Complete urodynamic examination
When is this exam indicated?
The complete urodynamic examination is not a first level examination. It is recommended in cases of complex urinary dysfunction not responsive to a first line of treatment or when it may be useful in changing the therapeutic approach to the patient. It is sometimes useful in predicting the outcome of certain types of lower urinary tract surgery and in selecting patients who are most likely to benefit from a certain surgical approach. It is also very important that it is performed in a whole range of neurological diseases with bladder involvement.
How is it performed?
A standard urodynamic examination includes: free uroflowmetry, cystomanometry and pressure/flow study. The examination takes 50 to 60 minutes. Flowmetry is the graphic recording of urinary flow during urination. Cystomanometry is the continuous recording of bladder pressure changes during bladder filling. The Flow Pressure Study is performed, instead, for the monitoring of the bladder emptying phase as it allows to evaluate the exact intravesical pressure along with the flow, during the emptying phase. From the practical point of view, to carry out the examination it is necessary to place two catheters, one in the bladder and one in the rectum (or vagina), which allows to fill the bladder, by means of a saline solution or contrast medium (where an X-ray evaluation is planned), with known volumes of liquid, measuring at the same time the pressures in the bladder and abdomen. At the end of the filling, when the patient will feel the need to urinate, the urinary assessment is carried out by measuring both the urinary flow and the corresponding pressures.
There are no absolute contraindications to this type of examination. After a urodynamic examination, it is quite common for the patient to experience discomfort upon urination. Typically, this sensation lasts for a maximum of 24 hours. More rarely, the patient may also suffer from hematuria (or blood in the urine); as in the previous case, this disturbance does not last for more than one day after the conclusion of the diagnostic test. The test should not be performed in the presence of the following pathologies: macroscopic hematuria, urinary tract infections, bladder stones, bladder tumors.