Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Reporting urodynamics

39 views

Published on

ICS working group published an update on standardised terminology in 2016.

Published in: Health & Medicine
  • DOWNLOAD THAT BOOKS INTO AVAILABLE FORMAT (2019 Update) ......................................................................................................................... ......................................................................................................................... Download Full PDF EBOOK here { http://bit.ly/2m6jJ5M } ......................................................................................................................... Download Full EPUB Ebook here { http://bit.ly/2m6jJ5M } ......................................................................................................................... Download Full doc Ebook here { http://bit.ly/2m6jJ5M } ......................................................................................................................... Download PDF EBOOK here { http://bit.ly/2m6jJ5M } ......................................................................................................................... Download EPUB Ebook here { http://bit.ly/2m6jJ5M } ......................................................................................................................... Download doc Ebook here { http://bit.ly/2m6jJ5M } ......................................................................................................................... ......................................................................................................................... ................................................................................................................................... eBook is an electronic version of a traditional print book that can be read by using a personal computer or by using an eBook reader. (An eBook reader can be a software application for use on a computer such as Microsoft's free Reader application, or a book-sized computer that is used solely as a reading device such as Nuvomedia's Rocket eBook.) Users can purchase an eBook on diskette or CD, but the most popular method of getting an eBook is to purchase a downloadable file of the eBook (or other reading material) from a Web site (such as Barnes and Noble) to be read from the user's computer or reading device. Generally, an eBook can be downloaded in five minutes or less ......................................................................................................................... .............. Browse by Genre Available eBooks .............................................................................................................................. Art, Biography, Business, Chick Lit, Children's, Christian, Classics, Comics, Contemporary, Cookbooks, Manga, Memoir, Music, Mystery, Non Fiction, Paranormal, Philosophy, Poetry, Psychology, Religion, Romance, Science, Science Fiction, Self Help, Suspense, Spirituality, Sports, Thriller, Travel, Young Adult, Crime, Ebooks, Fantasy, Fiction, Graphic Novels, Historical Fiction, History, Horror, Humor And Comedy, ......................................................................................................................... ......................................................................................................................... .....BEST SELLER FOR EBOOK RECOMMEND............................................................. ......................................................................................................................... Blowout: Corrupted Democracy, Rogue State Russia, and the Richest, Most Destructive Industry on Earth,-- The Ride of a Lifetime: Lessons Learned from 15 Years as CEO of the Walt Disney Company,-- Call Sign Chaos: Learning to Lead,-- StrengthsFinder 2.0,-- Stillness Is the Key,-- She Said: Breaking the Sexual Harassment Story That Helped Ignite a Movement,-- Atomic Habits: An Easy & Proven Way to Build Good Habits & Break Bad Ones,-- Everything Is Figureoutable,-- What It Takes: Lessons in the Pursuit of Excellence,-- Rich Dad Poor Dad: What the Rich Teach Their Kids About Money That the Poor and Middle Class Do Not!,-- The Total Money Makeover: Classic Edition: A Proven Plan for Financial Fitness,-- Shut Up and Listen!: Hard Business Truths that Will Help You Succeed, ......................................................................................................................... .........................................................................................................................
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • Be the first to like this

