What is Urodynamics?
The term Urodynamic refers to a sophisticated type of test on the bladder that is only performed by suitably trained Urologists with specialised equipment.
This test provides details of the function of the bladder, both as it fills and as it empties. We measure the pressure in the bladder at the same time as observing the bladder on X-Ray and measuring urine flow rate. There are several other tests we do, including simple urinary flow rates, which could also be called Urodynamic, but we use the term to mean the full test, with simultaneous pressure and flow measurement and X-Ray control (as described in Medicare Item 11919)
Where can I have this test?
Specialised equipment and suitably trained Urologists perform Video Urodynamics studies. Both Mr. John Rogerson and Dr. Jyotsna Jayarajan perform the studies for North Eastern Urology and by referral from other Specialists.
The locations include Northpark Private Hospital, Epworth Hawthorn, Austin Health and Mildura Private.
Why is it done?
Urodynamics allows us to understand why patients have various problems with their bladder function. Proper diagnosis of problems such as incontinence, urinary frequency, incomplete bladder emptying or difficulty in emptying sometimes requires urodynamic testing.
Because the test is labour intensive, requires sophisticated equipment and is somewhat invasive, we do not recommend it for every case of incontinence or voiding difficulty. The type of cases which we usually recommend to have Urodynamics are complex problems, often patients who are sent for a second opinion, often after poor results from other treatments.
Who should have urodynamics studies?
- Newly diagnosed spinal cord injured persons
- Neurological diseases where the person is experiencing voiding difficulties
- Stress incontinence in females
- Stress incontinence in the male particularly those who have developed stress incontinence following a radical prostatectomy
- Recurrent urinary tract infections – where other tests have failed to make a diagnosis
- Pre-surgery – as a baseline study
- Incomplete bladder emptying or difficulty emptying where the cause is not clear
What can you expect?
You will have two tests – a flexible cystoscopy and followed by Urodynamic studies.
- Flexible cystoscopy
Is the visual assessment of the bladder and the urethra (a tube leading out of the bladder). Prior to the procedure, a nurse will instruct you to put on a gown. You will be required to empty your bladder. In some patients, if you are unable to empty your bladder, the Urologist or Nurse may insert a catheter to empty your bladder prior to commencing the test. After being positioned on a table the first manoeuvre is the insertion of a fine pressure line into the rectum (‘back passage’) which requires you to lie on your side. This line allows the measurement of abdominal pressure as the bladder sits in the abdominal cavity. Once inserted, you will then be asked (and assistance is also given) to position yourself on your back. The external genitals are cleansed with an anti-bacterial solution and a local anaesthetic gel is introduced into the urethra. A fine tube (flexible scope) with a video camera at the tip is passed into the bladder via the urethra by the Urologist.This view allows assessment of any blockages and weakness in the urethra, as well as potentially showing a variety of other conditions in the bladder. When complete, the fine tube (flexible scope) is removed and the second phase of the test is commenced.
- Urodynamics study A fine catheter (with 2 lines) is passed into the bladder. Once in place the doctor will then connect the catheter to the pressure transducers and the filling pump.The bladder is filled with fluid, you will be asked to cough at times, both to test the equipment calibration and to see the effect of coughing on bladder function. X-Ray images of the bladder are recorded. For those patients with normal mobility the X-Ray table is usually adjusted so you are in a standing position to see a more normal voiding pattern. You will be requested to withhold urination until the tubes and pressure lines have been readjusted and a urinal has been put in place to measure flow rate. You will then be asked to void, as normal as possible. If you are unable to void a catheter may be inserted to drain the bladder. This is particularly relevant for those who have neurological impairment.Both parts of the procedure take about one hour, including the set up time. It is not painful and we do our best to ensure that patients are not embarrassed by the setting. The staff wear X-Ray protection because they are continually exposed to radiation. The amount of radiation received by the patient for a single study is well within safety limits.
What happens after the procedure?
Following the procedure, when you have had an opportunity to get dressed, the doctor will usually discuss the outcome of the test and may make further arrangements as necessary. If this is not possible, you will be given an appointment to return to the rooms to discuss results and possible treatment plan.
You may be given a single antibiotic tablet to reduce the chances of developing an infection due to the procedure. You may experience some burning and pain when urinating following the procedure. You will also be asked to increase your fluid intake in the 24- 48 hours following the test and to take Ural sachets every 6 hours for 24 hours to help with this.
You will be able to resume activities as normal and drive yourself home from the test.
Points to note:
- If you have any neurological impairment you will be given a request form to obtain a urine culture one week before the procedure. This will check if there is an infection present. If the culture is positive, you must be prescribed antibiotics for a minimum of 2-4 days before the procedure. Failure to do this will result in cancellation of your test.
- Ensure you increase your fluid intake for 1-2 days following the procedure to ensure the contrast is out of your bladder.
- Please alert staff if you have an iodine allergy.
- Urodynamics studies cannot be performed if you have an indwelling catheter.
- No fasting is required and medications may be taken as prescribed.
Although unlikely, we would encourage you to call the rooms and speak to the Practice Nurse if you experience any of the following symptoms:
- Offensive, cloudy urine
- Burning, frequency and urgency
- Presence of blood in the urine
- Supra pubic pain.