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. INTRODUCTION
• Findings in filling phase with physiological correlates
• Findings in voiding phase with physiological correlates
• Reporting pattern for multichannel urodynamics
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. 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. 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. Cystometry
• Bladder –
Over-activity
Abrams P. Urodynamics 2006; Agarwal MM. Manual of urodynamics. 2014
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
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. 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. 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. 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. 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. Graph and plot
• “ICS standard urodynamic (time-based) graph”
• “ICS standard pressure-flow plot”
Rosier et al. Neurourol Urodynam 2016
31. Graph and plot
• “ICS standard urodynamic (time-based) graph”
• “ICS standard pressure-flow plot”
32. Graph and plot
• “ICS standard urodynamic (time-based) graph”
• “ICS standard pressure-flow plot”
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