Urodynamic Testing

Since you were a teenager, or maybe even younger, you were probably aware that gynecologists existed. You knew that, as you matured, they were there for your basic women’s health issues, annual checkups, Pap smears and other feminine physical needs. It probably wasn’t until you began experiencing problems that you learned about different specialists and subspecialists. Words like ‘female pelvic medicine reconstructive surgeon’ (FPMRS), urogynecologist and urodynamic testing may have begun to litter your doctor’s vocabulary, and though they may sound daunting, they’re very simply explained.

From the time you were potty trained, the exercise of urinating was something you did automatically. Your body told you when it was time to go and, depending on the intensity of the message your bladder was sending you, you either strolled, trotted, or ran to the bathroom to take care of business.

However, as you age, you may have noticed some changes – unexpected involuntary leaks when you laugh or cough, sudden urges that leave you very little time to make it to the toilet, recurring infections, discomfort and maybe even the need to rush right back into the bathroom.

When your quality of life becomes compromised, our experts are here to step in. Our FPMRS accredited specialists are intensely educated urogynecologists and experts in the field of women’s pelvic health issues. One of the many things we do is recommend and administer urodynamic testing to study, and subsequently, correct your urinary problems or disorders.

What is Urodynamic Testing?

Urodynamic testing is a series of tests that are run in order to evaluate exactly how well the bladder, sphincter and urethra are functioning in their job of storing and emptying the urine in your body. These tests can accurately pinpoint the reason for your particular problem.

Why Might You Need Urodynamic Testing?

You may need one or several different urodynamic tests if a routine pelvic examination does not reveal a visible reason for your problem. Your doctor may then recommend further testing if you have experienced any of the following:

• A pressing need to urinate without any flow
• Difficulty in starting urine flow
• Difficulty emptying your bladder completely
• Recurring urinary tract infections
• Burning or painful urination
• Unexpected and sudden urge to urinate
• Slow urine flow
• A need to urinate immediately after voiding
• Frequent urination (polyuria): You suddenly need to void more often than is normal for you, or find that you need to use the bathroom two times or more nightly (nocturia).
• Urge incontinence or overactive bladder (OAB): This is an uncontrollable leakage resulting from the inability to reach a restroom in time.
• Stress incontinence: You experience bladder leakage while lifting, exercising, laughing, coughing or sneezing.

How Can You Prepare For These Tests?

You will probably be asked to stop any bladder medications you are currently taking. Some tests may require that you arrive with a full bladder, while in other cases, you will be asked to arrive earlier and drinks at the testing site. Your doctor will give you this information. Complete testing should take approximately 2 to 3 hours, but again, this depends entirely on what tests are required for your particular issue.

What Will Happen During the Test?

The first part of urodynamic testing deals with emptying your full bladder, checking for any residual urine, and monitoring your urine flow.

The second part examines how your bladder behaves as it fills up. Catheters are used for this and may cause some discomfort or pinching, but the experience is not intolerable.

Leakage is common and expected, so there is absolutely no need to be embarrassed by this. It is an important part of the testing. Your input as you answer questions throughout the process is also important. You will be asked to shift positions, stand and cough. Again, your body’s reaction is important to your diagnosis and subsequent treatment.

When testing is complete, you will be required to void again while the catheters are still attached, after which they will be removed and the testing will be complete.

What Tests are Performed During Urodynamic Testing?

There are several tests. Depending on your particular case, you may need one or more of the following:

• Video urodynamic test: While your bladder is filling and emptying, a technician will take pictures of the process, either through X-rays or via ultrasound. These are then studied, enabling your physician to make a diagnosis of your bladder function.
• Uroflowmetry: This test measure both how quickly you empty your bladder (free uroflowmetry) and the amount of pressure exerted (pressure uroflowmetry) while doing so. The purpose is to assess why there may be a problem voiding, and to check for any possible blockages or muscle weakness.
• Postvoid residual measurement: This measures any urine that is left in the bladder after you’ve finished urinating. Measurement can be obtained through either catheter tube drainage directly from the bladder or through an ultrasound scan. Depending on how much urine is extracted or scanned, anything over 100 milliliters may indicate inefficient bladder evacuation.
• Multichannel Cystometry: Under local anesthesia, two pressure catheters are placed in the rectum and the bladder to gauge bladder capacity, and to determine the amount of pressure buildup as the bladder fills with warm water. You will be required to indicate when the urge to urinate begins. This procedure can also determine if there are contractions while the bladder fills, or it can pinpoint the bladder muscle (detrusor) that may not be contracting as it should.
• Leak Point Pressure Measurement: During the cystometric test, while the bladder is filling, a sudden contraction may occur resulting in some of the water squirting out. This test, where one of the previously mentioned catheters is equipped with a pressure sensor called a manometer, measures the pressure at that leak point moment. You may also be asked to cough, or hold your nose and mouth while trying to exhale (Valsalva maneuver) at this time to check for any urine leakage that may indicate stress incontinence, and for any sphincter deficiency.
• Electromyography: This test determines if the bladder neck and sphincters are working correctly by using special sensors to measure bladder and sphincter electrical activity. Depending on where the sensors are placed, the procedure may or may not require local anesthesia.
• Cystoscopy: a camera is inserted through the urethra and into the bladder to check for any bulge, (diverticula) tumors, enlarged kidneys, or foreign bodies.
• Fluoroscopic Urodynamics Study (FUDS): This is a sophisticated computerized study that measures the pressure readings of both the bladder neck and urethra while you are voiding.

How Long Does it Take to Get Results?

Uroflowmetry and cystoscopy results can usually be given to you the same day. Several other tests may take up to a few days, but you should have all your results within two weeks.

What Can I Expect After Testing is Complete? Are There Any After Effects?

You may feel a little burning upon urination for a few hours. In order to minimize this discomfort, drinking a glass of water every half hour may help. A warm bath, or even a warm washcloth held against the sensitive site helps as well.

Avoid caffeine or any strong beverages for about 48 hours to minimize irritation upon urination. Take your time urinating to make sure your bladder is empty, and try voiding again after about a minute to make sure it is.

It is normal to see a small amount of blood in the urine after urodynamic testing. However, this should not last more than 24 hours.

Infections rarely occur, but should you experience any of the following, contact your doctor immediately:

• Fever
• Chills
• Excessive bleeding
• Pain that exceeds mild discomfort
• Foul smelling, bloody or cloudy urine
• Lower back pain in the area of your kidneys
• Burning or stinging while urinating even several hours after testing
• An urgent need to urinate
• Frequent urge to urinate at night.

What Are My Treatment Options?

Once the results are reviewed and a diagnosis is made, your treatment plan may vary. A simple exercise regimen may be all you need. Medication, if necessary, will be prescribed. If a pessary, a mesh or even surgery is warranted, your doctor will discuss this with you and arrangements will be made. You will be informed of all your options, and any questions you have will be answered frankly, openly and honestly.

Voiding orders are very common in women, especially after giving birth or as you age. Early recognition, prevention and treatment are extremely important in order to avoid more serious problems or further pelvic health damage. We can help you.

If you are experiencing bladder problems, make an appointment today at 770.720.7733.