Invasive Urodynamics Research Articles

The Effect of Different Education Methods Before Invasive Urodynamics on Patients’ Anxiety, Pain, Readiness and Satisfaction Levels: Randomized Controlled Clinical Trial

Urodynamic testing is an invasive procedure that causes pain and anxiety. Patient education is an evidence-based nursing intervention that relieves pain and anxiety and increases patient satisfaction. This study was carried out to compare the effects of different education methods utilized before a urodynamic testing procedure on patients' pain, anxiety, readiness for the procedure, and satisfaction. The study is a randomized controlled clinical trial. Participants (n = 80) were randomly assigned to four groups. While patients in the control group were provided with routine clinical information, patients in the intervention group were given education with brochures, videos, and brochure-supported videos. The research data were collected by using a Data Collection Form with items about participants' descriptive characteristics, the Visual Analog Scale, and the State Anxiety Inventory. It was determined that pain expectation before urodynamics and the severity of pain during urodynamics were lower in intervention groups than in the control group. Pain expectation before urodynamics was lower in the brochure-supported video education group than in the brochure education group. Anxiety levels were lower and satisfaction levels were higher in the video education and brochure-supported video education groups than in the control and brochure education groups. Of the methods utilized, it was determined that the most effective one was brochure-supported video education as it affected all parameters positively.

63 - In how many patients invasive urodynamics should be omitted? Data from a single center database analysed on the basis of the UPSTREAM trial findings.

63 - In how many patients invasive urodynamics should be omitted? Data from a single center database analysed on the basis of the UPSTREAM trial findings.

118 - Nomogram for Classifying Minimally Invasive Urodynamics Pressure-Flow Data

118 - Nomogram for Classifying Minimally Invasive Urodynamics Pressure-Flow Data

The role of invasive urodynamics in female stress urinary incontinence

The role of invasive urodynamics in female stress urinary incontinence

32 - Delphi consensus on antibiotic prophylaxis in invasive urodynamics

32 - Delphi consensus on antibiotic prophylaxis in invasive urodynamics

37 - In how many patients invasive urodynamics should be omitted? Data from a single centre database analysed on the basis of the UPSTREAM trial findings

37 - In how many patients invasive urodynamics should be omitted? Data from a single centre database analysed on the basis of the UPSTREAM trial findings

Transcutaneous posterior tibial nerve stimulation on demand during multichannel urodynamics: A new approach in the management of overactive bladder

Background:Overactive Bladder Syndrome (OAB) affects individuals across all ages and genders, reducing quality of life. Although Transcutaneous Posterior Tibial Nerve Stimulation (TTNS) is an effective treatment, its acute effects on OAB remain underexplored. Objectives:This study aimed to assess the acute effects of TTNS on OAB through invasive urodynamics (UDI), using an intermittent, on-demand approach; with a focus on urinary urgency as the central axis for its application. Methods:A proof-of-concept trial was conducted involving patients with OAB symptoms and no previous treatment. An initial urodynamic evaluation (UDI DG) identified patients with detrusor overactivity (DO) associated with urgency, who then received on-demand TTNS during a second urodynamic study (UDI TENS). Parameters measured included the number of involuntary detrusor contractions (IDC), episodes of urge urinary incontinence (UUI), and maximum cystometric capacity (MCC). Statistical significance was assessed using Student’s t-test and Wilcoxon test, with a p-value ≤ 0.05 chosen as significance threshold. Results:Of the initial twenty-nine participants, 12 completed the study. UDI DG measurements showed an average of 3.33 ± 1.3 IDCs, 0.67 ± 0.98 UUI episodes, and MCC of 235 ± 79 ml. During UDI TENS results demonstrated a significant reduction in IDCs to 0.08 ± 0.29 (p ≤ 0.001), an absence of UUI episodes, and an increase in MCC to 315 ± 83 ml (p = 0.00012). Conclusions:Our findings suggest that an acute, on-demand TTNS protocol is effective for managing OAB symptoms and improvement of UDI parameters. However, the limited number of participants and absence of a control group highlight the need for further research through larger, controlled studies.

