ICS teaching module: Ambulatory urodynamic monitoring

Digesu, G. Alessandro; Gargasole, Clara; Hendricken, Caroline; Gore, Michelle; Kocjancic, Ervin; Khullar, Vik

doi:10.1002/nau.22933

Cited by 19 publications

(12 citation statements)

References 26 publications

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“…However, DO could be of importance in terms of its effect prediction of other treatments. The ICS urodynamics committee recommends the use of ambulatory-UDS as a second line diagnostic in specific cases [25]. Our study shows that objective improvement on ambulatory-UDS is associated with the standard evaluation parameters of subjective treatment success and the more objective voiding diary parameters.…”

Section: Discussionmentioning

confidence: 51%

The Value of Ambulatory Urodynamics in the Evaluation of Treatment Effect of Sacral Neuromodulation

et al. 2019

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Objectives: To assess the improvement of symptoms by sacral neuromodulation (SNM) in an objective way by carrying out an ambulatory urodynamic study (ambulatory-UDS). Until now, successful treatment has been defined as a ≥50% improvement recorded on voiding diaries. Voiding diaries are a patient reported outcome tool. A tool with less bias is desired to evaluate the treatment results before an expensive permanent system is implanted. Methods: Between 2002 and 2015, a total of 334 patients with lower urinary tract symptoms were included consecutively in an ambulatory-UDS database. From this database, a subgroup of patients was selected which underwent SNM. Results: In 51 patients, an ambulatory-UDS was performed both at baseline and during the SNM test period. A positive treatment outcome after test stimulation based on the patients’ voiding diary, correlated (p < 0.0001) with an improvement on ambulatory-UDS. Twenty-six of the 30 patients, who have showed improvement of more than 50% on voiding diary parameters and who had subjective improvement of their symptoms, showed an early improvement on ambulatory-UDS. Conclusions: Ambulatory-UDS can be used in clinical decision making, as it is associated with voiding diary improvement during the SNM test period. Using ambulatory-UDS to confirm success could in the future justify the shortening of the test period.

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Section: Discussionmentioning

confidence: 51%

The Value of Ambulatory Urodynamics in the Evaluation of Treatment Effect of Sacral Neuromodulation

et al. 2019

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“…The longer duration of observation has increased detection of urodynamic abnormalities such as detrusor overactivity. [5,6] However, this technique has seen limited usage in practice. Catheters may cause discomfort or become dislocated.…”

Section: Introductionmentioning

confidence: 99%

Wireless intravesical device for real-time bladder pressure measurement: Study of consecutive voiding in awake minipigs

et al. 2019

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Traditional urodynamics have poor correlation with urological symptoms. Ambulatory urodynamics may improve this correlation but the need for a transurethral catheter and the time-consuming nature of this examination limits its use. Therefore, the objective of this study was to develop a wireless real-time bladder pressure measurement device for repeated and prolonged-term measurement of bladder behavior in awake pigs. The Bladder Pill is an intravesical device with a pressure microsensor and a 3-dimensional inductive coupling coil for energy supply. A corresponding external coil provides wireless power transmission and real-time communication of bladder pressure data. To test the correlation between the pressure data measured by the device and by standard methods, we compared static water column pressures with this device and water-filled urodynamic catheter systems. In vivo assessment of awake voiding by the pill was done by introducing the bladder pill into the bladder of Göttingen minipigs. An air-charged urodynamic catheter was introduced transurethrally as control for pressure measurements. The optimal physical configuration of the pill was investigated to maximize the containment in the bladder. We used two versions of external signal receivers (one waistband and one rectangular frame) to test the optimal external signal capture. Next to that, we performed short-term and medium-term comparative pressure studies. The in vitro static pressure measurement demonstrated a mean difference of less than 1 cm H2O between the methods. The optimal design of the pill for maximal retainment in the bladder proved to be a pigtail configuration. The bending of the device during bladder contractions caused offset of 2.7 +/- 1.4 cm H2O (mean +/- SD) on the pressure measurements. The rectangular frame performed signal capture during 5 consecutive voids with a good correlation of the pressure measurements. The device can be inserted through the urethra and is retrieved using string or endoscopic extraction. In conclusion, wireless long-term measurement of bladder pressure is demonstrated and yields comparable results to current available catheter methods of measurement in a pig model.

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“…Last, considerable embarrassment and a lack of privacy (due to continual observation by clinicians, nurses and technicians) leads to many individuals being unable to void during UDS, which greatly limits the diagnostic information obtained from the study. Together, these shortcomings result in 19-44% of UDS being nondiagnostic 28 .…”

Section: Diagnostic Failurementioning

confidence: 99%

“…One would expect that transient symptoms in patients with intermittent claudication represent an excellent example of a time during which a short office study might be negative whereas a longer physiological study could identify pathology. In patients with nondiagnostic conventional UDS, one study reported that AUM improved the detection of OAB compared with conventional UDS 28 . In a prospective study of 106 women with UUI, involuntary detrusor activity was identified in 32 patients using conventional UDS and in 70 patients using AUM (patients underwent both procedures in a randomized crossover design) 12 .…”

Section: Ambulatory Urodynamic Monitoringmentioning

confidence: 99%

Ambulatory urodynamic monitoring: state of the art and future directions

et al. 2019

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Urodynamic studies are a key component of the clinical evaluation of lower urinary tract dysfunction and include filling cystometry, pressure-flow studies, uroflowmetry, urethral function tests and electromyography. However, pitfalls of traditional urodynamics include physical and emotional discomfort, artificial test conditions with catheters and rapid retrograde filling of the bladder, which result in variable diagnostic accuracy. Ambulatory urodynamic monitoring (AUM) uses physiological anterograde filling and, therefore, offers a longer and more physiologically relevant evaluation. However, AUM methods rely on traditional catheters and pressure transducers and do not measure volume continuously, which is required to provide context for pressure changes. Novel telemetric AUM (TAUM) methods that use wireless, catheter-free, batterypowered devices to monitor bladder pressure and volume while patients carry out their daily activities are currently being investigated. TAUM devices under current development are innovating in the areas of remote monitoring, rechargeable energy sources, device deployment and retrieval and materials engineering to provide increased diagnostic accuracy and improved comfort * damasem@ccf.org. Author contributions Competing interests S.M. and M.S.D. are co-inventors on a patent titled 'Implantable Pressure Sensor' (US 10,143,391 B2), which might be perceived as a competitive technology to those described in this paper. This patent is assigned jointly to the Cleveland Clinic, Case Western Reserve University and the US Department of Veterans Affairs. It has not been licensed or optioned by a company. Additional related intellectual property with S.M. and M.

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ICS teaching module: Ambulatory urodynamic monitoring

Cited by 19 publications

References 26 publications

The Value of Ambulatory Urodynamics in the Evaluation of Treatment Effect of Sacral Neuromodulation

The Value of Ambulatory Urodynamics in the Evaluation of Treatment Effect of Sacral Neuromodulation

Wireless intravesical device for real-time bladder pressure measurement: Study of consecutive voiding in awake minipigs

Ambulatory urodynamic monitoring: state of the art and future directions

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