Urodynamics & Uroradiology

  • Urodynamic studies (UDS) are done to test how well the bladder, sphincters, and urethra are able to hold and release urine.

  • Cystometry, or cystometrogram is a urodynamic test done to measure the efficiency and functionality of the bladder.

  • IVU is a special x-ray performed after an ultrasound screening of the abdomen has shown any urinary system abnormalities. During this examination, a contrast injection is given to the patient, which is selectively absorbed and later excreted by the kidneys.

Urodynamics & Uroradiology (Brief)

Urodynamics

Urodynamic studies (UDS) are done to test how well the bladder, sphincters, and urethra are able to hold and release urine. These tests are performed to investigate how well the bladder works and if there could be any leaks or blockages. Urodynamic tests can be performed in various ways and the doctor may recommend one or more based on the patient's symptoms.

Usually urodynamic tests are simple and can be done in a doctor's office. In some cases, advance tests may be required using expensive and sophisticated instruments to measure the amount of pressure experienced by the bladder and the urethra.

Urodynamics help find the cause of problems related to:

- Urine leaks
- Bladder not emptying all the way
- A need to urinate too often
- A need to go suddenly
- Weak urine flow
- Inconsistent urine flow
- Getting urinary tract infections often

Urodynamic Tests

Cystometry, or cystometrogram is a urodynamic test done to measure the efficiency and functionality of the bladder. Cystometry is done to find the cause of the bladder and bladder sphincter problems resulting in uncontrolled urine leakage or an urgent feeling to urinate. It also helps to measure how much urine the bladder can store and the amount of urine left in the bladder after urinating.

For urodynamic test patients are instructed to come with a full bladder. The patient is then asked to urinate into a toilet that is connected to a machine called uroflowmeter to measure the volume of urine and the rate at which the bladder empties. This machine also measures the time and effort needed by the patient to start urine flow, the number of times patient stops and starts the flow of urine and the dribbling near the end of urinating is also recorded.

One or more catheter(s) (thin tube) is then gently inserted through the urethra into the bladder to measure the volume of remaining urine in the bladder, known as the post-void residual, or PVR. This is then drained and measured.

The catheter(s) is/are attached to a device called cystometer. The bladder is then gradually filled with sterile saline through one catheter while the other catheter helps record the bladder pressure.

For advance urodynamic testing, another catheter may be placed in the rectum to measure the pressure of the muscles while the bladder of the patient fills. Also a small needle or pad may be placed near the anus to investigate the muscle function in this area.

With Urodynamic tests, the doctor can diagnose if:

- The patient retains more than a normal amount of fluid in the bladder after urinating suggesting that the bladder is partially blocked or the
  bladder muscle is not contracting properly to force the urine out.
- The bladder contains abnormal level of fluids (either less or more), when the urge to urinate is felt.
- The patient is not able to retain urine even when the bladder contains less than normal amount of fluids.

Uroradiology

Uroradiology refers to radiology of the urinary tract. Uroradiology tests include:

IVU (Intravenous Urography):

IVU is a special x-ray performed after an ultrasound screening of the abdomen has shown any urinary system abnormalities. During this examination, a contrast injection is given to the patient, which is selectively absorbed and later excreted by the kidneys. This helps in investigating the how well each kidney is functioning. IVU is only performed after assessing normal functionality of the kidney through a blood test called serum creatinine.

MCU (Micturating Cysto-Ureterogram):

MCU is a special x-ray done to investigate the bladder and the urethra to check for any abnormalities in the bladder neck, narrowing of the urethra, or reflux of urine into the kidneys. It is only performed after the initial ultrasound screening, basic blood test and urine test of the urinary tract. A contrast medium is injected into the bladder through a catheter. X-rays are then captured while the patient is passing urine for investigation.

RGU (Retrograde Urethrogram):

RGU is a special x-ray usually done in male patients to evaluate the urethra to check for any abnormalities such as stricture (narrowing), etc. RGU is done on patients with week urinary stream, straining to pass urine, dribbling of urine, or have a genital injury. RGU is performed after the initial ultrasound screening and uroflowmetry tests suggest any abnormalities in the bladder functioning. A local anesthesia solution is introduced through the urinary outlet in the reverse direction. The contrast medium is pushed using a catheter at the tip of the penis. This is then captured through x-ray for further investigation.

NEPHROSTOGRAM:

Nephrostogram is a special x-ray procedure done to measure the drainage of urine from the kidney, through the ureter into the bladder. A tube called Nephrostomy is placed through the skin directly into the kidney to drain urine. The contrast medium filled through this tube and images are taken immediately and again after 20 minutes to see if it drains into the bladder and the level of obstruction.

Case Study

FRACTURE:

Shock Wave Lithotripsy

Women’s Health

Transposition AV Fistula