reading

Cover
Title Page
Copyright Page
Abbreviations
Contributors
Preface
1. References
First Foreword
Second Foreword
Part I: Basic Principles
1. 1 Basic Urodynamics and Fundamental Issues
  1. Introduction to Urodynamics
  2. Basics of Urodynamics
  3. Fundamentals
  4. A Brief History of Urodynamics
  5. Summary
  6. References
2. 2 Applied Anatomy and Physiology
  1. Introduction
  2. Upper Urinary Tract
  3. The Urinary Bladder
  4. The Male Urethra
  5. The Female Urethra
  6. The Pelvis
  7. Nervous System Control of the Lower Urinary Tract
  8. References
3. 3 The Physics of Urodynamic Measurements
  1. Measurement of Pressure
  2. Measuring Pressure in Urodynamics
  3. Measuring Pressure Correctly; Setting Zero (Reference) Pressure and Calibrating
  4. Measuring Infused Volume
  5. Measuring Flow Rate
  6. References
Part II: Functional Urology
1. 4 Patient Assessment
  1. Patient‐Reported Outcome Questionnaires
  2. FVCs and Bladder Diaries
  3. Medical History
  4. Physical Examination
  5. Other Investigations
  6. References
2. 5 Treatments for Lower Urinary Tract Dysfunction
  1. Storage Phase Problems
  2. Voiding Problems
  3. Post‐Micturition Symptoms
  4. References
Part III: Urodynamic Techniques
1. 6 Uroflowmetry
  1. How to Do the Test
  2. Reporting a Test Result
  3. Interpretation
  4. Equipment
  5. Summary
  6. References
2. 7 Cystometry and Pressure‐Flow Studies
  1. Principles of Cystometry
  2. Technique of Filling Cystometry
  3. Voiding Cystometry; Pressure‐Flow Studies
  4. Electromyography
  5. References
3. 8 Video Urodynamics
  1. Anatomical and Physiological Observations During VUDS
  2. Roles of VUDS in Men
  3. Roles of VUDS in Women
  4. VUDS in People with Neurological Disease and Children
  5. Renal Failure and Transplant Patients
  6. Whitaker Testing
  7. Using VUDS to Understand Limitations of Pressure Recording
  8. Equipment Needed
  9. Considerations when Using X‐rays
  10. Performing the Test
  11. Advantages and Disadvantages of VUDS
  12. Alternatives to VUDS
  13. References
4. 9 Ambulatory Urodynamics
  1. Indications for AUDS
  2. Technique of AUDS
  3. Analysis
  4. References
5. 10 Studies Assessing Urethral Pressures
  1. Static Urethral Pressure Profilometry
  2. Interpreting the UPP
  3. The ‘Stress’ Urethral Profile
  4. Urethral Leak Point Pressure Measurement
  5. Indications for Urethral Function Testing
  6. References
6. 11 Non‐invasive Urodynamics
  1. Introduction
  2. Non‐invasive Urodynamic Techniques
  3. The Penile Cuff Test
  4. Practicalities of the Penile Cuff Test
  5. Current Standing
  6. References
Part IV: Urodynamics in Clinical Practice
1. 12 Urodynamics in Children
  1. Children with Neurological Disorders
  2. Children with Non‐neurological Disorders
  3. Practical Aspects of Urodynamic Studies
  4. Summary and Recommendations
  5. References
2. 13 Urodynamics in Women
  1. Stress Urinary Incontinence
  2. Overactive Bladder
  3. Urethral Relaxation Incontinence
  4. Mixed Urinary Incontinence
  5. Mixed Incontinence (Urinary and Faecal ‘Double’ Incontinence)
  6. Situational Incontinence; Coital/Orgasm Leakage and Giggle Incontinence
  7. BOO and Detrusor Underactivity (DUA)
  8. Urinary Infections and Inflammation
  9. Conclusions
  10. References
3. 14 Urodynamics in Men
  1. Men with LUTS
  2. Post‐Prostatectomy Symptoms
  3. Special Situations
  4. References
4. 15 Structural Changes of the Bladder Outlet
  1. Impaired Blood Supply to the Bladder Outlet
  2. Trauma
  3. Hypospadias
  4. Surgical Mesh
  5. Gender Confirmation Surgery
  6. References
5. 16 Neurological Disease and LUTS
  1. Impaired Neurological Control of the Lower Urinary Tract: General Principles
  2. Understanding the Neurological Situations
  3. Life‐Threatening Issues in NLUTD
  4. Assessment of LUTS in Neurological Disease
  5. Urodynamic Observations
  6. Urodynamic Technique in the Neurogenic Patient
  7. NLUTD Treatment
  8. Specific Neurological Diseases
  9. Assisting Neurology and Neurosurgery Teams in Defining the Neurological Lesion
  10. References
6. 17 Urodynamics in Older People
  1. Understanding and Evaluating Frailty
  2. The Management Pathway in Older People
  3. Patterns of LUTS in Older People
  4. Therapy Decisions
  5. References
Part V: Running a Urodynamics Unit
1. 18 Troubleshooting During Urodynamics
  1. Uroflowmetry
  2. Filling Cystometry
  3. Pressure‐Flow Studies
  4. Conclusions
  5. References
2. 19 Artefacts in Urodynamics
  1. Artefacts During Flow
  2. Artefacts During Filling Cystometry
  3. Artefacts During Pressure‐Flow Studies
  4. References
3. 20 Anorectal Physiology
  1. Anorectal Physiology
  2. Conservative Treatment
  3. Management of Colorectal Pelvic Floor Patients
  4. Faecal Incontinence
  5. Psychological Distress and Quality of Life
  6. Future Direction of Colorectal Pelvic Floor Surgery
  7. References
4. 21 Organisation of the Urodynamic Unit
  1. Patient Referral
  2. The Patient's Hospital Attendance
  3. Planning a New Urodynamic Service
  4. Reference
5. 22 Equipment
  1. Maintenance Routines and Regular Checks
  2. Procurement
  3. Reference
6. 23 Working with Limited Resources
  1. Clinical Issues
  2. Equipment
  3. Maintenance Requirements
  4. Teaching
7. 24 Research Evidence on the Clinical Role of Urodynamics
  1. References
Appendix A: Key Patient Assessment Metrics from the International Consultation on Incontinence Questionnaires (ICIQ)
1. ICIQ‐FLUTS
2. ICIQ‐MLUTS
3. ICIQ‐BD
Appendix B: Fundamentals Documents from the International Continence Society
1. N&U 2018 Volume 37 Supplement 6
Appendix C: Patient Information Leaflets from the Bristol Urological Institute
Appendix D: Practice, Standards, and Equipment Recommendations
1. International Consultation on Incontinence 2016; Executive Summary: Urodynamic Testing
2. United Kingdom Continence Society: Minimum standards for Urodynamic Studies, 2018
3. UK Centre for Evidence Based Purchasing; Buyers' Guide Urodynamics Systems
4. Good Urodynamic Practices Documents from the International Continence Society
Index
End User License Agreement

List of Tables

