Urodynamic Study

Urodynamic testing is a series of specialized diagnostic examinations that evaluate the function of the lower urinary system.

The lower urinary system, consisting of the bladder and urethra, is a functional unit for storing and voiding urine.

During the normal urine storage phase, we feel fullness at a specific moment and then have the urge to urinate. It is not normal to feel pain, urgency to urinate, or have urinary incontinence. The ability of the urethra to remain closed and the bladder’s compliance (i.e., the bladder's ability to expand while maintaining low internal pressure) makes it possible to store urine at low and stable pressures. This allows urine to drain from the upper urinary system (kidneys and ureters).

During the normal voiding phase, urination begins whenever we decide and the flow is strong and continuous. At the end, there is no residual urine in the bladder. To achieve this function, the pelvic floor and external urethral sphincter relax synchronously with the contraction of the detrusor muscle. When we have high pressures in the bladder, urine drainage from the upper urinary system can be affected and subsequently its function (renal dysfunction).

This modern diagnostic method provides accurate information about how urine is stored and emptied.

Our purpose in urodynamic testing is to provoke/reproduce the patient's symptoms and through pressure measurements to make the correct diagnosis and define an appropriate treatment plan.

Urodynamic testing is a painless examination and the patient is in full communication with the doctor and nurse during the examination.

The doctor may recommend urodynamic examination in cases where there are urination symptoms such as:

1. Urinary incontinence
2. Difficulty initiating urination
3. Weak urine flow
4. Sensation of incomplete bladder emptying
5. Frequency and nocturia
6. Painful urination
7. Uterine and bladder prolapse (cystocele)

Examination Stages

1. Initial assessment: Recording history and symptoms and ultrasound examination
2. Uroflowmetry: Urination in a special toilet
3. Catheter placement: Insertion of thin catheters into the bladder and rectum
4. Bladder filling phase: Gradual filling of the bladder with special solution
5. Bladder emptying phase: Recording measurements during urination

Examination Duration

Urodynamic testing usually lasts 30-60 minutes, depending on the complexity of the case.

1. Uroflowmetry
   This is a non-invasive study. The patient urinates in a special toilet. It is very important for the woman to urinate with privacy to have results that represent reality. The speed, flow time, and urine volume are recorded.
   Uroflowmetry records the rate and pattern of urinary flow. It provides information about:
   
   1. Maximum urination velocity
   2. Total urine volume
   3. Urination time
2. Post-Void Residual Measurement
   With ultrasound or catheterization after urination, the amount of urine remaining in the bladder is estimated.
3. Cystometry
   Cystometry measures pressure inside the bladder during filling.
   This examination evaluates:
   1. Bladder capacity
   2. Bladder wall sensitivity
   3. Presence of involuntary bladder contractions
   4. Urine loss with coughing
   5. Bladder compliance
4. Urethral Pressure MeasurementUrethral Pressure Measurement
   This examination evaluates urethral sphincter function and helps diagnose urinary incontinence.
5. Pressure-Flow Study or Voiding Cystometry
   We record pressures during urination. It always begins with an instruction to urinate and ends when the patient feels urination is complete. With the pressure-flow study, we draw important conclusions, such as diagnosing hypotonic bladder or obstructive voiding. In the case of hypotonic bladder, we have low urine flow and low bladder pressure, while in obstructive voiding we have increased detrusor pressure with low urine flow. The main causes of obstruction are pelvic organ prolapse and previously performed incontinence surgery.

Preparation Instructions

Before urodynamic testing, patients should:

1. Discontinue specific medications following medical advice
2. Drink normal amounts of fluids
3. Avoid emptying the bladder before examination
4. Contraindications

Urodynamic testing is avoided in cases of:

1. Cystitis
2. Hematuria

Normal Findings

In a healthy individual, urodynamic testing shows:

1. Stable bladder pressure during filling
2. Normal sensation of fullness
3. Normal urine volume
4. Continence
5. Smooth and complete emptying

Pathological Findings

Based on results, we can diagnose:

1. Overactive bladder
2. Hypotonic bladder
3. Type of urinary incontinence
4. Obstructive voiding (obstacle to urine outflow)
5. Sphincter dysfunction

Diagnostic Accuracy

Urodynamic testing offers:

1. Objective evaluation of symptoms
2. Accurate diagnosis of the cause of urination problems
3. Guidance for appropriate treatment

Treatment Planning

The results help with:

1. Planning personalized treatment
2. Predicting therapeutic outcomes

Mild Side Effects and Complications

During the urodynamic testing, the patient may feel slight discomfort, but the examination is not painful. After the urodynamic testing, the patient may temporarily feel an urgent need to urinate or mild burning. In rare cases, a urinary tract infection (cystitis) may occur, which is treated with antibiotics.

Patients are advised to drink plenty of fluids for 24-48 hours in order to prevent urinary tract infection.

Urodynamic testing is a powerful diagnostic tool for evaluating lower urinary system problems. With proper preparation and interpretation, urodynamic examination provides accurate information leading to effective therapeutic solutions.

Timely diagnosis through urodynamic testing contributes to selecting the optimal therapeutic approach. The examination must be performed by an experienced, specialized urogynecologist for correct recording and evaluation of the results.

Kostis Nikolopoulos has the expertise for personalized interpretation and guidance.

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