Urodynamic testing | DIAGNOSTIC TESTS

Urodynamic testing is used to assess the functioning of the bladder and the urinary sphincter. 

Specifically, this test evaluates volume, pressure, flow rate and electromyographic activity in the pelvic floor muscles. The results of urodynamic testing enable Dr. Marois to diagnose bladder problems (urinary incontinence and other issues with storing and voiding urine) and determine the best treatment options. Appointments can be booked at his clinics in Montreal, Laval, Greenfield Park and Quebec City

When is urodynamic testing recommended?

  • After a clinical exam and simple tests have failed to reveal the cause of abnormal bladder functioning.
  • If urinary incontinence persists despite medical treatment (for example, the patient continues to have an overactive bladder).
  • As a preliminary test for intravesical Botox therapy.
  • As an assessment for neurogenic bladder (a condition resulting from a neurological disorder). The test can detect abnormalities in the nervous control of the bladder and urethral sphincter.
  • As a preliminary test prior to an operation related to urinary incontinence.
  • After a previous treatment for incontinence, such as midurethral sling surgery, has failed.
  • To analyze complex bladder dysfunctions such as an overactive bladder or other type of bladder emptying disorder.

How does urodynamic testing work?

  • This first step in the process is an examination, which is performed by a nurse on site at one of Dr. Marois’ clinics. The patient does not need to fast in the time leading up to the appointment.
  • The nurse will begin by asking about the patient about his or her symptoms and performing a clinical examination of the perineum.
  • The second step of the process is the test itself. It lasts from 30 to 45 minutes and consists of three parts: filling (cytometry), emptying (uroflowmetry) and profiling (urethral pressure profile).
  • The process involves inserting a very fine catheter into the bladder through the opening of the urethra. The catheter fills the bladder with sterile water and simultaneously records the pressure. A small catheter is also inserted into the rectum through the anus. When evaluating neurologically related bladder conditions, it can also be useful to record the electrical activity of the perineum muscles. This is done by attaching two patches to the perineum.
  • The examination can be uncomfortable, but it isn’t painful. The insertion of the catheter causes only slight discomfort. It’s important for the patient to relax as much as possible. Every measure is taken to make the patient comfortable and treat him or her with dignity. The patient should communicate any sensations he or she feels during the exam, particularly a slight, moderate or urgent need to urinate.
1. Cytometry (first part of urodynamic testing)
  • This part of the testing consists of recording the pressure in the bladder while it’s being filled.
  • During the cytometry, the patient, whether the individual is a man or woman, is seated, semi-seated, lying down or in the lithotomy position.
  • Specifically, the test evaluates the functioning of the bladder as it fills up and records involuntary contractions.
2. Uroflowmetry (second part of urodynamic testing)
  • During this part of the testing, the patient urinates in a special funnel connected to a measuring instrument that calculates the strength of the stream of urine and its volume. The patient is supposed to urinate in their usual manner and do their best to relax.
  • For the purpose of interpreting the results, an adequate quantity of urine needs to be collected. However, the patient’s bladder shouldn’t be too full, as this can affect its functioning or result in a blockage.
3. Urethral pressure profile (third part of urodynamic testing)
  • This part of the testing consists of examining the patient’s sphincter. The urethral catheter is gradually removed. It’s important for the patient to be relaxed and not to move nor talk during this part of the testing.

What are the risks and potential complications of urodynamic testing?

Urinary tract infections are the most common complication. However, all the equipment used in the testing is sterile and every hygienic and sanitary precaution is taken to minimize this risk. When this complication does occur, Dr. Marois will prescribe several days of antibiotics to treat it.

The patient must notify Dr. Marois’ urology clinic right away if he or she experiences heavy bleeding, fever, difficulty urinating, persistent burning, bladder pain or strong, unusual odours when urinating.

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