Urodynamic Study Procedure in Hyderabad | Its Benefits & Cost

Before urodynamic test (preparation)

Most urodynamic study procedures don't require special preparation and planning. However, for some tests, a urologist may ask the patient to drink fluids before the test to keep the bladder full. It is recommended to ask the urologist any questions before the test.

The duration of each test varies. Usually, one can expect it to take 30–45 minutes on average. Urodynamic tests may not be painful. However, some may feel soreness for up to 24 hours afterward, but one cannot have severe pain. The patient may get the results from cystometry and uroflowmetry on the same day.

Test process of urodynamic studies involves continuous testing of the urine, to determine the diagnosis, plan treatment and to check whether the treatment is working or to monitor the disease over time. There are many types of urodynamic tests. A urologist may recommend one or more tests based on the person's symptoms. However, they are typically performed together as one test. The following are some of the common tests performed in the urodynamic study:

• Uroflowmetry
• Postvoid residual measurement:
• Cystometry or cystometrogram (CMG urodynamic study)
• Leak point pressure measurement
• Pressure flow study
• Electromyography
• Video urodynamic study
• Fluoroscopic urodynamic study
• Maximum urethral closure pressure (MUCP)

Uroflowmetry

Uroflowmetry measures the amount of urine in the patient's bladder and how fast the urine flows out (flow rate). It helps identify any difficulties in emptying the bladder. The results of the uroflowmetry may reveal any weakness of the bladder muscles or there is any blockage to the urine flow.

For this test, a urologist will ask the patient to arrive with a full bladder and to urinate into a special toilet or funnel (which has a container for collecting the urine and a measuring scale. The uroflowmetry equipment will help to measure the volume and speed of the urine and create a graph that shows modifications in the flow rate while the patient urinates.

A urologist uses a graph to visualize the flow rate's peak and the duration to reach it. The flow rate of the patient may also be estimated by recording how long it takes to urinate into a special container that precisely measures how much urine a patient release.

Postvoid residual measurement

This test measures the amount (how much) of urine left in the bladder after the patient urinates. Every person has a small amount of urine in the bladder after urination. If the patient has 100–150 milliliters of urine or more than that remains in the bladder, it indicates the bladder is not emptying completely. This test will be performed using ultrasound or by feeding a catheter (thin-flexible tube) into the patient's bladder to drain and measure the remaining urine.

Cystometry or cystometrogram (CMG urodynamic study)

It measures the bladder capacity (amount of urine a patient's bladder can hold), the amount of pressure that builds up inside the bladder as it stores urine, bladder elasticity, and how the patient's bladder feels during filling to detect if there are any abnormal bladder spasms during filling of the bladder. These tests help to identify problems with urine storage and how well the patient's bladder can hold urine without leaking.

During this process, a catheter will initially empty the bladder completely. Then a special, smaller catheter may use placed in the bladder, and another catheter will be positioned in the rectum or vagina to record pressure there. A manometer (pressure measuring device) will be used to calculate the pressure present with the catheter.

Once the patient completely empties the bladder, warm water will be used to fill the bladder slowly. Then, the patient will be asked to describe how the bladder feels, and when the patient begins feeling that urge to urinate, the volume of bladder pressure and water will be recorded. Afterward, the patient may be asked to cough or strain, stand up, or jog to see if the bladder pressure changes or if the patient leaks' urine. A cystometric test also identifies if the patient's bladder is contracting when it is not supposed to.

Cystometric abnormalities do not diagnose any underlying problem; however, they describe the functional disturbance itself.

Leak point pressure measurement

If the patient's bladder is being filled with warm water for the cystometric test, the bladder of that patient may suddenly contract and squeeze some water out without warning.

When the leakage occurs, a manometer measures the pressure inside the urinary bladder to identify the leak point pressure. This information may tell the urologists what kind of bladder problem a person has.

The patient may be asked to cough, shift position, or try to exhale while holding the nose and mouth. These actions help the urologist to evaluate the sphincters that help keep the patient's urine in:

• Abdominal leak point pressure: ALPP is the dynamic test, which measures the minimum (lowest) bladder pressure within the urinary bladder when the urine leaks due to increased abdominal pressure without a detrusor contraction during coughing.
• Valsalva leak point pressure: VLPP is a type of ALPP measurement. This test measures the minimum (lowest) bladder pressure causing urine leakage during the Valsalva maneuver (forceful exhalation) or coughing without muscle contractions.

