NANCY L. BRIONESBSN-II I

CYSTOMETRY

CYSTOMETRY“CYSTOMETROGRAM” (CMG)

a test that measures the pressure inside the

bladder in order to see how well the urinary

bladder is working.

done when a muscle or nerve problem may be

causing problems with how well the bladder

holds or releases urine.

PURPOSE:

To find the cause of the problem affecting the bladder sphincter or

the bladder itself.

To measure how much urine can the bladder store and how much

residual volume there is.

To help the physician and the patient herself make decisions about

the appropriate treatment regimen.

To see how well the bladder works in people with progressive

neurological diseases like multiple sclerosis.

HOW THE TEST IS PERFORMED:

1. Patient will be asked to void into a special container (UROFLOWMETER) that is interfaced with a computer.

It records the (1) time it takes one to begin urinating; (2) the size, force, and continuity of one’s urinary stream; (3) the amount of urine; and (4) how long it took one to empty one’s bladder.

2. Patient will then lie down and a catheter is gently placed in her bladder to drain and measure the remaining urine.

• A smaller catheter is sometimes placed in one’s rectum in order to measure the abdominal pressure. Measuring electrodes, similar to the sticky pads used for an EKG, are placed near the rectum.

UROFLOWMETRY

HOW THE TEST IS PERFORMED:

3. The catheter is then filled with sterile, room-temperature water while a tube used to monitor bladder pressure (CYSTOMETER) is attached to it.

Water flows into the bladder at a controlled rate. Patient will be asked to tell the health care provider when she first feels the need to urinate and when her bladder is completely full.

4. Each time bladder is filled, patient will be asked to report when she first feels the urge to urinate. Patient’s bladder will then continue to be filled until she reports that she feels like voiding.

5. Then the catheter will be used to drain the bladder, or patient may be asked to urinate.

URETHRAL FILLING

CATHEETR

CYSTOMETER

URODYNAMICS

A three-fold procedure that involves different tests including:

1. Measured voiding without a catheter2. Filling phase Test3. Emptying phase test

• For complete urodynamic testing, a much smaller catheter is placed in the bladder so the patient will be able to urinate around it. Because this special catheter has a sensor on the tip, the computer can measure the pressure and volumes as the bladder fills and as the patient empties it. Patient may be asked to cough or push so that the health care provider can check for urine leakage.

VIDEOURODYNAMICS

Type of urodynamic test wherein x-rays can be taken during the test. In this case, instead of water, a special fluid that shows up on x-ray is used to fill one’s bladder rather than water or air.

HOW TO PREPARE FOR THE TEST:

Generally, no special preparations are needed for this test. However, for infants and children, preparation depends on the child's age, past experiences, and level of trust.

Before the test, patient must tell the healthcare provider if she is taking any medicines because some meds and herbal supplements can affect bladder function. (e.g. ANTIHISTAMINE)

Patient should also inform the healthcare provider if she is pregnant or is suspected to be.

HOW TO PREPARE FOR THE TEST:

Healthcare provider should also be notified by the patient if she has symptoms of a urinary tract infection: pain or burning with urination, foul-smelling or cloudy urine, or an urge to urinate more often than usual.

CYSTOMETRYThe test usually takes 30 to 60 minutes, but it

may take slightly longer if any special tests are done.

After cystometry, one will need to keep track of how much she drinks and how much she urinates for the next 24 hours. A burning sensation during urination is a common but temporary side effect. Drinking lots of fluids will help relieve this sensation. One may be given an antibiotic to help prevent a urinary tract infection.

One may feel sore after the test though a warm tub bath may be helpful to relieve the soreness.

RISKS OF CYSTOMETRY:

Cystometry usually does not cause problems though there is always a slight risk of developing a UTI when a catheter is inserted into the bladder.

If patient has a high spinal cord injury, she may have low heart rate, high blood pressure, headache, and feel flushed or sweaty during the test. Report these symptoms to the health professional conducting the test, since further testing may cause complications.

WHAT TO DO AFTER THE TEST:

Patient may need to urinate frequently, with some burning during and after urination for a day or two. Therefore, patient must drink lots of fluids to help minimize the burning and to prevent a urinary tract infection.

A pinkish tinge to the urine is common for several days after cystometry. But call the doctor immediately if:

urine remains red or you see blood clots after voiding X times have not been able to urinate 8 hours after the test. have a fever, chills, or severe pain in your flank or abdomen have symptoms of a urinary tract infection: Pain or burning upon urination. An urge to urinate frequently, but usually passing only small

quantities of urine. Dribbling or leakage of urine. Urine that is reddish or pinkish, foul-smelling, or cloudy. Pain or a feeling of heaviness in the lower abdomen.

RESULTS:

NORMAL ABNORMAL

The rate at which urine flows from

your bladder when you urinate is

normal.

The rate at which urine flows from

your bladder when you urinate is

slower than normal, or your urine

stream starts and stops.

The amount of urine left in your

bladder after you urinate (residual

urine volume) is less than 30 mL.

The amount of urine left in your

bladder after you urinate (residual

urine volume) is more than normal.

The point at which you first feel the

urge to urinate is within the normal

range, when the amount of liquid in

your bladder is between 175-250

mL.

You have trouble starting the flow

of urine.

RESULTS:

NORMAL ABNORMAL

The point at which you feel you must

urinate is within the normal range,

when the amount of liquid in your

bladder is between 350-450 mL.

The point at which you first feel the

urge to urinate is more or less than

normal or does not occur.

The maximum amount of liquid your

bladder can hold is within the normal

range: 400-500 mL.

The maximum amount of liquid your

bladder can hold is less than normal

or you can't feel it.

Tests of the function of the nerves

that control your bladder are normal.

Normal sensations and reactions do

not occur when the nerves that

control your bladder are tested.

Urine does not leak from your bladder

during the stress test.

Urine leaks from your bladder during

the stress test.

CAUSES OF ABNORMAL RESULTS:

Enlarged prostateMultiple sclerosisOveractive bladderReduced bladder capacitySpinal cord injuryStrokeUrinary tract infection

SUBTRACTED CYSTOMETRY

Intra-abdominal pressure (Pabd) is measured with an intravaginal or intrarectal pressure catheter. Bladder pressure (Pves) is measured with an intravesical catheter. Subtraction of Pabd from Pves yields the true detrusor pressure (Pdet). Fluid can be instilled into the bladder through a separate channel in the intravesical channel. Bladder contractions that occur as the bladder is filling and that the patient is unable to completely suppress indicate detrusor instability.