Urodynamics

Evaluation of bladder problems is often performed with the assistance of a functional test of the patient’s bladder. A simple office procedure which takes about 15 minutes offers a great deal of insight into the causes and potential treatments of bladder complaints.

The test is performed when the patient comes to the office with a relatively full bladder. Emptying into a regular toilet is timed. The bladder stem is carefully cleansed and a very small pressure transducer catheter is placed into the bladder. Another similar catheter is placed in the rectum. These catheters measure pressure changes as the patient’s bladder is filled and she is asked to cough and bear down as with bowel movements or pushing out a baby. The patient is asked to identify her first, second, and third sensations to urinate as the bladder is filled. I liken this to a trip to a department store. When you would first wonder where the bathroom is thinking you will need it while you’re there is the first sensation. When you would actually put your items you are shopping for down and go find the bathroom is your second sensation and the third sensation occurs when you imagine yourself in that bathroom in a line of others and feel you need to ask to be next ahead of the others. This gives me an idea of how much you hold and how well or how poorly you are able to suppress the urge to urinate. Coughing and bearing down may elicit leaking which often is the endpoint we are trying to evaluate. Measuring the pressure in the bladder neck as the catheter is removed allows me to assess the urethra or bladder neck itself inorder to establish success rates for different surgical approaches to your complaint. Frequently, women establish behaviors designed to be able to cope with bladder problems. These may include frequently voiding to avoid wetting, limiting fluids to avoid making urine to avoid wetting, and mapping the locations of bathrooms so that they can be accessed quickly. Knowing how your bladder works helps me help you either with conscious changes in your behavior, dietary changes, medications or surgery.