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Women's Health and Education Center (WHEC)

Uro/Gynecology

List of Articles

  • Urodynamic Assessment: Techniques
    Addressing the various technical aspects, controversies and techniques for performing cystometry. Cystometry (CMG) has been described as the reflex hammer of the urodynamicist. It is not only the method by which the pressure/volume relationship of the bladder is measured, but it is also an interactive process that permits examination of motor and sensory function. The International Continence Society (ICS) had defined certain terms that are used in the reporting of cystometric results.

  • Urodynamic Assessment: Cystometry
    A discussion of basic principles of cystometry, indications, normal and abnormal cystometric parameters. A basic principle of cystometry is the coupling of a manometer to the bladder lumen. A filling medium is instilled into the bladder and, as it fills, intravesical pressure is measured against volume. Testing apparatuses range from simple single-channel methods, which are performed manually or electronically, to complex methods combining electronic measurements of bladder, abdominal, and urethral pressure, together with electromyography and fluoroscopy. A cystometrogram has two phases: a filling/storage phase and an emptying (voiding) phase. The filling phase is subdivided into a brief initial rise in pressure to achieve resting bladder pressure, followed by a tonus limb that reflects vesicoelastic properties of accommodation of the smooth muscle and collagen of the bladder wall. There may be a third increase in pressure, which is attributed to stretching of detrusor muscle and collagenous elements of the bladder wall beyond their limits at bladder capacity. During this third stage, the patient is still able to suppress voiding. A detrusor contraction then is initiated voluntarily and the patient voids.

  • Urodynamic Assessment: Voiding Studies
    Uroflowmetry is an electronic measure of urine flow rate and pattern. Combined with assessment of postvoid residual urine volume (PVR), it is a screening test for voiding dysfunction. If the uroflowmetry and postvoid residual volume (PVR) are normal, voiding function is probably normal; however, if the uroflowmetry or postvoid residual volume (PVR) or both are abnormal, further testing is necessary to determine the cause. More sophisticated measures of voiding function include a pressure-flow voiding study with or without videofluoroscopy. Electromyography of the striated urethral sphincter may be useful to assess neurogenic voiding dysfunction.

  • Urodynamic Assessment: Leak Point Pressures and Urethral Pressure Profile
    A review of the definitions, methodology, interpretation variables, and clinical applications of these tests. One of the most important concepts to be put forth in recent years is that "adequate storage at low intravesical pressure" will avoid deleterious upper urinary tract changes in patients with bladder outlet obstruction and/or neuromuscular lower urinary tract dysfunction. Application of this concept to patients with storage problems caused by decreased compliance has also resulted in the concept of the "leak point" as a significant piece of urodynamic data. This "detrusor leak point pressure" is not the same as the "abdominal/coughing Valsalva leak point pressure". The latter parameter refers to the vesical pressure produced by straining, which is necessary to overcome sphincteric resistance and produce incontinence.

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