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Urinary tract disorders
Published in Henry J. Woodford, Essential Geriatrics, 2022
Cystometry is performed with a pressure-sensing probe in the rectum and a catheter in the bladder that can be used to instil fluid and also measure bladder pressure. Fluid is slowly run into the bladder (up to 100 ml/min). Bladder pressure should only rise slowly with filling. In healthy people, the first desire to pass urine should not occur until after 200 ml have been put into the bladder and a strong desire should only occur after at least 300 ml. This information gives an idea of bladder capacity. The rectal (abdominal) pressure reading is subtracted from the bladder reading to give an estimate of the pressure being generated by the detrusor muscle. In this way, abnormal detrusor contractions (overactivity) can be detected. During the process, the patient is also asked to cough and perform the Valsalva manoeuvre. Leakage of urine in the absence of an increase in detrusor pressure indicates stress incontinence (seeFigure 11.5).
DRCOG OSCE for Circuit A Answers
Published in Una F. Coales, DRCOG: Practice MCQs and OSCEs: How to Pass First Time three Complete MCQ Practice Exams (180 MCQs) Three Complete OSCE Practice Papers (60 Questions) Detailed Answers and Tips, 2020
The three investigations that can be arranged as an outpatient in hospital include a pelvic ultrasound to exclude fibroids, and basic urodynamic investigations such as uroflowmetry and cystometry. Uroflowmetry involves the patient urinating on a flow meter and measuring how quickly the bottom is filled. Normal flow rate is 15 ml s-1 for > 150 ml. Cystometry measures rectal, bladder, and detrusor pressures and flow.
Rectal Prolapse and Associated Pelvic Organ Prolapse Syndromes
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
André D’Hoore, Oliver M. Jones
Cystometry is used to measure bladder sensation, capacity, compliance, contractility and urethral function. Pressure measurements are made via a series of transducers. A transducer in the rectum or vagina approximates to intra-abdominal pressure, whilst intravescial pressure is measured within the bladder. To measure the subtracted detrusor pressure (those due to active and passive forces within the bladder wall) the intra-abdominal pressure reading is subtracted from the intra-vesical reading. A urethral filling catheter is also inserted, and the bladder is slowly filled. The first sensation and maximum cystometric capacity are both recorded in a manner similar to rectal sensory measurements as part of anorectal physiological studies. Bladder compliance can also be calculated during bladder filling. Detrusor over-activity during this filling phase can also be sought. The bladder catheter is then removed, and the patient is asked to cough to test for stress incontinence.
Validation of a new rat model of urethral sphincter injury and leak point pressure measurements
Published in Scandinavian Journal of Urology, 2021
Abdelkhalek Samy Abdelkhalek, Patrick D. Clarke, Matthew A. Sommers, Tyler Oe, Thomas M. Andersen, Chrissie T. Andersen, Eva Kildall Hejbøl, Henrik Daa Schrøder, Peter Zvara
Filling cystometry and LPP measurements were performed using three anesthetic protocols. A dose which provided sufficient sedation while preserving toe pinch reflexes was used. We assessed the feasibility and compared cystometric parameters under inhaled isoflurane (Attane Vet® 1000 mg/g, Piramal Critical Care, Netherlands) with oxygen as the carrier; intraperitoneal ketamine/xylazine (KX – Ketaminol® 50 mg/mL, MSD Animal Health, Netherlands; Rompun® 20 mg/mL, Bayer, Germany), and subcutaneous fentanyl-fluanisone-midazolam (FFM – Hypnorm®-fentanyl 0.315 mg/mL and fluanisone 10 mg/mL, Janssen-Cilag, UK; Dormicum®-midazolam, 5 mg/mL, Roche AB, Sweden). For intravesical filling, a syringe with 0.9% NaCl was placed in the infusion pump connected in series to a Digitimer/NeuroLog system pressure transducer (Digitimer Ltd., UK) and intravesical catheter. The infusion rate was set at 5 mL/hour. A Spike-2 software (CED, UK) was used to record three reproducible micturition cycles. Subsequently, spinal anesthesia was administered using repeated intrathecal injections of bupivacaine (50 µg) in 6-minute intervals and LPP was recorded. LPP was defined as intravesical pressure at the time when the first drop of urine appeared at the urethral orifice.
Recommendations for evaluation of bladder and bowel function in pre-clinical spinal cord injury research
Published in The Journal of Spinal Cord Medicine, 2020
Gregory M. Holmes, Charles H. Hubscher, Andrei Krassioukov, Lyn B. Jakeman, Naomi Kleitman
Cystometry is considered fundamental for most SCI studies with a focus on bladder dysfunction and is recommended for use as a supplement for all SCI studies when bladder function is a question of interest or target of potential therapy. Although the preference is for awake cystometry and inclusion of external urethral sphincter EMG recording, it is not always practical. Whichever approach is taken (sometimes based upon skill set, timing and convenience), cystometry is recommended as part of a multidisciplinary approach using a combination of different techniques. A few examples of LUT studies investigating a therapeutic intervention using multiple outcome measures including cystometry14,15,30,34,40,41 illustrate the benefit of having an array of different methods to demonstrate strong evidence of a therapeutic effect.
Can rectal catheters be avoided during paediatric urodynamic studies?
Published in Arab Journal of Urology, 2020
Abhilash Cheriyan, Arun Jacob Philip George, Antony Devasia, J. Chandrasingh
Based on these observations in routine practice, the present study aimed to determine if pressure–flow studies in children can be interpreted satisfactorily with single-channel cystometry to avoid the discomfort of a rectal catheter. There are few studies that have evaluated the role of one-channel cystometry [4,5] in identifying bladder overactivity and stress urinary incontinence (UI) in adults. Ricci et al. [6] found single-channel cystometry to be a useful adjunct to clinical examination in women with UI. Single-channel cystometry interpreted carefully in relation to clinical findings is considered a reasonably accurate, safe and cheap method for diagnosing neurogenic bladder dysfunction, especially in spinal cord injuries [7]. In another study comparing single- and multi-channel cystometry as a screening tool for detrusor instability in women, single-channel studies had acceptable specificity but the predictive value was poor as a screening tool [8]. There are no such studies in the paediatric population to our knowledge.