Minimally Invasive Urodynamics: “One-Exam-Fits-All”?

Minimally Invasive Urodynamics: “One-Exam-Fits-All”?

Antibiotic prophylaxis in invasive urodynamics, a Delphi consensus of the Italian Society of Urodynamics (SIUD).

Although antibiotic prophylaxis (AB) demonstrated a statistically significant reduction in bacteriuria after invasive urodynamics (UDS), no significant decrease in the incidence of urinary tract infections (UTI) has been confirmed. No absolute recommendations on the use of AB in case of relevant potential risk of UTI have been reported, though some categories of patients at increased infective probability after UDS have been recognized. The aim of this study is to report the experts' consensus on the best practice for the use of AB before UDS in the main categories of patients at potential risk of developing UTI. A systematic literature review was performed on AB before UDS in males and females. A panel of experts from the Italian Society of Urodynamics, Continence, Neuro-Urology, and Pelvic Floor (SIUD) assessed the review data and decided by a modified Delphi method on 16 statements proposed and discussed by the panel. The cut-off percentage for the consensus was a ≥70% of positive responses to the survey. The study was a Delphi consensus with experts' opinions, not a clinical trial involving directly patients. The panel group was composed of 57 experts in functional urology and UDS, mainly urologists, likewise gynaecologists, physiatrists, infectivologists, pediatric urologists, and nurses. A positive consensus was achieved on 9/16 (56.25%) of the statements, especially on the need for performing AB before UD in patients with neurogenic bladder and immunosuppression. Urine analysis and urine culture before UDS are mandatory, and in the event of their positivity, UDS should be postponed. A consensus was reached on avoiding AB in menopausal status, diabetes, age, gender, bladder outlet obstruction, high postvoid residual, chronic catheterization, previous urological surgery, lack of urological abnormalities, pelvic organ prolapse, and negative urine analysis. Antibiotic prophylaxis is not recommended for patients without notable risk factors and with a negative urine test due to the potential morbidities that may result from antibiotic administration. However, AB can be used for risk categories such as neurogenic bladder and immunosuppression. The evaluation of urine analysis and urine culture and postponing UDS in cases of positive tests were considered good practices, as well as performing AB in the neurogenic bladder and immunosuppression.

Comparison of maximum voided volume and maximum bladder capacity in voiding diary, uroflowmetry and cystometrography in children with non-neurogenic lower urinary tract dysfunction

BackgroundMaximum voided volumes (MVV) and maximum bladder capacities (MBC) are important parameters in the evaluation of lower urinary tract functions in children. However, consistency of MVV and MBC measurements between voiding diary (VD), uroflowmetry (UF) and cystometrography (CMG) in children with non-neurogenic lower urinary tract dysfunction (LUTD) has not been addressed specifically. ObjectiveWe aimed to compare the MVV in VD and UF and MBC in CMG in children with non-neurogenic LUT dysfunction and investigate for possible factors for discrepancies. Materials and MethodsChildren with non-neurogenic LUTD were retrospectively evaluated with a focus on VD, UF, and CMG. VD applied for 2 days and MVV recorded except for first urine in morning. UF repeated in children with < 50% of expected bladder capacity (EBC) for age. Highest value and post voiding residual urine (PVR) was recorded. CMG was performed if these conditions were present: High PVR or LUT dysfunction resistant to standard urotherapy (conservative management with biofeedback) and medical therapy (oral anticholinergics) or LUT dysfunction accompanied by VUR or recurrent UTI. MBC in CMG was recorded according to International Children Continence Society (ICCS) standards. MVV and MBC in VD, UF, CMG were compared and possible factors for discrepancy were investigated. Results54 children (median age: 10 (4-17) years) were included in the study. 39 (72.2%) were girls, 15 (27.8%) were boys. Median MVV was 232.50 (20-600) ml in VD, 257.50 (69-683) ml in UF and MBC was 184 (31-666) ml in CMG (p= 0.012) (Summary Table). In the subgroup analysis, it was shown that the bladder capacities obtained from all three tests were not compatible with each other in children younger than 10 years of age, in girls, in those with recurrent urinary tract infection, detrusor overactivity, high PVR and normal flow pattern (p=0.003, p=0.016, p=0.029, p<0.001, p=0.045, p=0.03, respectively). DiscussionThere is a discrepancy between bladder capacities obtained from VD, UF and CMG In children with non-neurogenic LUT dysfunction. In particular, the lower capacity obtained from invasive urodynamic tests may be related to the poor compliance of children during the procedure. Therefore, when invasive urodynamics is required in these cases, we recommend that maximum cystometric capacity to be evaluated by comparing with voided volumes at UF, VD and other clinical signs and symptoms, and urodynamic parameters in more detail. ConclusionMVV in VD and UF are comparable, but MBC in CMG is lower in children with non-neurogenic LUTD selected for invasive urodynamic studies. More attention should be paid to bladder capacity obtained from urodynamic studies in children exhibiting the characteristics identified in the subgroup analysis. We believe that evaluating bladder capacity values, especially obtained from invasive studies, in conjunction with clinical findings can prevent misdiagnosis, over investigation and overtreatment in children with non-neurogenic LUTD.

