Advanced Urodynamics(Urology)

Urodynamic is a procedure that looks at how well the bladder, sphincters, and urethra are storing and releasing urine. Most urodynamic tests emphasize the bladder’s ability to hold urine and empty it steadily and completely. Urodynamic tests can also show whether the bladder is having involuntary contractions that may cause urine leakage. A health care provider may recommend urodynamic tests if symptoms suggest problems with the lower urinary tract.

Lower urinary tract symptoms (LUTS) include:

1. Overactive Bladder (OAB): Children with OAB may feel an urgent need to urinate even when their bladder may not be full, and may use the bathroom more than 10 times per day or about every hour. Most children with OAB will have urinary tract infections (UTIs) and urinary incontinence, and sometimes these symptoms will be continued even after the UTI is treated. Some children may (unsuccessfully) try to “hold it” by crossing their legs or using other physical maneuvers. OAB is the most common type of voiding dysfunction and occurs in about 22% of children between the ages of 5 - 7 years old.

1. Dysfunctional Voiding: With this type of dysfunction, the muscles which control the flow of urine out of the body don’t relax completely, and the bladder never fully empties. This may cause a range of symptoms such as daytime wetting, night wetting, a feeling that the bladder is always full, urgency, and straining to urinate. With severe cases of dysfunctional voiding, children may develop symptoms similar to those of a neurogenic bladder and be at higher risk for complications such as kidney infection and disease.
2. Underactive Bladder: Children with an underactive bladder will urinate less than 3 times a day, or will be able to go for more than 12 hours without urinating. These children have to strain to urinate because the bladder muscle itself will be “weak” and doesn’t respond to the brain’s signal that it is time to go. Accidental wetting with underactive bladder is caused by the bladder becoming too full and overflowing.

1. Urine leakage.
2. Painful urination.
3. Frequent urination.
4. Sudden, strong urges to urinate.
5. Problems starting a urine stream.
6. Problems emptying the bladder completely.
7. Recurrent urinary tract infections.

Urodynamic tests may range from simple observation to precise measurements using sophisticated instruments. For simple observation, a healthcare provider may keep a record of the length of time that it takes a person to produce a urinary stream, note the volume of urine produced, and record the ability or inability to stop the urine flow in midstream. For precise measurements, imaging equipment takes pictures of the bladder filling and emptying, pressure monitors record the pressures inside the bladder, and sensors record muscle and nerve activity. The health care provider will decide the type of urodynamic test based on the person’s health information, physical exam, and LUTS. The urodynamic test results will help diagnose the cause and nature of a lower urinary tract problem.

Most urodynamic tests do not involve special preparations, though some tests may need a person to make a change in fluid intake or to stop taking certain medications. Depending on the test, a person will be instructed to arrive for testing with a full bladder.