Urology

The procedure of urodynamics testing

Your health care provider may first start with the urine flow test.

Jan 10, 2018
BY admin

Urodynamics testing is an important examination for studying urination status and analyzing abnormal urination. The inspection process is as follows:

1. Briefly ask about the medical history and necessary physical examination, and clarify the purpose of the examination and the examination items. The patient emptied stool before the examination.

Symptoms: Acute urinary system, reproductive system, lower gastrointestinal tract inflammation, bleeding; rubber allergy; unconsciousness, inability clear expression of wishes and feelings; pediatric urodynamics must be completed by experienced operating doctors.

2. Check the working condition of the urodynamic tester, if necessary, check the urinary flow rate meter; pressure sensor; pump; UPP rod perform calibration and calibration; connect pressure sensors (3), connecting pipes (3), pump pipes, and perfusion pipes.

3. Briefly introduce the examination situation to the patient, reduce the patient's anxiety and fear, and obtain the patient's cooperation.

4. Generally, the urine flow rate should be checked first to objectively evaluate the urination status.

5. Preparations before inspection:

  • Physical examination position can choose semi-recumbent, seated, or standing position. If you need to test the urination period, choose as much as possible.

The urinating position that the patient is accustomed to. If you change your position during the examination, it will cause a change in the zero points of the bladder pressure. When analyzing the results should be pay more attention.

  • Instruct the patient to remove the outer pants and underwear, and lie on the examination table at the stone cutting position; prepare a one-time catheterization kit-one and various pressure tube tests.

  • Routine disinfection of iodophor, 2% lidocaine gel (1 piece), surface anesthesia, urinary tract insertion, bladder pressure measurement catheter; determination residual urine volume.

  • Rectal piezometer tube and penile sleeve are inserted through the rectum; the catheter is inserted into the rectum, 10~15cm male 6-10, female.The depth is the same as that of the cystometry tube, 6-10cm, the balloon can be filled with an appropriate amount of saline, and the filling amount is equal to the volume of the balloon.About 2%, the pressure measuring catheter of our company is generally 2ml. There are no air bubbles in the balloon. If the rectum has been removed, the piezometer tube can be used placed in the vagina, ileum, or colostomy.

  • The most common use is to insert a double-chamber or triple-chamber piezometer tube into the bladder through the urethra. Although the suprapubic bladder puncture catheter is more consistent with spontaneous urination, but unless there is a contraindication to urinary catheterization or the inability to place a catheter through the urethra, there are few clinical applications due to trauma. The fistula can directly use the fistula tube to measure the pressure. A cystometry tube thinner than 8F should be selected to minimize the impact on urination.The operation should be gentle when intubating, and lubricant should be fully applied to reduce urethral damage. With urinary catheter or bladder fistula.In patients with urinary dynamism, if it is inconvenient to withdraw the catheter, you can also use a three-way connector to connect the urinary catheter or fistula connected with T101, the purpose of testing at this time is mainly to clarify the detrusor function.

  • There are no air bubbles in all connecting pipes.

  • There are 3 conventional external membrane electrodes in the perineum, and the two red electrodes are attached 3 to 5 cm away from the anus, as close as possible.

Near the anal margin, the patch is best completed before the perineum disinfection. If necessary, use iodophor to remove local sebum and dry local skin, that is, at the external sphincter, the green electrode is attached to the bone surface (usually the anterior superior iliac crest) inside the thigh and is in contact with the host even.

  • 0.9% saline 1000ml (1 bag) above 1000500m is connected to the perfusion pump through the connecting pipe.

6. Bladder capacity-excitation measurement:

First, confirm the patient's pubic symphysis. The upper edge and the top cap of the pressure sensor are in the same horizontal plane, and the empty beaker is placed in the urine.

On the flow rate meter, the pump tube is placed in the pump tank and exhausted. The pressure measuring catheter, etc. are ready.

Extracorporeal zero settings: After removing the air from the dome cover of the bladder pressure measurement and rectal pressure measurement sensor and the T101 connecting tube, respectively, remove the air.

The end of the T101 tube is placed in the same horizontal plane as the upper edge of the patient’s pubic symphysis and the top cap of the pressure sensor.

"Zero All" on the control panel of the component window, and then connect the end of the T101 tube to the corresponding pressure measurement tube pick up. Open all interfaces. At this time, the difference between Pves and Pabd is not more than 5cmH2O, otherwise, you need to check the connection or make adjustments.

