Presentation given at MAMC surgery update 2018, Delhi for PG students

1. Dr Santosh Agrawal
Chief Urologist and Transplant Surgeon
Bansal hospital, Bhopal, MP

2. Uro + Dynamics

7. LUTS ( lower urinary tract
symptoms)
 Storage (irritative)
symptoms
 Frequency
 Urgency
 Urge incontinence
 Nocturia
 Voiding (obstructive)
symptoms
 Poor stream
 Intermittency
 Straining
 Feeling of incomplete
evacuation

8. LUTS
 Failure of storage
1. Non compliant
bladder/unstable
bladder
2. Weakness of outlet
 Failure to void
1. Bladder weakness
2. Outlet obstruction

9. COMMON INDICATION OF
URO-DYNAMICS
1. Young male patient with LUTS not responding to
medical treatment.
2. BPH patients with history of prolonged diabetes
mellitus and suspected diabetic cystopathy.
3. BPH patients with history of neurologic illness eg.
parkinsonism, cerebro vascular accident etc
4. Female patients with confusing mix of stress and
urge incontinence to guide appropriate therapy.
5. Children with spinal dysraphism.
6. Neurogenic bladder dysfunction to guide
appropriate therapy

10. COMPONENT OF
URODYNAMIC STUDY
1. Uro flowmetry
2. PVR (post void residual urine) assessment
3. Cystometrography ( CMG)
4. Pressure flow study
5. Electrometrography (EMG)
 Urethral pressure profile
 Video urodynamic study

11. Uro flowmetry
 Measurement of
urine flow rate
overtime.
1. Voided volume
2. Maximum flow rate
3. Average flow rate
4. Flow time
5. Time to maximum
flow

13. Cystometrography
 Double lumen catheter in put per-urethrally
for bladder filling and vesicle pressure
measurement
 Rectal balloon catheter is put in the rectum
for intrabdominal pressure measurement.
 Bladder is filled slowely by filling cathetar
and change in intravesical pressure with
bladder filling is plotted on computer
screen.
 Detrussor pressure Pdet = Pves- Pabd

16. Electromyography ( EMG)
 Measurement of electronic potential of
striated sphincter muscle during bladder
filling and bladder emptying.
 It is measured by electrode placed on
muscle (surface electrode) or insrted in
the sphicter muscle (needle electrode).

17. URODYNAMIC EQUIPMENT
AND SET UP
1. Urodynamic table /couch
2. Cathetars (double lumen cathetar for bladder
filling/ intravesical presuure measurement and
rectal balloon cathetar for intra abdominal
pressure measurement)
3. Pressure transducers and EMG electrodes
4. Uro flowmeter
5. Display monitor and printer
6. Computer software programme installed on
PC– for secure storage of pressure and fow
measurement data

21. PREREQUISITE FOR
URODYNAMIC STUDY
 Uro-dynamic question – one should
have specific question in mind which
urologist want to know in that particular
patient.
 Urine culture should be sterile.
 Severe constipation should be treated.

23. Procedure

24. Filling phase results - CMG
 First desire
 Normal desire
 Strong desire
 Urgency
 Maximum cystometric capacity
 Urine leakage
 Compliance = P/V
 End filling detrussor pressure

26. Voiding phase results - PFS
 Peak flow rate
 Pdet at Q max
 Maximum detrussor pressor
 Post void residual urine
 Nomograms - obstrcted/non obstructed

27. Normal curves

30. Urodynamic report
impression Suggestion
 Filling phase results
1. First sensation
2. UDCs
3. Leakage
4. Capacity
5. Compliance
6. End filling pressure
7. DLPP
8. ALPP
 Voiding phase results
1. PFR
2. Pdet Qmax
3. Max Pdet
4. Nomogram

31. Thank you