Chapter 1
1. Table 1.1 Classification of lower urinary tract symptoms (LUTS) [1].
2. Table 1.2 Prevalence rates of the urodynamic observation of DO and pressure‐f...
Chapter 2
1. Table 2.1 Comparison of male and female lower urinary tract.
2. Table 2.2 Matching specific LUT functions to subpopulations of LUT nerves.
3. Table 2.3 Synergic actions of lower urinary tract nuclei determined by the PM...
Chapter 4
1. Table 4.1 Frequency‐volume chart basic patterns.
2. Table 4.2 The measurements taken in pelvic organ prolapse‐Quantification (POP...
Chapter 5
1. Table 5.1 Individual issues which potentially could influence patient attitud...
2. Table 5.2 Success rates of learning intermittent self‐catheterisation in a we...
Chapter 6
1. Table 6.1 Guide values for normal minimum peak flow rates.
Chapter 7
1. Table 7.1 Normal and abnormal observations in terms of bladder and urethral b...
2. Table 7.2 The requirements that should be covered when compiling a urodynamic...
3. Table 7.3 Resting pressures [3].
Chapter 8
1. Table 8.1 Comparative doses of ionising radiation for different situations en...
Chapter 10
1. Table 10.1 Values for maximum urethral pressure (cmH₂O) in patients in whom n...
2. Table 10.2 Mean and 95% confidence interval values for maximum urethral closu...
3. Table 10.3 Comparison of Valsalva leak point pressure (VLPP) and maximum uret...
Chapter 11
1. Table 11.1 Summary of performance of non‐invasive urodynamic tests derived fr...
Chapter 12
1. Table 12.1 Comparison of formulae to estimate bladder capacity in infants and...
Chapter 13
1. Table 13.1 Urinary incontinence categorised by mode of delivery [2].
2. Table 13.2 Logistic regression analysis of variables in women with coital inc...
Chapter 14
1. Table 14.1 BOOI changes when two filling and voiding cycles are undertaken at...
2. Table 14.2 BCI changes when two filling and voiding cycles are undertaken at ...
3. Table 14.3 Satisfaction with urodynamics in men considering surgery for voidi...
4. Table 14.4 The rankings for prevalence of severe symptoms according to sympto...
Chapter 16
1. Table 16.1 Classification of neurological diseases according to key influence...
2. Table 16.2 Recommendations by the UK National Institute of Health and Care Ex...
3. Table 16.3 Recommendations by NICE, the EAU, and the ICI regarding medication...
4. Table 16.4 Recommendations by NICE, the EAU, and the ICI regarding catheter u...
5. Table 16.5 Recommendations by NICE, the EAU, and the ICI regarding minimally ...
6. Table 16.6 Recommendations by NICE, the EAU, and the ICI regarding surgical m...
Chapter 17
1. Table 17.1 Comparison of clinical and urodynamic analysis of men and women ag...
Chapter 18
1. Table 18.1 Summary table listed by observed feature – a troubleshooting guide...
Chapter 22
1. Table 22.1 Recommended equipment for different levels of urodynamic service.
2. Table 22.2 Essential requirements for uroflowmetry, filling volume measuremen...
Chapter 24
1. Table 24.1 Challenges in the design of a multinational and multicentre urodyn...

List of Illustrations

