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Urology
Published in Stephan Strobel, Lewis Spitz, Stephen D. Marks, Great Ormond Street Handbook of Paediatrics, 2019
Physical examination may reveal overt lower extremity neurological deficit and/or a hairy patch, dimple or skin tag on the spine may point to spina bifida occulta. Ultrasound will demonstrate upper tract hydronephrosis, bladder wall thickness and volume, and in children less than 3 months the terminal spinal cord. A plain film may show bony spinal abnormalities and constipation; however, for further details of spinal cord abnormalities MRI is required (Fig. 22.30). Ultrasound is also used during noninvasive bladder function assessment to ascertain the voiding pattern and efficiency. Urodynamics assess the pressures within the urinary tract during bladder filling and emptying through a small catheter placed into the bladder. MCUG can provide further information during filling and voiding, including secondary VUR, and is combined with urodynamics (videourodynamics) after infancy. DMSA isotope scanning assesses the kidneys for renal damage.
Physiology
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
Anwen Williams, Martyn D. Evans
Since transient urinary difficulties are not uncommon following pelvic surgery, urodynamic studies should be reserved for patients who have not improved after 2–3 months. These studies are pressure-flow studies to evaluate bladder function during the filling and voiding stages. A pressure sensitive catheter is placed in the bladder via the urethra to measure intravesical pressure, and a similar one is placed in the rectum or stoma in a patient who has undergone abdomino-perineal excision of rectum (APER), to measure intra-abdominal pressure. The pressure generated by the detrusor muscle is calculated by subtracting the intra-abdominal pressure from the intravesical pressure.
Urinary Symptoms and Investigations
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
A urodynamic evaluation provides information about bladder pressure and urine flow and as a consequence has been referred to as a pressure/flow study. A device for urodynamic assessment is shown in Figure75.35. During urodynamics, fine catheters (or a dual-lumen catheter) are inserted through the urethra into the bladder to allow bladder filling and to record the intravesical pressure. The test is commonly performed to investigate male patients with LUTS and female patients with LUTS or incontinence. It is also commonly used in those patients with a suspected bladder neuropathy. There are 2 phases to the test; a filling phase during which fluid is instilled into the bladder at a constant rate, and a voiding phase when the patient is asked to void. Involuntary rises in the intravesical (detrusor) pressure during the filling phase with or without a desire to void are classical of an overactive bladder (Figure75.36). High intravesical pressure during voiding with a reduced flow rate is typically seen in a man with bladder outlet obstruction (Figure75.37). An atonic bladder (no detrusor activity) is seen in diabetic neuropathy and in some patients following abdominoperineal excision of the rectum when damage to the pelvic nerve plexus has occurred. Detrusor-sphincter dyssynergia, when coordinated contraction of the detrusor muscle in conjunction with relaxation of the external sphincter, necessary to permit normal voiding, is lost, is often seen in neurological conditions such as multiple sclerosis (MS).
Diastolic blood pressure changes during episodes of autonomic dysreflexia
Published in The Journal of Spinal Cord Medicine, 2021
Steven Kirshblum, Fatma Eren, Ryan Solinsky, Kathryn Gibbs, Katharine Tam, Robert DeLuca, Todd Linsenmeyer
After approval by the Institutional Review Board, retrospective chart reviews were conducted for individuals who had consecutive urodynamic examinations from August 2018 to January 2019. Inclusion criteria consisted of a traumatic SCI, neurological level of injury ≥T6, age 18 years and above, and duration of injury of at least 3 months. In individuals who met the inclusion criteria, up to 10 years of prior urodynamic testing were reviewed. AD was defined as SBP >20 mmHg from their baseline blood pressure according to the current definition of the ISAFSCI.1 Data collected for each individual included age, sex, date of urodynamic examination, duration of injury from the most recent study, neurological level of injury, and the American Spinal Cord Injury Association (ASIA) Impairment Scale (AIS) according to International Standards for Neurological and Functional Classification of Spinal Cord Injury Patients.23
Safety and efficacy of robotic-assisted Burch for pure stress urinary incontinence: a large case series
Published in Journal of Obstetrics and Gynaecology, 2021
Toy G. Lee, Bekir S. Unlu, Victoria A. Petruzzi, Mostafa A. Borahay, Furkan Dursun, Antonio F. Saad, Gokhan S. Kilic
After Institutional Review Board (IRB #19-0154) approval, a retrospective chart review was performed on robotic-assisted Burch urethropexy cases between 2013 and 2019 at our academic teaching institution. In our institution, a single Current Procedural Terminology (CPT) code is used for laparoscopic / robotic Burch urethropexy (CPT code 51990; Anger et al. 2009). Laparoscopic cases were excluded from procedure notes for the study. Patients with SUI were diagnosed based on history and exam findings of a positive cough stress test. Preoperative three-day voiding diaries were obtained as a baseline. If the patient did not demonstrate leakage on the exam, urodynamics testing followed. Urodynamic tests positive for pure SUI were included in the study. Patients with recurrent SUI following previous surgery also underwent urodynamic testing. All efforts were made to restrict the study group to pure SUI patients. Demographics, patient history, operative data and postoperative outcomes were collected. All of these cases were performed by a board-certified female pelvic medicine and reconstructive surgeon with the assistance of an upper-level obstetrics/gynaecology resident.
Evaluation and treatment of urinary incontinence in the aging male
Published in Postgraduate Medicine, 2020
Urodynamics may be useful in men with UI, particularly those who have failed therapy, have underlying neurological condition, have comorbid condition(s) that may cause LUTS, and/or patients considering genitourinary reconstruction [53]. Urodynamic testing provides helpful information regarding the storage phase (detrusor activity, bladder sensation, bladder capacity, compliance, urethral function), as well as the voiding phase (detrusor activity, urethral function). Testing can be particularly helpful to assess for uninhibited contractions, UUI, SUI, evidence of bladder outlet obstruction versus underactive bladder, reduced bladder compliance, and reduced bladder capacity, all of which may contribute to UI. Ability of older adults to tolerate urodynamic testing, follow directions, and adequately participate may be compromised in those with cognitive impairment and/or mobility issues [46].