Urodynamic evaluation includes:
Non-Invasive Urodynamics
Urodynamics performed without the insertion of catheters, such as uroflowmetry and post-void residual evaluation.
The Urodynamic Study is indicated for patients who experience difficulty urinating, have urinary incontinence that does not respond to initial treatment, frequent urination, sudden urgency to urinate, increased nighttime urination, urinary retention, interrupted, thin, and weak stream, and incomplete bladder emptying. It is also used to characterize urinary dysfunctions in patients with neurological diseases and to evaluate the function of the urinary sphincter.
No special preparation is needed for this study, although it cannot be performed if the patient has an active urinary infection. Additionally, bladder-relaxing medications should be discontinued at least 2 days prior. The Urodynamic Study can be conducted on people of almost any age.
The urodynamic protocol includes, besides anamnesis (history of signs and symptoms), a voiding diary or frequency-volume chart, and urine analysis to screen for infection or hematuria (presence of blood):
Standard Urodynamic Test
Uroflowmetry and post-void residual volume evaluation, with filling cystometry and pressure-flow study (or voiding cystometry);
Supplementary Urodynamic Tests
Supplementation of the standard urodynamic test with electromyography, X-ray or fluoroscopy imaging (video-urodynamics), continuous urethral pressure measurement, and/or profilometry.
A first-line urodynamic test for diagnosing voiding dysfunction, characterized by measuring the urinary flow rate in volume per unit of time (milliliters/second). It also evaluates the maximum flow rate, voided volume, and post-void residual volume, and can also assess flow pattern, flow time, voiding time, and average flow rate.
Invasive Urodynamics
This is performed after uroflowmetry with the placement of an anal probe and urethral catheterization. Following this, if there is clinical suspicion of neurogenic/non-neurogenic voiding dysfunction, pelvic muscle electromyography may be performed.
Finally, the cystometry phase is conducted; first, filling cystometry, followed by voiding cystometry. The filling phase assesses the bladder's and pelvic muscles' capacity to contain urine, while the voiding phase analyzes the urinary flow rate, bladder pressure, pelvic muscle relaxation, and other parameters.
After undergoing a Urodynamic Study, it is important to increase water intake, and in some cases, a short course of antibiotics may be prescribed.
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