Management Modalities of Primary Bladder Neck Obstruction in Young Adult Men: A Systematic Review and Meta-analysis.

This systematic review was done to critically appraise the various evidence available in the literature for the presenting symptoms, diagnosis, and management modalities for primary bladder neck obstruction diagnosed on invasive urodynamics in young adult men 18-50 years of age. A search was conducted on PubMed, Embase, and Cochrane Central Register of Controlled Trials databases until July 2022 to find English-language studies relevant to the topic. A total of 10 studies were included. The estimated difference in International Prostate Symptom Score between baseline and 3 months in the subgroup of medical and surgical treatment was found to be -8.82 and -11.25, respectively (P = .37), and after 12 months, it was found to be -7.69 and -17.70 respectively (P .001). The pooled estimate for the difference in Qmax between baseline and 3 months after medical and surgical treatments in the subgroup was found to be 2.92 and 7.03, respectively (P = .18), and after 12 months, it was found to be 4.54 and 7.74, respectively (P .001). The pooled estimate of the difference in post-void residue before and after 3 months of medical and surgical treatments in a subgroup was found to be -31.15 and -70, respectively (P .001), and after 12 months, it was found to be -31.49 and -156.00, respectively (P .001). Quality of life scores improved in both subgroups. The alpha-blockers are effective in managing primary bladder neck obstruction in the short term, while bladder neck incision is preferred for better longterm outcomes.

Urodynamic assessment of detrusor function in the very acute phase of traumatic spinal cord injury: A prospective cohort study.

The bladder is believed to be acontractile due to the phase of spinal shock and there is a lack of data on the detrusor function within the first few days after spinal cord injury (SCI). This study intended to assess the detrusor function with invasive urodynamics (UDS) during the first 15 days of SCI. This prospective observational study was carried out from January 2020 to June 2021 and consecutive stable patients older than 18 years of age who had a history of traumatic SCI within the past 15 days were screened for inclusion. For each patient, the International Standards for Neurological Classification of SCI Worksheet was filled. All patients underwent bedside invasive UDS within 15 days of injury. There were a total of 41 patients with a mean age of 35 years. The thoracic cord was most commonly involved (46.3%) with Type A AISA grade being the most common (68.2%). The mean duration of injury at the time of UDS was 6 days. Abnormality in the filling phase could be identified in six patients. Three patients had neurogenic detrusor overactivity (NDO), with one having a high-pressure phasic NDO and one having a sustained NDO. Two patients had poor compliance and one had borderline poor compliance. None of the patients generated any detrusor pressure during voiding cystometry. In patients with SCI, 14.5% of the patients had abnormal findings during the filling phase on the UDS performed within 15 days of the injury. These findings are in stark contrast to the traditional understanding that the detrusor is acontractile during the early phase of the SCI and merit further evaluation.

