Basics of videourodynamics for adult patients with lower urinary tract dysfunction

Wyndaele, Michel

doi:10.1002/nau.23778

Cited by 19 publications

(7 citation statements)

References 24 publications

(38 reference statements)

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“…An important technical confounder of intravesical pressure measurement is pressure venting by a large diverticulum or (secondary) vesicoureteral reflux. Such venting can lead to a gross underestimation of storage pressures and may lead to misclassification of patients 24 . Reflux (5%) and bladder diverticulum (11%) have been noted in men undergoing videourodynamics 20 .…”

Section: Discussionmentioning

confidence: 99%

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Is isolated bladder outlet obstruction associated with hydronephrosis? A database analysis

Sinha

Matai

2020

Neurourology and Urodynamics

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Aims: To examine whether isolated bladder outlet obstruction in the absence of associated lower urinary tract abnormality results in hydronephrosis. Isolated obstruction causes a brief rise in bladder pressure that might not trigger hydronephrosis. Methods: Data included adult men who underwent urodynamics for refractory non-neurogenic lower tract symptoms between 2011 and 2020. International Continence Society indices for obstruction (bladder outlet obstruction index [BOOI] ≥ 40) and underactivity (bladder contractility index [BCI] < 100) were calculated. Storage abnormality was defined as detrusor overactivity (DO) or poor compliance (<20 ml/cm H 2 0). Isolated obstruction was defined as BOOI ≥ 40, BCI ≥ 100 and no storage abnormality. Nonparametric tests using R program (3.5.0) applied (p < .05 significant). Logistic regression analyses were performed to study the relationships of hydronephrosis with lower urinary tract function. Results: A total 1596 men (range, 18-91 years; median, 51.0 years; Q3, 64.0 years; Q1, 34.0 years) were eligible. Hydronephrosis was noted in 274 (17.2%). A total of 45.4% were obstructed, 52.3% were underactive and 41.7% had storage abnormality. Storage abnormality (odds ratios [OR], 2.05; 95% confidence interval [CI]: 1.56, 2.69; p < .001) and bladder contractility (OR, 1.68; 95% CI, 1.25-2.26; p < .001) but not obstruction (OR, 1.07; 95% CI, 0.80-1.44; p = .634) was associated with hydronephrosis. Of eight possible combinations, men with BOO ≥ 40, BCI ≥ 100 and storage abnormality had highest probability of hydronephrosis (OR, 0.29; 95% CI, 0.24-0.33). Subanalysis showed that poor compliance (OR, 3.39; 95% CI, 2.49-4.60; p < .001) but not DO was associated with hydronephrosis. Younger age and higher postvoid residual urine were also associated with hydronephrosis. Conclusions: In adult men with refractory non-neurogenic lower urinary tract symptoms, isolated bladder outlet obstruction is not associated with hydronephrosis.

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Section: Discussionmentioning

confidence: 99%

“…Such venting can lead to a gross underestimation of storage pressures and may lead to misclassification of patients. 24 Reflux (5%) and bladder diverticulum (11%) have been noted in men undergoing videourodynamics. 20 While reflux may lead to under-recording of pressure, a large bladder diverticulum might protect the upper tracts.…”

Section: Discussionmentioning

confidence: 99%

Is isolated bladder outlet obstruction associated with hydronephrosis? A database analysis

Sinha

Matai

2020

Neurourology and Urodynamics

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“…The review focusses on cystometry and PFS in adults without relevant neurological abnormalities and with intact “normal” anatomy of the LUT. Flow rate testing and video‐urodynamics are described in separate documents.…”

Section: Methodsmentioning

confidence: 99%

Fundamentals of urodynamic practice, based on International Continence Society good urodynamic practices recommendations

Drake

Doumouchtsis

Hashim

et al. 2018

Neurourology and Urodynamics

101

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Aims To review the recommendations on basic urodynamic testing in the International Continence Society (ICS) standardization documents, specifying key recommendations for delivery and interpretation in clinical practice. Methods Fundamental expectations described in the ICS standards on good urodynamic practices, urodynamic equipment, and terminology for lower urinary tract (LUT) function were identified and summarized. Results The ICS standard urodynamic protocol includes clinical history, including symptom and bother score(s), examination, 3‐day voiding chart/diary, representative uroflowmetry with post‐void residual, and cystometry with pressure‐flow study (PFS). Liquid filled catheters are connected to pressure transducers at the same vertical pressure as the patient's pubic symphysis, taking atmospheric pressure as the zero value. Urodynamic testing is done to answer specific therapy‐driven questions for treatment selection; provocations are applied to give the best chance of reproducing the problem during the test. Quality of recording is monitored throughout, and remedial steps taken for any technical issues occurring during testing. Labels are applied during the test to document events, such as patient‐reported sensation, provocation tests, and permission to void. After the test, the pressure and flow traces are scrutinized to ensure artefacts do not confound the findings. An ICS standard urodynamic report details the key aspects, reporting clinical observations, technical, and quality issues. Urodynamic services must maintain and calibrate equipment according to manufacturer stipulations. Conclusions The review provides a succinct summary of practice expectations for a urodynamic unit offering cystometry and pressure flow studies (PFS) to an appropriate standard.

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“…Note that the approach is technically analogous to videourodynamics, which is used in urological clinical practice for the diagnosis of LUTd in selected patients (13). A key difference is that we imaged mice at video rate for the entire duration of the videocystometry experiments, whereas during videourodynamics in patients, only a few x-ray images ("snap shots") can be taken to minimize radiation damage (13). We initially established videocystometry in urethane-anesthetized mice (Figs.…”

Section: Establishment Of Videocystometrymentioning

confidence: 99%

X-ray videocystometry for high-speed monitoring of urinary tract function in mice

et al. 2021

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Lower urinary tract dysfunction (LUTd) represents a major health care problem with a high, unmet medical need. Design of additional therapies for LUTd requires precise tools to study bladder storage and voiding (dys)function in animal models. We developed videocystometry in mice, combining intravesical pressure measurements with high-speed fluoroscopy of the urinary tract. Videocystometry substantially outperforms current state-of-the-art methods to monitor the urine storage and voiding process, by enabling quantitative analysis of voiding efficiency, urethral flow, vesicoureteral reflux, and the relation between intravesical pressure and flow, in both anesthetized and awake, nonrestrained mice. Using videocystometry, we identified localized bladder wall micromotions correlated with different states of the filling/voiding cycle, revealed an acute effect of TRPV1 channel activation on voiding efficiency, and pinpointed the effects of urethane anesthesia on urine storage and urethral flow. Videocystometry has broad applications, ranging from the elucidation of molecular mechanisms of bladder control to drug development for LUTd.

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Basics of videourodynamics for adult patients with lower urinary tract dysfunction

Cited by 19 publications

References 24 publications

Is isolated bladder outlet obstruction associated with hydronephrosis? A database analysis

Is isolated bladder outlet obstruction associated with hydronephrosis? A database analysis

Fundamentals of urodynamic practice, based on International Continence Society good urodynamic practices recommendations

X-ray videocystometry for high-speed monitoring of urinary tract function in mice

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