Preface
1. Figure A classic picture of the fundamental insights on the implications of ...
First Foreword
1. Figure Marcus Drake, Hashim Hashim, Paul Abrams, and Andrew Gammie holding a...
Chapter 1
1. Figure 1.1 Flow rate testing in men gives an uncertain understanding. This m...
2. Figure 1.2 A woman who reported leakage with coughing in her history, sugges...
3. Figure 1.3 The importance of training and interpretation. This trace shows a...
4. Figure 1.4 A man with a functioning artificial urinary sphincter (AUS) previ...
5. Figure 1.5 Urodynamics pathway in Bristol UDS Unit.
6. Figure 1.6 The diagnostic and therapeutic pathways for important patient gro...
7. Figure 1.7 A schematic diagram of the set‐up of three‐way taps to enable key...
8. Figure 1.8 Additional evaluation to undertake in the event that a patient ha...
9. Figure 1.9 Features to look out for when looking at a complete trace done by...
10. Figure 1.10 Examples of some of the quality control issues that need to be i...
11. Figure 1.11 Two key parameters are scrutinised routinely throughout the runn...
12. Figure 1.12 An unusual error (fortunately) is to connect the filling pump to...
13. Figure 1.13 This pressure‐flow study of a male patient shows a grossly abnor...
14. Figure 1.14 Adaptations to urodynamic practice in response to the Coronaviru...
Chapter 2
1. Figure 2.1 The lower urinary tract joins the upper urinary tract at the uret...
2. Figure 2.2 The male genitourinary tract. Key differences from the lower urin...
3. Figure 2.3 The upper urinary tract comprises the kidneys and ureters. In thi...
4. Figure 2.4 Influences on voiding frequency; how often someone passes urine i...
5. Figure 2.5 Anatomical relationships of the bladder scanned with magnetic res...
6. Figure 2.6 Relationship of the bladder to the pubis; X‐ray taken during vide...
7. Figure 2.7 Thick muscle of the detrusor (light grey). On the left, the muscl...
8. Figure 2.8 Left: a schematic representation of the midpoint of a muscle bund...
9. Figure 2.9 Detrusor muscle can show localised contractions which distort the...
10. Figure 2.10 Anatomy of the male urethra shown with a magnetic resonance imag...
11. Figure 2.11 In the postero‐anterior (PA) view (left), an object resembling t...
12. Figure 2.12 Urethroscopy showing the prostatic urethra, to illustrate the en...
13. Figure 2.13 The location of the urethral bulb, and how knowledge of this are...
14. Figure 2.14 Coudé catheter. Gently rotating the catheter during the insertio...
15. Figure 2.15 Urethral pressure profile in a woman showing the small pulsation...
16. Figure 2.16 The bones of the pelvis, seen straight on (top) and obliquely; t...
17. Figure 2.17 Computed tomography‐guided placement of a needle for injection o...
18. Figure 2.18 Open bladder neck in the storage phase (purple arrow) caused by ...
19. Figure 2.19 Cystoscopic appearance of inflammation in bladder pain syndrome....
20. Figure 2.20 Computed tomography scans in people with extrinsic inflammation ...
21. Figure 2.21 Abdominal computed tomography scan (left: antero‐posterior view;...
22. Figure 2.22 Urethral receptors can cause urgency. In this man undergoing vid...
23. Figure 2.23 Structural changes related to the urethra can lead to lower urin...
24. Figure 2.24 Key parts of the central nervous system responsible for lower ur...
25. Figure 2.25 The dermatomes are the areas of skin supplied by the various spi...
26. Figure 2.26 A wiring diagram summarising sacral spinal centres and their int...
27. Figure 2.27 Magnetic resonance imaging of the lower spine and spinal cord. T...
28. Figure 2.28 Key centres in the higher regions of the central nervous system....
Chapter 3
1. Figure 3.1 The pressures in the bladder can be appreciated by connecting the...
2. Figure 3.2 External transducer. The most common arrangement for urodynamics ...
3. Figure 3.3 A pressure change produces a movement of the transducer diaphragm...
4. Figure 3.4 Microtip transducer. The white silicone covers the strain gauge, ...
5. Figure 3.5 Air‐filled catheter system. A dual sensor catheter is shown, with...
6. Figure 3.6 External pressure transducers with water‐filled tubing (left‐hand...
7. Figure 3.7 Setting zero. In the top two diagrams, the three‐way tap on the r...
8. Figure 3.8 Setting zero with a catheter‐tip sensor. Note that the balloon is...