Could a better understanding of the underlying pathophysiologies lead to more informed treatment choices in patients with lower urinary tract dysfunction due to an acontractile or underactive detrusor? ICI-RS 2023.

The underlying pathophysiology behind a diagnosis of acontractile or underactive detrusor at invasive urodynamics is very heterogeneous. Lack of etiological classification currently limits the possibility of stratifying therapy. This subject was discussed at a think-tank on the subject at the International Consultation on Incontinence-Research Society held in Bristol, June 2023. This manuscript is a result of those deliberations and the subsequent discussions of the think-tank. There are challenges in defining abnormalities of detrusor contraction with resultant implications for available evidence. Pathology at any level of the neuromuscular pathway can impair or prevent a detrusor voiding contraction. Attempts have been made to identify clinical markers that might predict an underactive detrusor but strong supporting evidence is lacking. Hence, a holistic approach to phenotyping requires specialized neuro-imaging as well as physiological investigations. Several general measures can help individuals with an abnormal detrusor contraction. The search for a molecule to enhance the detrusor voiding contraction remains elusive but there are promising new candidates. Neuromodulation can help select individuals but data is not well stratified by underlying etiology. Manipulation of central neurotransmitters might offer an alternate therapeutic option. A better understanding of the underlying pathophysiologies behind an abnormality of the detrusor voiding contraction is needed for improving management. Towards this goal, the think-tank proposes a classification of the underactive detrusor that might help in selecting and reporting more well-defined patient cohorts.

First in Human Subjects Testing of the UroMonitor: A Catheter-free Wireless Ambulatory Bladder Pressure Monitor.

Urodynamics is the standard method of diagnosing bladder dysfunction, but involves catheters and retrograde bladder filling. With these artificial conditions, urodynamics cannot always reproduce patient complaints. We have developed a wireless, catheter-free intravesical pressure sensor, the UroMonitor, which enables catheter-free telemetric ambulatory bladder monitoring. The purpose of this study was twofold: to evaluate accuracy of UroMonitor pressure data, and assess safety and feasibility of use in humans. Eleven adult female patients undergoing urodynamics for overactive bladder symptoms were enrolled. After baseline urodynamics, the UroMonitor was transurethrally inserted into the bladder and position was confirmed cystoscopically. A second urodynamics was then performed with the UroMonitor simultaneously transmitting bladder pressure. Following removal of urodynamics catheters, the UroMonitor transmitted bladder pressure during ambulation and voiding in private. Visual analogue pain scales (0-5) were used to assess patient discomfort. The UroMonitor did not significantly alter capacity, sensation, or flow during urodynamics. The UroMonitor was also easily inserted and removed in all subjects. The UroMonitor reproduced bladder pressure, capturing 98% (85/87) of voiding and nonvoiding urodynamic events. All subjects voided with only the UroMonitor in place with low post-void residual volume. Median ambulatory pain score with the UroMonitor was rated 0 (0-2). There were no post-procedural infections or changes to voiding behavior. The UroMonitor is the first device to enable catheter-free telemetric ambulatory bladder pressure monitoring in humans. The UroMonitor appears safe and well tolerated, does not impede lower urinary tract function, and can reliably identify bladder events compared to urodynamics.

77 - Invasive urodynamics in patients with complicated urinary incontinence: A modified Delphi consensus

77 - Invasive urodynamics in patients with complicated urinary incontinence: A modified Delphi consensus

74 - Invasive urodynamics in patients with refractory overactive bladder: A modified Delphi consensus

74 - Invasive urodynamics in patients with refractory overactive bladder: A modified Delphi consensus

Defining bladder outlet obstruction and detrusor underactivity in females with overactive bladder: Are we forgetting about the free uroflowmetry?

