Defining achievable standards in urodynamics—a prospective study of initial resting pressures

Sullivan, J.; Swithinbank, Lucy; Abrams, Paul

doi:10.1002/nau.21229

Cited by 25 publications

(37 citation statements)

References 11 publications

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“…This range can be used as a reference level for neurogenic bladder patients. This initial resting level is lower than has been observed for nonneurogenic groups [3,7,8]. Whether the difference between different patient groups is statistically significant should be the subject of future studies based on the data obtained at our center.…”

Section: Discussionmentioning

confidence: 61%

Typical Value Ranges and Typical Signal Patterns in the Initial Cough in Patients With Neurogenic Bladder: Quality Control in Urodynamic Studies

Liu

2016

Int Neurourol J

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PurposeThe goal of this study was to establish typical value ranges (TVRs) and to analyze typical signal patterns (TSPs) of the initial cough (cough before bladder filling) for quality control in urodynamic studies.MethodsA total of 539 urodynamic traces from patients with neurogenic bladder obtained over the course of a year were retrospectively reviewed. The TVRs for cough amplitude in measurements of the intravesical pressure (Pves), abdominal pressure (Pabd), and detrusor pressure (Pdet) during the initial cough were established. We used the 95% range as a reference range for all parameters. Cough spikes in Pdet were described and classified, and the reasons for different patterns of cough spikes were established. The quality of all the cystometry traces was checked, and we also present remedial actions for inappropriate cough spikes.ResultsThe cough amplitudes in the measurements of Pves and Pabd were similar, with 95% of measurements falling within the following ranges: 4–62 cm H2O and 3–70 cm H2O, respectively, in supine position and 9–95 cm H2O and 8–98 cm H2O, respectively, in sitting position. For Pdet, the cough amplitude ranged from −38 to 25 cm H2O in supine position and from −44 to 41 cm H2O in sitting position. The cough spikes for Pdet were classified as follows: type I, Pdet pressure exhibited a minimal change (<5 cm H2O) during the cough; type II, a monophasic spike (>5 cm H2O) was observed for Pdet; and type III, biphasic spikes were observed for Pdet. Type I coughs were found to have more high-quality traces (P<0.01).ConclusionsTVRs for the initial cough test among neurogenic patients were established in order to provide guidelines for quantitative quality control. The TSPs for the initial cough signal were described, and the presence of a high-quality cough signal may be recommended as a component of quality control in urodynamic measurements.

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Section: Discussionmentioning

confidence: 61%

Typical Value Ranges and Typical Signal Patterns in the Initial Cough in Patients With Neurogenic Bladder: Quality Control in Urodynamic Studies

Liu

2016

Int Neurourol J

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“…Typical ranges for p ves and p abd are: supine 5‐20 cmH 2 O; sitting 15‐40 cmH 2 O; standing 30‐50 cmH 2 O . Usually both recorded pressures are almost identical (and they must not be zero: see Figure ), so that the initial p det is is between −5 and +5 cmH 2 O in the majority . Gentle flushing of both catheter channels and/or filling 20‐30 mL into the bladder may be needed before the initial resting pressures are registered.…”

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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“…Initial resting pressure (NEW) is the p ves and the p abd pressure at the beginning of the cystometry. To prevent reading measurements from a kinked catheter in an empty bladder with the catheter holes blocked with (insertion) gel and/or pushed against the bladder surface, the WG recommends (GUP2002) gentle flushing of both catheter channels and/or filling 20–30 mL of the bladder, before the initial resting intravesical pressures are considered to be “established.” Initial resting pressures should be within the physiological limits specified in previous manuscripts and GUP2002.…”

Section: Technical and Clinical Quality Control During Invasive Urodymentioning

confidence: 99%

International Continence Society Good Urodynamic Practices and Terms 2016: Urodynamics, uroflowmetry, cystometry, and pressure‐flow study

Rosier

Schaefer

Lose

et al. 2016

Neurourology and Urodynamics

447

562

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Defining achievable standards in urodynamics—a prospective study of initial resting pressures

Cited by 25 publications

References 11 publications

Typical Value Ranges and Typical Signal Patterns in the Initial Cough in Patients With Neurogenic Bladder: Quality Control in Urodynamic Studies

Typical Value Ranges and Typical Signal Patterns in the Initial Cough in Patients With Neurogenic Bladder: Quality Control in Urodynamic Studies

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

International Continence Society Good Urodynamic Practices and Terms 2016: Urodynamics, uroflowmetry, cystometry, and pressure‐flow study

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