9. Figure 3.9 Manual checking of transducer calibration is easy. For a water‐fi...
10. Figure 3.10 Catheter‐tip sensing systems can be calibrated by submerging the...
11. Figure 3.11 Arrangement for infusion of fluid into the bladder. In this case...
12. Figure 3.12 Urine flowmeters; rotating disc type on the left, weight transdu...
13. Figure 3.13 Calibrating a flowmeter with a known volume or weight.
Chapter 4
1. Figure 4.1 Fundamental focus on some underlying factors in lower urinary tra...
2. Figure 4.2 The International Consultation on Incontinence Questionnaire blad...
3. Figure 4.3 Information abstracted from a bladder diary showing some commonpl...
4. Figure 4.4 A diary which clearly indicates a considerable caffeine intake, i...
5. Figure 4.5 Two days from a 3‐day diary showing a high alcohol intake, releva...
6. Figure 4.6 A patient with diabetes insipidus, a situation where the kidneys ...
7. Figure 4.7 Two days from a 3‐day diary of a man with congestive cardiac fail...
8. Figure 4.8 Urine concentration test; the ability to make concentrated urine ...
9. Figure 4.9 Two days from a 3‐day diary illustrating frequent voiding to prev...
10. Figure 4.10 One day from a 3‐day bladder diary for a patient with both overa...
11. Figure 4.11 Nocturia caused by urgency. This patient's nocturia may improve ...
12. Figure 4.12 Summary diagram for assessment of male nocturia patients based o...
13. Figure 4.13 Ultrasound and cystoscopy images of a transvaginal tape (TVT) cl...
14. Figure 4.14 The considerably distorted bladder of a man following pelvic tra...
15. Figure 4.15 On physical examination, this man was noticed to have an abnorma...
16. Figure 4.16 The six defined points used to quantify pelvic organ prolapse (P...
17. Figure 4.17 How the six defined points and three measurements relate to a 3 ...
18. Figure 4.18 POP‐Q staging of a second‐stage anterior (left) and second‐stage...
19. Figure 4.19 POP‐Q staging of a stage IV pelvic organ prolapse (procidentia)....
20. Figure 4.20 Practical aspects of performing POP‐Q.
Chapter 5
1. Figure 5.1 An example of why it is appropriate to review the situation if fa...
2. Figure 5.2 Managing benign lower urinary tract dysfunction can require succe...
3. Figure 5.3 Combination of beta‐3 agonist (mirabegron 50 mg) with antimuscari...
4. Figure 5.4 Mean improvement from baseline in the proportion of patients who ...
5. Figure 5.5 Computed tomography (CT) scan of a sacral nerve stimulator in pos...
6. Figure 5.6 Applying treatment with a tibial nerve stimulator. The inserted e...
7. Figure 5.7 Three crucial steps in an augmentation cystoplasty. Left image: b...
8. Figure 5.8 A summary of the approach to assessing and treating nocturia in m...
9. Figure 5.9 Conservative measures to manage nocturia. DM: Diabetes mellitus....
10. Figure 5.10 Some of the penile compression clamps available for managing mal...
11. Figure 5.11 X‐ray of a male with stress incontinence wearing a penile clamp ...
12. Figure 5.12 Penile compression device (PCD) and the penile blood supply. Dia...
13. Figure 5.13 Colposuspension, viewed from the inside of the pelvis, with the ...
14. Figure 5.14 The anatomical location of an autologous sling. This figure illu...
15. Figure 5.15 An X‐ray of an artificial urinary sphincter (AUS) in two women. ...
16. Figure 5.16 An X‐ray of an artificial urinary sphincter in a man, showing th...
17. Figure 5.17 Changing use of medications used to treat male LUTS showing the ...
18. Figure 5.18 Changing use of interventional treatments for male bladder outle...
19. Figure 5.19 A Mitrofanoff extra‐urethral channel to enable intermittent self...
20. Figure 5.20 Video urodynamic study of a patient with a Mitrofanoff channel a...
21. Figure 5.21 X‐ray during pressure flow studies of a woman who reported post‐...
Chapter 6
1. Figure 6.1 The factors that determine flow function are the bladder (detruso...
2. Figure 6.2 A visit to the flow clinic should be a chance to measure a few vo...
3. Figure 6.3 Example of a trace that provides useful information despite the v...
4. Figure 6.4 A standard reporting sheet for a free flow rate appointment. It d...
5. Figure 6.5 Some fluid‐filled structures in the pelvis that a bladder scanner...
6. Figure 6.6 Ultrasound scan showing the septum (red arrow) between a bladder ...