Reporting urodynamics

  1. 1. REPORTING URODYNAMICS Dr Mayank Mohan Agarwal ​MS, MRCS(Ed), ​DNB, MCh (PGI, Chd) ​VMMF and IAUA Fellowships Uro-Oncology, Pelvic Floor Reconstruction (MSKCC, NY; UCLA, LA; WFUBMC, NC)​ Ex-Associate Professor of Urology (PGI, Chd) Consultant and Head of Urology Aster Ramesh Cardiac and Multispecialty Hospitals Guntur (AP), India
  2. 2. INTRODUCTION • Findings in filling phase with physiological correlates • Findings in voiding phase with physiological correlates • Reporting pattern for multichannel urodynamics
  3. 3. Cystometry - setup • Fill rate • Implication – physiological vs supra-physiological (~10% of FBC on FVC or Weight/4) • Position of patient • Sitting / standing / squatting • Size of catheters • The smaller the better for bladder (dual lumen vs 2 IFT) • Type of transducers – water / air-charged / micro-tip • Results may not be comparable – most standardization on water transducers acceptable Rosier et al. Neurourol Urodynam 2016
  4. 4. Cystometry - sensations • Initial resting pressure pves and the pabd pressure at the beginning of the cystometry. • First sensation of filling (FSF) moment when you perceive that your bladder is not empty anymore • First desire to void (FDV) when you have the sensation that normally tells you to go to the toilet, without any hurry, at the next convenient moment • Strong desire to void” (SDV) without any pain or any fear of losing urine, will not postpone the voiding; you will visit the nearest restroom also, for example, while shopping • Urgency – for leak / pain Rosier et al. Neurourol Urodynam 2016
  5. 5. Cystometry - sensations • Initial resting pressure pves and the pabd pressure at the beginning of the cystometry. • First sensation of filling (FSF) moment when you perceive that your bladder is not empty anymore • First desire to void (FDV) when you have the sensation that normally tells you to go to the toilet, without any hurry, at the next convenient moment • Strong desire to void” (SDV) without any pain or any fear of losing urine, will not postpone the voiding; you will visit the nearest restroom also, for example, while shopping • Urgency – for leak / pain SENSATIONS (FSF) 0-------100---------200--------- CAPACITY 0-------200---------600--------- COMPLIANCE 0---------10---------20----------50--------- HYPO HYPERNORMAL LOW HIGHNORMAL V. LOW NORMALLOW HIGH
  6. 6. Cystometry • Bladder –  Over-activity Abrams P. Urodynamics 2006; Agarwal MM. Manual of urodynamics. 2014
  7. 7. Cystometry • Bladder –  Over-activity  Compliance ∆V/∆P In case of reduced compliance – mention flow was stopped for __min and ___drop of pressure was observed / not observed Abrams P. Urodynamics 2006; Agarwal MM. Manual of urodynamics. 2014
  8. 8. Cystometry • Bladder –  Over-activity  Compliance ∆V/∆P • Urethra – ♀ ♂  Resting profile length 30mm 40-50mm  MUCP 40-100 40-120cmH2O Abrams P. Urodynamics 2006
  9. 9. Cystometry • Bladder –  Over-activity  Compliance ∆V/∆P • Urethra –  Resting profile  MUCP • EMG –  Guarding reflex URETHRA BLADDER Abrams P. Urodynamics 2006; Agarwal MM. Manual of urodynamics. 2014
  10. 10. Cystometry • Bladder –  Over-activity  Compliance ∆V/∆P • Urethra –  Resting profile  MUCP • EMG –  Guarding reflex Abrams P. Urodynamics 2006; Agarwal MM. Manual of urodynamics. 2014
  11. 11. Cystometry – leak point pressure • No standard method – report as it was done • Abdominal LPP (Urodynamic stress test) • The provocation method (cough/Valsalva) • Bladder Volume • Detrusor LPP • Detrusor overactivity (DO) • DO associated leak • Cough associated detrusor overactivity Abrams P. Urodynamics 2006; Agarwal MM. Manual of urodynamics. 2014
  12. 12. Cystometry – leak point pressure • No standard method – report as it was done • Abdominal LPP (Urodynamic stress test) • The provocation method (cough/Valsalva) • Bladder Volume • Detrusor LPP • Detrusor overactivity (DO) • DO associated leak • Cough associated detrusor overactivity ALPP 0-------60------------90--------- LOW HIGHborderline DLPP 0---------40--------- SAFE UNSAFE
  13. 13. Pressure-flow study: BNO / prostatic obstruction - - + - + + ++ Abrams P. Urodynamics 2006; Agarwal MM. Manual of urodynamics. 2014
