system
*******
•Only for urodynamics
•No GI manometry
expansion

59. THANK YOU