7. Figure 6.7 Calculating a PVR with an ultrasound uses the formula length × wi...
8. Figure 6.8 An artefact affecting the machine‐measured Q_max which must be cor...
9. Figure 6.9 An artefact affecting the machine‐measured Q_max which must be cor...
10. Figure 6.10 An artefact affecting the machine‐measured Q_max which must be co...
11. Figure 6.11 Behavioural muscle contractions can affect the flow pattern. The...
12. Figure 6.12 The normal flow curve characterised by a rapid upstroke, good Q_m...
13. Figure 6.13 On the left is an endoscopic view and flow trace pattern for a s...
14. Figure 6.14 A flow trace pattern characterised by a slow upstroke, low Q_max,...
15. Figure 6.15 A fluctuating pattern, with several peaks and a prolonged voidin...
16. Figure 6.16 An intermittent and prolonged pattern, with several peaks separa...
17. Figure 6.17 A mnemonic to help remember important things to assess when scru...
18. Figure 6.18 Photographs of rotating disc (left) and weight transducer (right...
19. Figure 6.19 A defined flow and volume bottle can be used for roughly checkin...
20. Figure 6.20 The flow pattern generated when two regular users of intermitten...
Chapter 7
1. Figure 7.1 Disposable equipment used for measuring abdominal pressure; syrin...
2. Figure 7.2 A rectal catheter measures abdominal pressure (1), but will also ...
3. Figure 7.3 A filling cystometry showing rectal contractions (1) and detrusor...
4. Figure 7.4 Attempting to provoke urodynamic stress incontinence. Valsalva ma...
5. Figure 7.5 Provocation testing for detrusor overactivity (DO). At 1, the wat...
6. Figure 7.6 Top image: two pressure transducers are needed for standard urody...
7. Figure 7.7 The arrangements for switching between configurations. External s...
8. Figure 7.8 Effects of position change on the rectal pressure. Top row: when ...
9. Figure 7.9 Zero to patient error. The ‘zero all lines’ command has been pres...
10. Figure 7.10 When measuring with water‐filled catheters and external transduc...
11. Figure 7.11 Bladder expansion is constrained in front by the pubis (grey arr...
12. Figure 7.12 The start of a urodynamic trace demonstrating the setting up seq...
13. Figure 7.13 Above is a photograph of an air‐charged catheter system. The yel...
14. Figure 7.14 Bland–Altman graph comparing filling pressure values measured by...
15. Figure 7.15 How position of the patient affects pressure for an air‐filled c...
16. Figure 7.16 The two‐catheter technique. Above: photographs of the catheters ...
17. Figure 7.17 A straight catheter may be difficult to get past the bladder nec...
18. Figure 7.18 Pressure variations resulting from the filling pump mechanism, a...
19. Figure 7.19 Single lumen bladder catheter for filling and p_ves measurement. ...
20. Figure 7.20 Two catheters (left side) and double lumen catheters (right) ill...
21. Figure 7.21 Recording abdominal pressure from a colostomy during filling cys...
22. Figure 7.22 Cough testing of recording fidelity. A cough generates a short‐l...
23. Figure 7.23 When someone coughs, it affects the bladder and the rectum at th...
24. Figure 7.24 A steady declining pressure (here affecting p_ves, i.e. the blue ...
25. Figure 7.25 Filling cystometry, showing how position can affect detrusor ove...
26. Figure 7.26 A bubble (red arrow) in a pressure transducer dome, which will d...
27. Figure 7.27 Resting pressures can change in response to both the position of...
28. Figure 7.28 There is poor pressure transmission on p_ves at the start of the ...
29. Figure 7.29 Problems with the rectal line have the potential to mistakenly i...
30. Figure 7.30 Different patterns of detrusor overactivity (DO) as defined by a...
31. Figure 7.31 Filling cystometry showing detrusor overactivity (DO), which is ...
32. Figure 7.32 Cough‐provoked detrusor overactivity (DO) incontinence. The pati...
33. Figure 7.33 Calculating compliance requires pressure and volume values at tw...
34. Figure 7.34 If leakage happens, the pressure change calculation should use t...
35. Figure 7.35 Implications of poorly compliant detrusor for filling cystometry...
36. Figure 7.36 Two cases where compliance deteriorated as filling cystometry pr...
37. Figure 7.37 Urethral relaxation supplemented by straining. This figure illus...
38. Figure 7.38 Pelvic floor contraction in response to detrusor overactivity (D...
