Urodynamic study is functional assessment of lower urinary tract namely bladder and urethra. It is useful for proper diagnosis of lower urinary tract symptoms like urinary leakage, obstructive urinary symptoms like poor urine flow, straining during urination etc.
Urinary bladder function is controlled by lower spinal cord from where nerve fibers controlling bladder function emerges. Bladder function gets affected when any disease, trauma & surgery damages or involve spinal cord & its emerging nerves. In these situation nerves can’t control or control bladder function abnormally.
Either due to nerve damage patient develops urinary leakage or develops urinary retention. Accurate
diagnosis of either condition is possible using urodynamic study. This helps us to guide patients how to manage their bladder symptoms.
Bladder function (leakage / obstruction) can be affected without spinal cord injury or disease. Usually cases are organic or structural obstruction in lower urinary tract like enlargement of prostate or stricture urethra (narrowing of urine pipe). Certain disease like chronic or recurrent urinary tract infection, tuberculosis of urinary bladder etc causes bladder to shrink resulting in repeated voiding, urgency & urge urinary incontinence.
Another type of urinary leakage is known as stress urinary incontinence (SUI). Urine leaks while coughing and sneezing. This may happen in males after prostate surgery. In females this is more common & under reported. Stress incontinence in women results from multiple normal child birth which weakens the pelvic floor. SUI usually can be cured by endoscopic surgery known on TOT. Before surgery for SUI, urodynamic study testing is very essential for proper diagnosis & to rule out other causes of urinary leakage.
Often in elderly male prostate enlargement causes significant urinary obstruction and bladder muscle strain a lot to produce a better flow; this results in bladder loosening or its muscles become underactive or hypotonic. Before prostate surgery urodynamic test is often done to assess whether bladder tone (pumping action) has decrease or lost.
If bladder tone is lost then surgery doesn’t help. In such situation patients are kept with catheter in bladder for a period of 1 – 3 months; continuous emptying of bladder helps it to regain its tone. Once tone or pumping action of bladder is regained then prostate surgery is usually successful.
How urodynamic test is done
Test is performed in OPD. Usually there is a designated urodynamic lab; prior to the test it is preferable to get urine culture sensitivity done few days before to control infection if any. Broad speculum intravenous antibiotics are administrated 30’ before the test. First bladder is emptied & then two catheters are placed; one each in the bladder & other in the rectum.
Electrodes are place in the perineum to record sphinctric activity. All the tubes are connected to urodynamic machine & patients are made to sit in a special chair by the side of the machine. Then bladder is gradually filled with normal saline at a particular speed using inbuilt pump within the machine. During the study (mainly performed by a urologist) various bladder activity is recorded like bladder sensation, full bladder capacity, strong desire to void.
Once strong desire to pass urine is achieved then patients are asked to urinate in sitting position. Then voiding activity is recorded. Electrodes in the perineum record external sphincter activity. From the graphic recording, interpretation is reached and patients are explained about the diagnosis & what should be the proper line of treatment. Patients are advised 5 – 7 days of antibiotics following the tests to prevent any infection from occurring.
Fever with chills may occur within 1 – 3 days following the tests due to urinary infection; usually good antibiotic coverage helps to overcome the problem. Rarely patients may experience urinary frequency and / or urgency following the test; sometimes small amount of blood in urine is observed which usually subsides on its own.
Thus urodynamic tests is an excellent tool to diagnose various lower urinary tract disorder. Proper diagnosis helps urologist to prescribe treatment with precision. Institute of urology is performing urodynamic test using state of the art machine since 2007.
Any queries regarding urodynamic test or appointment for urodynamic tests please free to call at 98290 – 13468.