These tests are helpful to assess urinary leakage without detrusor muscle contraction. A VLPP less than 60 cmH20 is thought to represent sphincter weakness, while over 90 cmH2O indicates sphincter competence. ALPP > 150cmH2O suggests incontinence is unlikely due to urethral weakness.

Pressure flow study

A pressure flow study is helpful to measure the amount of pressure needed for the bladder to urinate and how quickly the patient's urine flows at that pressure. This test finds any bladder outlet blockage that may be caused by prostate enlargement, cystocele, or urinary incontinence correction surgery.

During this procedure, the patient will be asked to pass urine using a small catheter inserted into the urethra. This test may help find the cause of a weak urinary stream. Normal values may be impacted by patient age and voided (urinating) volume. Flow patterns in pressure flow studies are the same as for another urodynamic study, such as uroflowmetry.

EMG will be used to test the electrical activity of the muscles in the pelvic area. EMG may help identify if a urinary problem is from the pelvic nerve or muscle damage. A urologist may recommend this test if the patient's urinary problem is likely related to muscle or nerve damage. Electromyography utilizes special sensors to calculate the electrical activity of the muscles and nerves around and within the bladder and sphincters.

The sensors are placed on the patient's skin near the urethra and rectum or on an urethral or rectal catheter to record the nerve and muscle activity on a machine. These sensors measure the action of the bladder muscle and urethral sphincter muscle during the filling and emptying of the bladder.

The patterns of nerve impulses indicate correct coordination of messages to the bladder and pelvic floor muscles.

Bladder filling (cystometry) and emptying studies (uroflowmetry) can be combined with EMG measurement.

During rest, a healthy muscle may show no electrical activity (no signs of action potential) but will show when it contracts.



However, suppose the muscle is damaged or has lost input from nerves. In that case, it may show abnormal electrical activity during rest, and abnormal patterns may occur when damaged muscle contracts due to electrical activity.

Video urodynamic study

Video urodynamic tests use ultrasound or X-rays to take images and videos of the bladder while it fills and empties. For a better picture, a trained technician or urologist may use a catheter to fill the bladder with dye or contrast.

Fluoroscopic urodynamic study

Using X-ray (fluoroscopy) may help find problems that are more complicated. In this case, the bladder is filled with a contrast solution (not saline) that shows up on An X-ray to help see the bladder anatomy.

Maximum urethral closure pressure (MUCP)

This test is designed to measure the highest possible difference between the pressure in the urethra and the pressure inside the bladder (intravesical pressure).

• <20 cm H2O: suggests ISD (Intrinsic urethral sphincter deficiency: dysfunction of internal sphincter muscle of the bladder.

Urodynamic study findings

Five main types of information are gathered using urodynamic studies:

• Bladder emptying: Process of urinating the urine out from the urinary bladder.
• Bladder sensation: The first sensation of bladder filling (FSF) is the feeling when a person first becomes aware of bladder filling.
• Maximal bladder capacity: Maximum capacity (volume) of the bladder to hold urine
• Bladder compliance: It refers to the ability of the bladder to accommodate (to make fit) large volumes of urine
• Detrusor (bladder muscle) contractility

Before planning urodynamic studies, a urologist may thoroughly check the urological symptom history, patient's past medical history, and medications, and they perform physical examination and pelvic exam for females.

Patients being investigated for lower urinary tract symptoms (LUTS) are required to complete a validated symptom score that indicates the impact of symptoms on their quality of life.

After urodynamic test

After having urodynamic bladder tests, it is common for some patients to feel mild discomfort or pain for some hours when urinating. The medical team may recommend drinking some water every half-hour for 2 hours to reduce pain, and taking a warm water bath or holding a warm/damp washcloth over the urethral opening to relieve discomfort. They may also prescribe some drugs, such as antibiotics, to prevent infection.

It is recommended that a urologist be consulted if the patient experiences any signs of infection, including pain, chills, or fever. Results for simple tests such as uroflowmetry and cystometry are often available immediately after the test. However, results of other tests, such as video urodynamic tests and electromyography, may take a few days to return. The urologist will discuss with the patient about the results and possible treatments.

Risks of invasive urodynamic testing may include as follows:

• Haematuria (blood in urine)
• Dysuria (difficult or painful urination)
• Urinary tract infection
• Urinary retention