39. Figure 7.39 Evaluating a woman with stress urinary incontinence (SUI) sympto...
40. Figure 7.40 This man had stress urinary incontinence symptoms after radical ...
41. Figure 7.41 A problem with rectal recording in this filling cystometry cause...
42. Figure 7.42 Pressure parameters during PFS in a male patient. The initial re...
43. Figure 7.43 Two ‘after contractions’, meaning detrusor contractions followin...
44. Figure 7.44 In this man, detrusor overactivity (DO) is seen towards the end ...
45. Figure 7.45 In this man, detrusor overactivity (DO) with some incontinence i...
46. Figure 7.46 Detrusor activity during voiding may be normal, underactive (lef...
47. Figure 7.47 A ‘stop test’ to assess detrusor contractility (see main text). ...
48. Figure 7.48 The t_20‐80 approach to estimating detrusor contractility; ...
49. Figure 7.49 Pressure‐flow study demonstrating dysfunctional voiding in an ad...
50. Figure 7.50 In this woman, the pressure‐flow study (right) gives the appeara...
51. Figure 7.51 Problems with the vesical line in a pressure‐flow study (all mal...
52. Figure 7.52 Pressure‐flow study (PFS) for a woman. The cough before and afte...
53. Figure 7.53 Pressure‐flow study (left) illustrating how straining may be don...
54. Figure 7.54 Attempts to increase flow rate do not have any effect if bladder...
55. Figure 7.55 A woman with Fowler's syndrome. Free‐flow rate testing (top left...
Chapter 8
1. Figure 8.1 The bony pelvis viewed from two projections in patients with sacr...
2. Figure 8.2 Images from three different viewpoints taken during video urodyna...
3. Figure 8.3 45° horizontal oblique view of the male outlet during voiding. Th...
4. Figure 8.4 Vertical oblique centred above the bladder. This projection was u...
5. Figure 8.5 Severe bilateral vesicoureteric reflux; this is grade V, due to l...
6. Figure 8.6 The mobile X‐ray C‐arm showing the X‐ray source (black arrow), im...
7. Figure 8.7 An obese patient can represent a challenge for X‐ray imaging. In ...
8. Figure 8.8 Female pelvic floor support. In the left image, the base of the b...
9. Figure 8.9 Male pelvic floor support. Denervation of the pelvic floor in a m...
10. Figure 8.10 Intrinsic sphincter deficiency in a woman. Stress incontinence c...
11. Figure 8.11 Intrinsic sphincter deficiency in a man after radical prostatect...
12. Figure 8.12 A ‘fir tree’ bladder in a child with neurological disease illust...
13. Figure 8.13 A bladder diverticulum (red arrow) that only became visible when...
14. Figure 8.14 The appearance of a sliding hernia in a man undergoing video uro...
15. Figure 8.15 Two images which identified that part of the bladder had been ca...
16. Figure 8.16 A ureterocoele (blue arrow), visible as it does not contain cont...
17. Figure 8.17 Vesicoureteric reflux (VUR). VUR can first become visible during...
18. Figure 8.18 Obstruction at the bladder neck in a man undergoing pressure‐flo...
19. Figure 8.19 Obstruction at the prostate in a man undergoing pressure‐flow st...
20. Figure 8.20 Obstruction at the external urethral sphincter in a man undergoi...
21. Figure 8.21 Male urethral strictures. Left image: a stricture affecting the ...
22. Figure 8.22 Urethrogram of a stricture affecting virtually the entire urethr...
23. Figure 8.23 Bladder outlet obstruction in a woman where her previous miduret...
24. Figure 8.24 A urethral stricture in a woman (green arrow). There is also a s...
25. Figure 8.25 A urethral false passage in a man. At this point, two tracks can...
26. Figure 8.26 A urethral fistula in a man going to the perineum (blue arrow). ...
27. Figure 8.27 Reflux into the prostatic ducts in a man with neurological disea...
28. Figure 8.28 Reflux of contrast into a seminal vesicle (red arrow). This is a...
29. Figure 8.29 Posterior urethral valves (PUV) seen endoscopically (left) and d...
30. Figure 8.30 Severe PUV, indicated by a red arrow. There is enormous swelling...
31. Figure 8.31 After pressure‐flow study, the presence of a post‐void residual ...
32. Figure 8.32 Pseudoresidual. Images taken at the end of voiding in a boy with...
33. Figure 8.33 Intravaginal reflux. Two cases where a woman passing urine has e...
34. Figure 8.34 A urethral diverticulum in a woman can cause post‐micturition dr...
35. Figure 8.35 Internal and external foreign bodies seen on video urodynamics; ...
