Urodynamic testing

In this episode of PodMD,  highly experienced and certified urogynaecologist Dr Rebecca Young will be discussing the topic of urodynamic testing, including the kind of patients that benefit from this testing, how it is performed, the role of repeat testing, the treatment options following urodynamics and more.


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  • Transcript
    Please note this is a machine generated transcription and may contain some errors.
    *As always, all in this PODMD podcast is intended for health professionals and the comments are of a general nature. Information given is not intended as specific medical advice pertaining to any given patient. If you have a clinical issue with one of your patients please seek appropriate advice from a colleague with expertise in the area.

    Today I’d like to welcome to the PodMD studio Dr Rebecca Young

    Dr Rebecca Young is a highly experienced and certified Urogynaecologist specialising in the treatment of conditions such as prolapse and urinary incontinence, as well as providing general gynaecological care to women.

    Dr Young completed her obstetrics and gynaecology training at Royal North Shore Hospital in Sydney, with rotations at Northern Beaches, Port Macquarie, and Gosford Hospitals. Dr Young furthered her expertise with advanced gynaecological and laparoscopic training at Westmead Hospital, earning her the Fellowship of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (FRANZCOG). Dr Young went on to complete 3 years of subspeciality training in Urogynaecology at Gold Coast University and St George Hospital, before commencing private practice

    Today, we’ll be discussing the topic of urodynamic testing.

    *We do hope you enjoy this podcast but please remember that the advice here is of a general nature and is not intended as specific advice about a given patient. The views and opinions expressed in this podcast are those of the doctor, not PodMD.
    If you do have a patient on whom you require specific advice, then please seek advice from a colleague with appropriate expertise in that area.

    Rebecca, thanks for talking with us on PodMD today.

    Rebecca : Thank you for having me

    Question 1
    The topic of today’s discussion is urodynamic testing. Rebecca, can you give us a brief overview about urodynamic testing?

    Rebecca: Urodynamic testing is a study performed to assess lower urinary tract function. It comprises of a uroflow, where the patient voids into a commode to assess voiding function. Following this urethral and either a rectal or vaginal catheter is placed and the bladder is filled with water for what is termed cystometry. During bladder filling the patient’s symptoms and leakage are assessed. This is followed by a pressure flow study where the patient voids whilst the small catheters remain in place, allowing for further assessment of their voiding function.

    Urodynamics is usually performed with water as the filling fluid however in some instances it is performed with fluoroscopy using radio-opaque contrast, which is termed videourodynamics.

    Question 2
    What kind of patients benefit from having urodynamic testing?

    Rebecca: Urodynamics help to provide further information on bladder function in patients who have had unsuccessful conservative treatment of lower urinary tract conditions, or in patients with complex conditions. It can help to provide information as to how to best direct therapy – for example in patients with mixed urinary incontinence, in patients with refractory overactive bladder, or in those considering surgical interventions. It can also be used to help counsel patients regarding their risk of incontinence following prolapse surgery.

    Question 3
    How is urodynamics performed?

    Rebecca: The patient attends the office and the test is performed there whilst they are awake. They are given a gown prior to voiding, placement of the catheters and bladder filling. Given it is an invasive test it is important for patients to be aware prior to the day of what is involved, as well as why the test is being performed. Good practice involves patients performing a bladder diary prior to urodynamics, as well as having had a careful history and examination performed.

    A urine culture is usually performed prior to the day to exclude infection at the time. I advise patients to stop any medication they are on for incontinence such as anticholinergics prior to the test to allow for an accurate assessment. Following the test the clinician will discuss the result with the patient as well as how best to move forward with treatment.

    Question 4
    What are the risks/efficacy of performing urodynamics?

    Rebecca: Urodynamic testing is very safe as the catheters are incredibly small and the urethral line is placed under sterile conditions. There is however a low incidence of urinary tract infection following the procedure. In patients who have a contrast allergy the use of intravesical contrast for videourodynamics is contraindicated. Urodynamics only provide information on the patient’s condition at the time, and do not always correlate with patient symptoms, which need to be kept in mind. Expertise is required to perform the test and to interpret the result which results in a lack of availability in some settings.

    Question 5
    What are the treatment options following urodynamics?

    Rebecca: This depends on the conditions that are diagnosed. In cases of detrusor overactivity the first line treatments remain the same as patients with overactive bladder – bladder retraining, avoidance of caffeine/alcohol, appropriate fluid intake, vaginal oestrogen if postmenopausal. Following this medication such as anticholinergics or beta 3 agonists are used. Most patients having urodynamics would have trialled these therapies prior to a diagnosis of urodynamic detrusor overactivity, and if so may be appropriate for 3rd line treatment options such as intravesical botox of sacral neuromodulation.
    In patients with stress incontinence, urodynamics form part of the assessment regarding the severity, which allows counselling on ongoing conservative treatment such as pessaries, or surgical options.
    In patients who have voiding dysfunction treatment, urodynamics provides information on if the issue is related to the outlet/obstruction due to previous surgery or due to impaired detrusor muscle contractility. In patients with a prolapse who are deciding on having concomitant incontinence surgery I place a vaginal pessary during the test, which helps to assess for the risk of occult stress urinary incontinence developing after a prolapse repair.

    Question 6
    Have there been any recent developments in the use of urodynamics?

    Rebecca: There is conflicting evidence on the need for routine urodynamic testing prior to stress incontinence procedures. Some evidence indicates that for straightforward patients who have pure stress symptoms, a normal post void residual, no prolapse and visible stress leak on examination there may be little benefit to urodynamics before surgical management. Despite this, given the controversy around stress incontinence surgery and the need to counsel patients carefully about their options of a transvaginal mesh tape or non mesh surgical options, urodynamics is now performed more commonly in this setting and many would advocate that it be done routinely.

    Question 7
    What is the role of repeat urodynamic testing?

    Rebecca: Repeat testing should be performed in patients who are considering surgical management if it has been some time since their previous test, and definitely if they have undergone any procedures such as prolapse or continence surgery following the prior urodynamics.

    Question 8
    When should a GP refer?

    Rebecca: A GP should refer female patients to a Urogynaecologist for assessment of conditions such as prolapse or urinary incontinence, and in most instances they will be seen for an initial review prior to deciding if urodynamic testing is warranted. Sometimes I will see a patient for an initial review and urodynamics if they are travelling some distance to see me. They will be provided with information before their appointment about what to expect on the day.

    Question 9
    What role does the GP play?

    Rebecca: It is important for GP’s to understand the role urodynamics has in the assessment and subsequent treatment of their patients. This can help the GP to answer questions patients may have around why urodynamics have been recommended for them, and also to explain the benefits of referral to a subspecialist in cases where initial treatment is unsuccessful.

    Concluding Question
    Thank you for your time here today in the PodMD studio. To sum up for us, could you please identify the three key take home messages from today’s podcast on urodynamic testing.

    Rebecca:
    1. Urodynamics is a commonly performed minimally invasive investigation performed to assess bladder function, which is performed in the office setting whilst the patient is awake.
    2. It is very safe, with a small risk for subsequent urinary tract infection.
    3. It provides detailed information on a patient’s voiding, bladder filling, the presence or absence of detrusor overactivity and stress incontinence which can help to guide the best treatment options at that time.

    Thanks for your time and the insights you’ve provided.

    Rebecca: Thank you

*As always, all in this PODMD podcast is intended for health professionals and the comments are of a general nature. Information given is not intended as specific medical advice pertaining to any given patient. If you have a clinical issue with one of your patients please seek appropriate advice from a colleague with expertise in the area.