Execute the operation command, enter the state before the inspection record, and ask the patient whether the working state of the detection instrument such as cough is in compliance.

Requirements, (that is, the rising pattern of bladder pressure=abdominal pressure when coughing), adjust accordingly if necessary, until satisfactory.

Execute the bladder perfusion command, and ask the patient's bladder feel while infusing, and mark the bladder according to the patient's bladder feel.

Corresponding events of the cyst, and understand the sensation, volume, stability, and compliance of the bladder at the same time, and mark the events if necessary.

Note:

Check the working status of the monitoring instrument at the same time, adjust it at any time if necessary, and remove the pseudo phase at the same time.

Adjust the speed of the bladder perfusion pump according to the specific situation and the purpose of the examination. At the beginning of the routine, use a low speed or 30ml/min, after infusing 50ml, it can be adjusted to medium speed or 60ml/min, and use high speed or 90ml/min when appropriate.

Pressure measuring medium and perfusion speed, the most commonly used pressure measuring medium is normal saline at room temperature. If the temperature is too low, it should be heated appropriately.

According to ICS regulations, the perfusion speed is divided into low speed (<10ml/min), medium speed (10~100m/min), and high speed (> 100ml/min). Choose different perfusion speeds according to different inspection purposes. Commonly used clinical perfusion rate is 50m/min. Bladder filling speed is too fast, due to incomplete stress relaxation, it is easy to cause bladder pressure to increase and smooth the illusion of reduced responsiveness. If you have doubts about the test results, you can suspend the perfusion for 2 minutes, if the pressure is significantly reduced, it is perfusion. Due to too fast, the speed can be adjusted to 10m/min or lower during reperfusion.

Exclusion of stress urinary incontinence test: the infusion volume reaches 200ml (for those who feel 150-200ml or more at this time.

Preliminary estimation of the patient’s bladder capacity is normal), or when the patient’s first sensation occurs (for the occurrence of earlier than normal values, preliminary estimation.

The patient's bladder capacity is too small, or compliance is poor). Stop the perfusion at this time, and ask the patient to cough continuously or do breath-holding.

Push down (Valsalva) to observe whether there is leakage of urine at the urethral orifice.

Lower abdominal pressure is marked as "ALPP abdominal leakage point pressure.

Any fluctuation of the detrusor muscle during perfusion is regarded as an abnormality of the detrusor function. It can be used to suddenly increase the perfusion rate and ice water.

Tests and so on induce involuntary contraction of the detrusor muscle.

7.Excitation flow rate determination:

When the patient reaches a strong urge to urinate, the perfusion time can be appropriately extended to obtain the maximum pressure measurement capacity of the bladder, but pay more attention.

When the patient responds and is safe, then stop the perfusion, and ask the patient to cough and confirm that the pressure measuring catheter position is normal and the response is normal.

It urinates and an event of "Order to urinate" is marked.

Real-time observation of changes in bladder pressure, rectal pressure, detrusor pressure, electromyography, urine flow rate, and urinary passages.

Pseudo-phase is present, so that it can be eliminated, which is conducive to the analysis of the results.

Monitor the working status of the instrument in real-time, find problems, and troubleshoot them in time.

8. Measurement of urethral pressure:

A pressure-measuring catheter is placed under conventional iodophor disinfection and 2% lidocaine gel surface anesthesia; the pressure measuring catheter Pura interface is connected to the urine.

Road pressure sensor (black mark) is connected.

A bag of 500-1000ml saline is put into a compression sleeve bag, connected to the T219 rate-limiting tube, and the pressure is increased to 250mmHg (or the pressure display shows a green mark). Connect a capillary outlet to the Pura top cap, open it turn it off. The other capillary port is closed and not used.

Set zero outside the body, as before, make sure that the capillary port of the velocity-limiting tube is in the connected state at this time.

Start the urethral pressure measurement program, and the perfusion pump injects about 200 ml of 0.9% saline into the bladder; determine the patient's bladder capacity about 50-150ml, if necessary, pump tube perfusion.

Initiate urethral traction.

When the urethral pressure measurement catheter is pulled outwards, the patient is instructed to continuously cough.

Observe the changes in bladder pressure and urethral pressure.

9.Result analysis:

Use tool software to process the inspection results and make the urodynamic diagnosis.

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