36. Figure 8.36 Another form of external foreign body seen on video urodynamics;...
37. Figure 8.37 A two chamber penile implant seen during video urodynamics, the ...
38. Figure 8.38 Another implant in a man, a Memokath intraurethral stent (orange...
39. Figure 8.39 A man undergoing filling cystometry to assess bladder compliance...
40. Figure 8.40 Extrinsic structures impinging on the bladder. On the left, comp...
41. Figure 8.41 Oblique view of a man using his hand (orange arrow) to direct hi...
42. Figure 8.42 Plain X‐ray of a man who had previously undergone radical prosta...
43. Figure 8.43 The left image was interpreted as showing vesicoureteric reflux ...
44. Figure 8.44 A man with a history of post‐prostatectomy incontinence undergoi...
45. Figure 8.45 Three men with an artificial urinary sphincter (AUS) around the ...
46. Figure 8.46 Oblique view of the bladder neck in a man before (left) and afte...
47. Figure 8.47 A retrograde urethrogram or ‘upogram’ requires placement of a ca...
48. Figure 8.48 A retrograde urethrogram, ‘upogram’, demonstrating a near‐oblite...
49. Figure 8.49 Urodynamic stress incontinence caused by urethral hypermobility....
50. Figure 8.50 Filling cystometry of extreme neurogenic lower urinary tract dys...
51. Figure 8.51 A transplant patient with a Foley catheter (black arrow), a uret...
52. Figure 8.52 Pressure‐flow studies in a transplant patient. Top left: before ...
53. Figure 8.53 A renal transplant with graft dysfunction due to poorly complian...
54. Figure 8.54 A man with two previous transplants. His first graft (non‐functi...
55. Figure 8.55 A Whitaker test showing the contrast perfusion (left) and pressu...
56. Figure 8.56 A Whitaker test showing the contrast perfusion (left) and pressu...
57. Figure 8.57 Filling cystometry showing a large bladder diverticulum (red arr...
58. Figure 8.58 A case of severe vesicoureteric reflux is shown in the top left ...
59. Figure 8.59 Visible shape change associated with bladder contraction.
60. Figure 8.60 As a radiological test, the study room needs to have warning not...
61. Figure 8.61 Good practice caring for lead aprons is vital to ensure they mai...
62. Figure 8.62 The distorting effect on relative size due to different distance...
63. Figure 8.63 C‐arm position for men during filling cystometry (left) and tran...
64. Figure 8.64 C‐arm position for women during filling cystometry and pressure‐...
Chapter 9
1. Figure 9.1 Equipment for ambulatory urodynamics, set up and in use. The equi...
2. Figure 9.2 Ambulatory trace for a woman, who experienced detrusor overactivi...
3. Figure 9.3 A short series of coughs (red arrow), followed by a longer cough ...
4. Figure 9.4 A study which identified urodynamic stress incontinence. The prov...
5. Figure 9.5 Bristol experience with ambulatory urodynamics. LUTS: lower urina...
Chapter 10
1. Figure 10.1 Filling cystometry, showing detrusor overactivity (green arrow),...
2. Figure 10.2 Schematic diagram of the key arrangements for evaluating a ureth...
3. Figure 10.3 Catheters for running a urethral pressure profile test. The p_ura
4. Figure 10.4 Features of the normal urethral pressure profile for women (left...
5. Figure 10.5 A urethral pressure recording taken from the maximum closure pre...
6. Figure 10.6 Urethral pressure profile nomenclature. Maximum urethral closure...
7. Figure 10.7 Features on a urethral pressure profile of a woman (left) and a ...
8. Figure 10.8 The p_ves line is usually comparatively featureless in a urethral...
9. Figure 10.9 The difference between gluteal and sphincter contraction is seen...
10. Figure 10.10 Pulsations in p_ura caused by the arterial pulse (left) and a tr...
11. Figure 10.11 Photograph of a urethral pressure profile setup. The catheter i...
12. Figure 10.12 The trace from a complete urethral pressure profilometry in a w...
13. Figure 10.13 An enlarged prostate can show up during urethral pressure profi...
14. Figure 10.14 Urethral pressure profiles for two women who previously underwe...
15. Figure 10.15 A urethral pressure profile for a man who had TURP where prosta...
16. Figure 10.16 A urethral pressure profile for a 37‐year‐old woman with severe...
17. Figure 10.17 Urethral pressure profile for a woman with Fowler's syndrome. M...
18. Figure 10.18 Urethral pressure profile before and after placement of a ring ...
