PARIS, FRANCE (UroToday.com) - The workshop provided a very good review of urodynamic studies including conventional or “office based,” ambulatory, and video UDS.
Werner Schaefer, of the University of Pittsburgh, presented the concepts of good UDS practice. He noted that UDS should reproduce a patient’s symptoms under the condition of precise measurement allowing the clinician to identify the underlying causes.
He reviewed sample records that patients were asked to complete, including a micturition time chart which noted the times of micturitions - day and night, frequency - and a volume chart that records micturitions (plus amount voided), and a bladder diary that recorded voiding times, voided volumes, UI episodes and severity, product use, fluid intake, and degree of urgency. He reviewed multiple tracings of actual UDS studies noting the different measurements.
According to Dirk Jensen, a urologist from the Netherlands, ambulatory UDS (AUDS) has been defined by the International Continence Society (ICS) as any functional test of the lower urinary tract predominantly utilizing natural filling of the urinary tract & reproducing the subject’s normal activity (activities and maneuvers of the subject during which symptoms are likely to occur). Indications for AUDS include neurogenic LUT dysfunction, and in those patients, when regular UDS fails to reproduce or explain the patient’s symptoms (up to 50% of DO is missed) and assessing when AUDS are unsuitable. However, there are practical problems with AUDS, as patients need extensive instructions, the clinician needs to test catheters in multiple positions, and the patient needs regular checks for catheter displacement (after voiding). It is felt that a VD is essential with AUDS. There are advantages and disadvantages as AUDS provides a longer-term evaluation of bladder dynamics with natural physiological bladder filling during normal daily activity. It is felt that there is a more accurate diagnosis of DO and the assessment of the causes of UI. But the disadvantages may outweigh the benefits as AUDS is very labor intensive, with more artifacts and requires the catheter to be in place for a much longer period of time.
A third type of UDS is video UDS (VDUS) defined as a combination of office-based UDS with X-ray or ultrasound real time images of both the upper and lower urinary tract during the filling and voiding phase. VUDS can be especially helpful in patients with neurogenic bladder dysfunctions, DSD, bladder outlet obstruction, and renal reflux. Professor Jensen also provided a review of the guidelines for UDS in neurogenic LUT dysfunction and their use in pediatric patients.
Presented at the 13th International European Association of Urology Nurses (EAUN) Meeting - February 25 - 27, 2012 - Le Palais des Congrès de Paris, Paris, France