Urodynamics Essay

1320 words - 6 pages

“Urodynamics is a collection of tests used to measure bladder, urethral, and pelvic floor muscle function, as well as diagnose functional disorders of the lower urinary tract” (Gray, 2010, p. 321). Urodynamics is used in addition to the patient’s history and a complete patient assessment. Moore (2013) states that urodyamics encompasses a number of tests, these include: flow study, cystometry, urethral pressure profile and leak point pressure. For the purpose of this paper a urodynamic test will be analysed to highlight normal and abnormal results. Possible reasons for these abnormalities will be discussed.

In this study the patient is a 42 year old lady who presented with a number ...view middle of the document...

The pdet remained elevated once filling had stopped. These results are indicative of decreased bladder compliance. Patel (2008) states that compliance relates to the bladders ability to distend and hold urine. In decreased bladder compliance the detrusor (pdet) rises steadily in an uninterrupted line at low volumes and remains elevated once filling has stopped. Bladder discomfort is also experienced (pp. 63-65). These abnormal findings were demonstrated in this study. “Bladder compliance is considered to be compromised if it is below 30cmH20” (Mahfouz et al. 2011, p. 277). In this test compliance was 22cmH20. Gray (2011a, p. 220) states that low bladder compliance can be caused by numerous pathology. Chronic bladder outlet obstruction is a common cause. It can be due to any anatomical obstruction such as pelvic organ prolapse, bladder neck obstruction, urethral diverticulum or prior incontinence surgery. Chronic inflammation, neurologic disorders and interstitial cystitis are also causes.

Testing for stress incontinence is also performed. Moore (2013) defines urodynamic stress incontinence as leakage which occurs with a rise in intra abdominal pressure, but without a rise in detrusor pressure (pdet). Intra abdominal pressure is increased by asking the person to cough. The urethral sphincter pressure is also measured via a maximum urethral closure pressure reading, also known as an MUCP. This reading indicates if the urethral sphincter mechanism is competent. An MUCP reading of less than 20cmH20 indicates an incompetent sphincter and the person is said to have intrinsic sphincter deficiency. In this study the MUCP was competent and nil stress incontinence was demonstrated. These are all normal findings. The reasons why stress incontinence was not demonstrated is due to good pelvic floor support of the bladder neck and a good urethral closure pressure. Gray (2011b, p. 272).

Detrusor overactivity is defined “as the urodynamic observation of involuntary detrusor contractions. An overactive detrusor contraction is considered clinically relevant when it is associated with urgency with or without urge incontinence “ (Gray, 2012a, p. 23). Patel (2008) states that an overactive bladder is demonstrated when the detrusor muscle contracts and subsequently causes the pdet to rise above 15cmH20. When the detrusor contractions are strong enough to overpower the urethral sphincter leakage occurs and the diagnoses of urge incontinence is made (p. 65). Detrusor contractions can be experienced during the filling phase or by various provoking activities such as change of position, running water and washing of hands (Flesh, 2014, para.10). In this study detrusor overactivity with a pdet rise to 19cmH20 occurred with water provocation. Strong urgency and moderate leakage were also experienced. The above findings are abnormal, as the detrusor muscle should not contract with any form of provocation and there should not be any leakage of urine. The patient was...

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