Urodynamic examinations are important methods of investigations used mainly in pediatric surgery and urology. This involves measurements of bladder pressure using pressure probes and electrodes to clarify the functionality of the urinary bladder. A urodynamic examination is usually painless, but is important for clarifying incontinence and other symptoms related to the urinary bladder.
What is a urodynamic examination?
A urodynamic examination is used to measure functional processes in the urinary tract to check the function of storing and emptying urine. A urodynamic examination is used to measure functional processes in the urinary tract to check the function of storing and emptying urine. In this procedure, a thin probe is inserted into the urinary bladder to clarify the pressure measurement in the urinary bladder. There are various examination methods such as uroflowmetry, residual urine determination, cystometry and urethrometry. In addition, further examinations such as a pelvic floor electromyogram or sonography are performed if necessary. The urodynamic examination is necessary to clarify disorders in the urinary tract and to examine the lower urinary tract in more detail. The methods of a urodynamic examination can generally be performed without pain or risk and also provide information about whether there is a urethral obstruction. Such urodynamic examinations are also informative if the treatment of incontinence has been unsuccessful, as well as before a planned surgical intervention for incontinence or forms of incontinence that cannot be clearly diagnosed. Furthermore, this examination method is useful if incontinence cannot be treated by conservative forms of treatment. Urge complaints such as an irritable bladder can also be clarified by means of a urodynamic examination and lead to a helpful diagnosis.
Function, effect and goals
The various procedures of a urodynamic examination are used to clarify complaints related to the release and storage of urine. The uroflow procedure checks urine flow, in which the volume product unit time is accurately measured and documented. Low urine flow may indicate an enlarged prostate, muscle weakness or urethral stricture. Cystometry assesses the storage capacity of the urinary bladder. Pressure is measured in the abdominal cavity as well as in the rectum, so that the closure pressure of the urinary bladder can be measured by comparing the two values. The urethral pressure profile, another procedure of a urodynamic examination, examines the ability of a urethra to close in a state of rest as well as during stress such as coughing jerks. At the same time, the pressure of the urethra and bladder is measured, so that urethral obstruction can be clarified. Micturition analysis is performed by accurate pressure and flow measurement, which allows conclusions to be drawn about the nature and severity of a micturition disorder through the values of obstruction pressure, urinary flow and muscle function recordings. During the examination itself, a thin probe is inserted into the urinary bladder through the urethra, which is then used to measure the bladder pressure and also to fill the bladder. Another measuring probe in the rectum provides a comparative value to the pressure measured in the abdomen. In exceptional cases, the pelvic floor activity of the sphincter is measured. In this case, three adhesive electrodes are electrically registered at the perineum. First, the bladder is filled with a sterile saline solution at a moderate pace. If the bladder is full, water can be let out despite the lying probe. If incontinence is present, it is recommended that the urinary catheter be removed from the bladder gently and appropriately slowly while continuously measuring the pressure of the urethra. In general, the urodynamic examination is not associated with pain or discomfort. A seated body position is recommended for the examination in order to simulate everyday stress as optimally as possible. A collection mechanism on the examination chair provides information about the involuntary loss of urine during the filling of the bladder as well as during the subsequent release of urine. Sometimes an X-ray contrast medium is also placed to perform an additional micturition cystography. The continuously documented measured values and the resulting pressure and flow curves are usually evaluated by a computer system, which is then interpreted by the physician.The urodynamic examination also allows a more precise examination of different forms of urinary leakage such as stress incontinence, sensory and motor urge incontinence as well as mixed forms. To control neurogenic bladder, urodynamic examination can detect vesicorenal reflux. Even if urodynamic examinations are not perceived as pleasant for every patient, it should be remembered that they are essential for the diagnosis of symptoms related to the lower urinary tract and support further and, above all, goal-oriented treatment.
Risks, side effects, and hazards
After a urodynamic examination, irritation of the bladder cannot be ruled out. There may be irritation of the bladder immediately after the examination, which may last for several hours, but may stop by itself after some time. Sometimes the insertion of a bladder catheter, as used in urodynamic examination, can lead to bladder inflammation or bleeding. With the administration of antibiotics, the cystitis will heal. Bleeding should stop within 48 hours after the examination. Injuries to the urethra as well as scarring that occurs as a result are very rare due to the performance of a urodynamic examination and are usually not to be expected. There may be a burning sensation during urination in the hours following the examination. Immediately after the examination, it is not recommended to drive a vehicle, although no medication is prescribed during the urodynamic examination that could affect attention or consciousness. In the patient’s mind, the discomfort is not pleasant, but it is used to clarify diseases and their complete cure and effective forms of treatment.