  14. 14. BNO/BPO • Bladder –  Pdet  Qmax  PVR  Bell-shaped curve Pdetmax 72 PdetQmax 62 Qmax 8 Abrams P. Urodynamics 2006; Agarwal MM. Manual of urodynamics. 2014
  15. 15. BNO/BPO • Bladder –  Pdet  Qmax  PVR  Bell shaped curve • Urethra –  Pressure gradient  Starting point Abrams P. Urodynamics 2006; Agarwal MM. Manual of urodynamics. 2014, Jain et al. Urology 2014
  16. 16. • Bladder –  Pdet  Qmax  PVR • Urethra –  Pressure gradient  Starting point • EMG –  Relaxation Batavia et al. J Urol 2011
  17. 17. • Bladder –  Pdet  Qmax  PVR • Urethra –  Pressure gradient  Starting point • EMG –  Relaxation • Pressure-flow relations – Agarwal MM. Manual of urodynamics. 2014
  18. 18. Pressure-flow study: EUSD with DUA - - + - + - + -
  19. 19. EUSD • Plateau pattern • Flow starts at Pdetmax • PdetQmax ≈ Pdetmax Agarwal et al. Ind J Urol 2016
  20. 20. EUSD • Plateau pattern • Flow starts at Pdexmax • PdetQmax ≈ Pdetmax Agarwal et al. Ind J Urol 2016
  21. 21. EUSD • Plateau pattern • Flow starts at Pdexmax • PdetQmax ≈ Pdetmax • Pura gradient at EUS Jain et al. Urology 2014
  22. 22. EUSD • Plateau pattern • Flow starts at Pdexmax • PdetQmax ≈ Pdetmax • Pura gradient at EUS • EMG – • Relaxation with intermittent spikes Batavia et al. J Urol 2011
  23. 23. EUSD • Plateau pattern • Flow starts at Pdexmax • PdetQmax ≈ Pdetmax • Pura gradient at EUS • EMG – • Increased activity Batavia et al. J Urol 2011
  24. 24. Voiding phase: DUA without EUSD
  25. 25. Pressure-flow study • Position of patient • pressure-flow analysis is only validated for voluntarily initiated micturitions and not for incontinence Rosier et al. Neurourol Urodynam 2016
  26. 26. Pressure-flow study • Position of patient • pressure-flow analysis is only validated for voluntarily initiated micturitions and not for incontinence • Comment on type of pressure-flow relation - Normal voiding function: flow rate (and pressure-rise) are within normal limits, begin more or less directly after permission to void and ends with an empty bladder. Rosier et al. Neurourol Urodynam 2016
  27. 27. Pressure-flow study • Position of patient • pressure-flow analysis is only validated for voluntarily initiated micturitions and not for incontinence • Comment on type of pressure-flow relation - Bladder Outflow Obstruction (BOO): ‘high pressure – low flow’ type relation, with / without hesitancy, with / without PVR [needs help from plots, formulae, clinical correlation] Rosier et al. Neurourol Urodynam 2016
  28. 28. Pressure-flow study • Position of patient • pressure-flow analysis is only validated for voluntarily initiated micturitions and not for incontinence • Comment on type of pressure-flow relation Detrusor underactivity (DUA): ‘low pressure – low flow’ relation, unsustained contraction or fading contraction with / without elevated PVR [needs help from plots, formulae, clinical correlation] Rosier et al. Neurourol Urodynam 2016
  29. 29. Pressure-flow study • Position of patient • pressure-flow analysis is only validated for voluntarily initiated micturitions and not for incontinence • Comment on type of pressure-flow relation “Situational inability to void” / “Situational inability to void as usual” when in the opinion of the person performing the test, in communication with the patient, the attempted voiding has been not representative. Rosier et al. Neurourol Urodynam 2016
  30. 30. Graph and plot • “ICS standard urodynamic (time-based) graph” • “ICS standard pressure-flow plot” Rosier et al. Neurourol Urodynam 2016
  31. 31. Graph and plot • “ICS standard urodynamic (time-based) graph” • “ICS standard pressure-flow plot”
  32. 32. Graph and plot • “ICS standard urodynamic (time-based) graph” • “ICS standard pressure-flow plot”
  33. 33. Graph and plot • “ICS standard urodynamic (time-based) graph” • “ICS standard pressure-flow plot” BOOI (pdetQmx –[2xQmx]) 0--------20--------40-------- DCI (pdetQmx + [5xQmx]) 0---------50---------100----------150----- VOIDING EFFICIENCY (%VV/[VV+PVR]) 0----------70----------100 UNOBS. OBS.BORDERL. V. WEAK NORMALWEAK STRONG ABNORMAL ACCEPTABLE
  34. 34. CONCLUSION
  35. 35. THANK YOU

×