Both detrusor underactivity (DU) and bladder outlet obstruction (BOO) can coexist in patients with overactive bladder. Definitions of both DU and BOO are based on pressure-flow study (PFS) data. However, invasive urodynamics study can differ from a natural micturition, in fact, discrepancies between free uroflowmetry (UFM) and PFS have been largely described. Our goal is to assess the correlation of free-flowmetry and PFS among patients with OAB and to evaluate how different definitions of DU/BOO are able to discriminate patients with different free UFMs. A retrospective review of urodynamics performed at a single institution was conducted. Females with OAB who voided more than 150 mL in both UFM and PFS were included. Parameters from both voiding episodes were compared with nonparametric test. Two definitions of DU were applied; PIP1: Pdet@Qmax+Qmax < 30 and Gammie: Pdet@Qmax < 20 cmH2 O, Qmax < 15 mL/s, and BVE < 90% (Bladder voiding efficiency). Also,two definitions of obstruction were chosen; Defretias: Pdet@Qmax ≥25 cmH2 O and Qmax ≤ 12 mL/s and Solomon-Greenwell female BOO index ≥ 18. Patients who matched with each definition were compared to those who did not, to assess if any definitions were able to discriminate different noninvasive uroflowmetries. A total of 195 patients were included. Overall, mean age was 55 ± 12 years, 90.8% had mixed urinary incontinence, and 39% complained of at least one voiding symptom. Globally, Qmax and BVE correlated poorly between UFM and PFS, showing that most of the variation corresponded to a systematic error. Twenty-two individuals were found to have DU, they had a difference of 13 mL/son both maximum flows. Fifty-four patients showed BOO, with a difference between their Qmax of 19 mL/s. Among the four definitions analyzed, only PIP1 and Defreitas were able to discriminate patients with actually a lower Qmax on the free UFM. Patients with overactive bladder seem to have a systematic discordance between the urine flow of the free and invasive studies. Current definitions of DU and BOO, which are based on the PFS parameters, are not consistently able to discriminate patients who actually void deficiently on the free UFM.

PD33-10 NON-INVASIVE OPTICAL DETERMINATION OF DETRUSOR PRESSURE RELATED TO DETRUSOR OVERACTIVITY

You have accessJournal of UrologyCME1 Apr 2023PD33-10 NON-INVASIVE OPTICAL DETERMINATION OF DETRUSOR PRESSURE RELATED TO DETRUSOR OVERACTIVITY Lynn Stothers, Andrew Macnab, Naser Hakimi, W. N. J. M. Colier, P. Pourabbassi, and M. Maresse Lynn StothersLynn Stothers More articles by this author , Andrew MacnabAndrew Macnab More articles by this author , Naser HakimiNaser Hakimi More articles by this author , W. N. J. M. ColierW. N. J. M. Colier More articles by this author , P. PourabbassiP. Pourabbassi More articles by this author , and M. MaresseM. Maresse More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003326.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Gold standard urodynamic studies use invasive methods and artificial filling of the bladder to determine detrusor pressure, a critical physiologic measure in determining care for lower urinary tract symptoms (LUTS). The benefits of non-invasive measurement of detrusor pressure (Pdet) include natural filling observations & the potential for a homebased wearable with real time data to determine both self-care and monitoring. Aim: to develop a wearable optical based technology to relate non-invasively measured changes in Pdet during natural filling. METHODS: A 10 x 10 cm optical grid using light emitting diodes (LED’s) (750 nm – 950 nm) was engineered & positioned suprapubically during simultaneous multichannel urodynamics (UDS). LED’s were paired with photodetectors, sampling at 50Hz from long (deep) and short (superficial) channels facilitating optical output compared to variations in Pdet. Output: Arterial pulse waveform changes in chromophore concentration related to variations in detrusor oxygenation (O2Hb), & fluctuations in the absorption of photons at 950nm (H20) related to CMG volume increases. Peak & trough envelopes were computed with Hilbert transformation and a filtered moving average was used mathematically. RESULTS: N=25 (5 controls no LUTS & 20 NLUTD female=N=5 age 64-82 yrs ASIA A, B & D; male=N=15 age 33 – 79 yrs being ASIA A,B,C & D. NLUTD management included: N=4 subjects using clean intermittent catheterization (CIC), 2 condom drainage, 5 using combinations of CIC and spontaneous voiding, 4 spontaneous voiding only. No subjects used anticholinergics, B 3 agonists or prior intra detrusor botulinum toxin. Controls: natural filling and uroflow, no LUTS on IPSS or UGDI, no prior GU surgery, volumes >150cc, repeated filling & emptying for internal consistency measures. CONCLUSIONS: A prototype wearable able to derive a real-time, non-invasive measure reflecting detrusor pressure was successfully prototyped. If further research confirms the ability of an optical parameter derived in this way to mirror variations in detrusor pressure, benefits that would accrue include: more frequent assessment than is possible with invasive UDS, & the ability to monitor changes in pressure continuously in an at risk population (e.g. NLUTD at risk for autonomic dysreflexia). Source of Funding: Craig H Neilsen Foundation © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e917 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Lynn Stothers More articles by this author Andrew Macnab More articles by this author Naser Hakimi More articles by this author W. N. J. M. Colier More articles by this author P. Pourabbassi More articles by this author M. Maresse More articles by this author Expand All Advertisement PDF downloadLoading ...

