Chapter 65 Urodynamics Testing
THE CHALLENGE
Scope of the Problem: Almost one half of all women have involuntary loss of a few drops of urine at some time in their lifetime, with 10% to 15% of women suffering significant, recurrent loss. It has been estimated that more than one fourth of women of reproductive age experience some degree of urinary incontinence. This number increases to 30% to 40% of women after the age of menopause.
TACTICS
Relevant Pathophysiology: The bladder is designed to gradually distend as urine is delivered by the ureters. This distention proceeds with little or no change in bladder pressure (normal compliance). When bladder volume reaches a certain point (generally 150 to 200 mL) the first sensation of bladder fullness occurs. Additional increases in volume can be accomplished with an increasing sense of urgency but without uninhibited bladder contraction or incontinence. When bladder emptying is allowed, it should happen in an expeditious and efficient manner. Although the specific content of urodynamics testing varies, at a minimum it includes cystometrics and provocative tests (such as coughing or straining while the bladder is full). Most centers include sophisticated evaluation of bladder compliance and contractility, cystoscopy, and evaluations of the voiding process itself. Pressure profiles of the bladder and urethra, electromyography, and fluoroscopic examinations may also be included.
