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setting up for urodynamics
Urodynamic studies require specialized equipment setup to accurately measure pressures and flows in the bladder and urethra. The key components include: 1. A uroflowmeter consisting of a base plate, funnel, and processor to measure voiding flow rates. 2. A multichannel urodynamics system using fluid or air-filled catheters placed in the bladder, rectum, and urethra to measure pressures during filling and voiding. 3. Electromyography electrodes to measure pelvic floor muscle activity. Proper calibration and maintenance of equipment is important for quality results. A private, clean testing environment helps patients relax for representative readings.
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setting up for urodynamics
- 1. URODYNAMICS SETUP Dr MayankMohan Agarwal MS, MRCS(Ed), DNB, MCh (PGI, Chd) VMMF and IAUA Fellowships Uro-Oncology, Urogynecology (MSKCC, NY; UCLA, LA; WFUBMC, NC) Associate Director Urology and Kidney transplant surgery Medanta Awadh Hospital Lucknow
- 2. Introduction • Setup ofuroflometry • Setup of urodynamics • Setup of video
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- 4. UROFLOMETRY • A small‘toilet’ like space or better still an existent toilet • Preferable to keep separate and independent from UDS machine • Keep it clean – else a source of infection • Dedicated Sanitation staff is MUST • Good idea to do a test run first thing in the morning • Check calibration every now and then • Recommended after every 10 flows (difficult)
- 5. UROFLOMETRY • A small‘toilet’ like space or better still an existent toilet • Preferable to keep separate and independent from UDS machine • Keep it clean – else a source of infection • Dedicated Sanitation staff is MUST • Good idea to do a test run first thing in the morning • Check calibration every now and then • Recommended after every 10 flows (difficult) POUR 300ML AT ‘PHYSIOLOGICAL SPEEDS’ AND CHECK READING OF THE MACHINE
- 6. PARTS OF UROFLOMETER BASEPLATE / TRANSDUCER BEAKER FUNNEL SEAT • Gravimetric • Rotating disc • Electronic dipstick • Magnetic
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- 8. • Wireless –no cable mess • Record keeping • Post-processing
- 9. ICS quality requirementof uroflometers ICS guidelines on urodynamic equipment performance. Neurourol Urodynam 2014. DOI 10.1002/nau
- 10. For an optimumreport • Educate the patient • No need to over-fill • No need to over-drink • No need to “perform” • Void in “preferred” position • Give privacy and quiet • Always Ask – “was it a representative void?”
- 11. Post-void residual urine •Very important adjunct to a uroflo report • Almost always by ultrasound • Must avoid catheterization as far as possible • Dedicated “bladder scans” available but prohibitively expensive
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- 13. WHAT DO WEWANT TO KNOW • Pressures and sensations in bladder • Pressure – flow relations • Pressure – leak relations • Pressures in urethra • EMG activity • Verify findings with fluoroscopy
- 14. WHAT DO WEWANT TO KNOW • Pressures and sensations in bladder • Pressure – flow relations • Pressure – leak relations Pves = Pdet + Pabd • Pabd = Prectum Pves Pdet Pabd
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- 17. SAVE COST 8-9FR INFANTFEEDING TUBE GLOVE FINGER FOR BALLOON 150CM ARTERIAL LINE
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- 19. WHAT DO WEWANT TO KNOW • Pressures and sensations in bladder • Pressure – flow relations • Pressure – leak relations • Pressures in urethra • EMG activity • Verify findings with fluoroscopy
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- 22. MANUAL PULLER :SAVE COST
- 23. Pves Pura Pclo = Pura- Pves
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- 25. AIR CHARGED CATHETER AIR-CHARGEDBALLOONS
- 26. WHAT DO WEWANT TO KNOW • Pressures and sensations in bladder • Pressure – flow relations • Pressure – leak relations • Pressures in urethra • EMG activity • Verify findings with fluoroscopy
- 27. Electromyography of pelvicfloor • Kinesiologic EMG (frequency and amplitude) • Most accurate for EUS activity – concentric needle electrodes • Painful and difficult to place • Anal sphincter activity ‘generally’ corroborates with EUS • Therefore, perianal surface electrodes are acceptable alternative
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- 30. ICS guidelines onurodynamic equipment performance. Neurourol Urodynam 2014. DOI 10.1002/nau
- 31. CALIBRATION • Check calibrationonce every 10 measurements or so (difficult) • For water filled system – ‘zero’ the transducer raise the catheter ≥ 50cm (by scale) look for pressure change in system
- 32. CALIBRATION • For air-chargedor catheter tip transducer system ‘zero’ the transducer submerge the tripod mounted catheter system into a deep tube fill water to defined height and watch corresponding change in computer
- 33. Set up fora study • Maintain sterility • Maintain privacy • Talk-communicate-talk • Unless the patient is mentally relaxed – the findings can drastically changed
- 34. Place and fixcatheters • Shave genitals and perineum – trimmer / cream • Maintain sterility while placing bladder catheters • Place balloon into rectum NOT in ANUS
- 35. Place and fixcatheters • Shave genitals and perineum – trimmer / cream • Maintain sterility while placing bladder catheters • Place balloon into rectum NOT in ANUS
- 36. Place and fixcatheters • Shave genitals and perineum – trimmer / cream • Maintain sterility while placing bladder catheters • Place balloon into rectum NOT in ANUS • Fix catheters well – as close to meatus as possible
- 37. Place and fixcatheters • Shave genitals and perineum – trimmer / cream • Maintain sterility while placing bladder catheters • Place balloon into rectum NOT in ANUS • Fix catheters well – as close to meatus as possible • If UPP catheter, fix to puller if available
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- 39. • Cough periodically duringthe study • Cough at the end of the study
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- 42. CORRECT POSITIONING OFPATIENT RESPECTIVE TO X RAY BEAMS FOR GOOD VIEW OF OUTLET
- 43. A EXAMPLE OFTHE SAME
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