Female voiding dysfunction: Survey of practice patterns amongst Indian urologists

Introduction:We report the findings of a survey conducted to ascertain practice patterns of members of the Urological Society of India (USI) with regard to diagnosis and management of female voiding dysfunction (FVD). Methods:A19-question survey was conducted on the SurveyMonkey® platform from December 17, 2019 to January 9, 2020. Questions included demographic details of respondents and policies regarding evaluation and treatment of FVD. Results:1278 of the 2649 qualified urologists of USI responded (48.2%). 1090 valid responses were included in the final analysis. While the majority of the respondents opted to check post void residual urine and 2/3rd ordered uroflowmetry in patients presenting with history of poor flow and/or incomplete emptying of urine, 38.6% and 45.7% of the respondents did not consider invasive urodynamics and cystoscopy, respectively, to be appropriate investigations in these patients. 29.6% were comfortable in dilating the urethra of female patients based on obstructive symptoms alone. 60% of respondents had performed at least one of the specialized surgical procedures for FVD. Conclusion:Most Indian urologists treat FVD with 60% having at least some experience with surgical interventions. However, this survey revealed considerable heterogeneity and identified critical lacunae in the practice of FVD by Indian urologists. Inappropriate evaluation and management practices are surprisingly common. Findings of this survey could be useful in designing appropriate training programs for practitioners.

International Survey on Urodynamic Investigations in Women Undergoing Stress Urinary Incontinence Surgery

To evaluate the role of invasive urodynamics (UD) in women candidates for stress urinary incontinence (SUI) surgery. This was a worldwide survey on current trends in use of preoperative invasive UD in women undergoing SUI surgery. Demographic respondents' data, whether routine invasive UD is performed before surgery and its diagnostic role were investigated. The survey was completed by 504 respondents: urologists 83.1%, gynecologists 16.8%. UD findings were reported influencing the surgical decision in 84.3% of the cases and may change planned surgery in 72.4%, may discourage it in 43.6%, may change surgical expectations in 55.5%, and are useful for preoperative counselling in 96.6%. We found a very low rate of routine performance of UD for uncomplicated SUI. The most impactful UD findings were related to the conditions of detrusor contractility, overactivity and underactivity. Among voiding disorders, dyssynergia was considered the most relevant dysfunction. Valsalva Leak Point Pressure was the most reported tool to investigate urethral function. The surgical management was influenced by UD findings in the vast majority of the cases, although about 60% reported that a relevant impact of the UD occurred in less than 40% of the investigations. The crucial effect of UD on surgical management was high. This finding showed that for many respondents UD still has a pivotal role before SUI surgery. This survey showed a worldwide picture on preoperative UD in SUI surgery highlighting the crucial role of UD. UD investigation influences surgical management, but whether it influences outcomes is unclear.