19. Figure 10.19 UPP in a woman with a urethrovesical fistula. Two profiles were...
20. Figure 10.20 A continent man with previous radical prostate‐ctomy, showing h...
21. Figure 10.21 A severely incontinent man with previous radical prostatectomy....
22. Figure 10.22 Urethral pressure profile (UPP) in a man with stress urinary in...
23. Figure 10.23 Urethral pressure profiles in another man with stress urinary i...
24. Figure 10.24 Urethral pressure profiles (UPPs) in another man with stress ur...
25. Figure 10.25 Demonstrated urodynamic stress incontinence in a man where a se...
26. Figure 10.26 Detrusor leak point pressure in a man with a poorly compliant d...
Chapter 11
1. Figure 11.1 Bladder wall thickness (red arrow) and detrusor wall thickness (...
2. Figure 11.2 Schematic diagram of the condom catheter method.
3. Figure 11.3 Illustration of the setup for the penile cuff test. The cuff sho...
4. Figure 11.4 Example cuff test time series data. Cuff pressure is shown in or...
5. Figure 11.5 Example pressure‐flow plot from an inflation where erratic flow ...
6. Figure 11.6 Example cuff test where the first inflation reaches the pressure...
7. Figure 11.7 Examples of marking cuff interruption pressure for three inflati...
8. Figure 11.8 The line separating the obstructed and equivocal regions in the ...
9. Figure 11.9 The Newcastle non‐invasive nomogram.
10. Figure 11.10 Bladder outlet obstruction diagnosed with penile cuff test.
11. Figure 11.11 Detrusor underactivity diagnosed with penile cuff test.
12. Figure 11.12 Unobstructed finding for penile cuff test.
Chapter 12
1. Figure 12.1 Video urodynamic filling cystometry of an 11‐year‐old boy with s...
2. Figure 12.2 The left image is an antenatal ultrasound of a male foetus at 22...
3. Figure 12.3 Video urodynamic pressure‐flow study (PFS) of a teenager w...
4. Figure 12.4 A representative pre‐intervention free flowmetry trace for a chi...
5. Figure 12.5 A representative pre‐intervention trace during animated biofeedb...
6. Figure 12.6 Video urodynamic filling cystometry of an 11‐year‐old boy with w...
7. Figure 12.7 Video urodynamic filling cystometry on a four‐year‐old girl with...
8. Figure 12.8 Top images: cystogram showing the severity of vesicoureteric ref...
Chapter 13
1. Figure 13.1 Recording from the posterior fornix of the vagina can provide a ...
2. Figure 13.2 Maximising the chances of identifying Urodynamic stress incontin...
3. Figure 13.3 Urinary leaks may have uncertain mechanism during urodynamics. L...
4. Figure 13.4 Pressure‐flow study in a woman with stress incontinence (not sho...
5. Figure 13.5 Stress provocation testing at the end of filling cystometry and ...
6. Figure 13.6 Stress provocation testing at the end of filling cystometry and ...
7. Figure 13.7 Using position change to stabilise the detrusor. This woman deve...
8. Figure 13.8 Voiding dysfunction caused by pelvic organ prolapse. Permission ...
9. Figure 13.9 Pessaries are an important stock item, requiring a range of type...
10. Figure 13.10 Cystogram of a vesico‐vaginal fistula after gynaecological surg...
11. Figure 13.11 Pressure‐flow study showing the voiding dysfunction caused by a...
12. Figure 13.12 DO incontinence in a woman who previously had a midurethral tap...
13. Figure 13.13 A woman who is managing to prevent detrusor overactivity (DO) f...
14. Figure 13.14 A woman who is unable to prevent DO incontinence with her urina...
15. Figure 13.15 Schematic representation of filling sensations for normal lower...
16. Figure 13.16 Urethral relaxation incontinence during an ambulatory urodynami...
17. Figure 13.17 Pressure‐flow study during video urodynamics showing how strain...
18. Figure 13.18 Urodynamic trace illustrating orgasm incontinence (non‐coital, ...
19. Figure 13.19 Urodynamic trace illustrating orgasm incontinence (non‐coital) ...
20. Figure 13.20 Ambulatory urodynamic trace showing detrusor overactivity durin...
21. Figure 13.21 Processes that can cause bladder outlet obstruction in women. O...
22. Figure 13.22 Pressure‐flow study in a woman with meatal stenosis. The size o...
23. Figure 13.23 A woman with obstruction after a transvaginal tape (TVT) placem...
24. Figure 13.24 Another woman with history of transvaginal tape (TVT) placement...
25. Figure 13.25 A woman with high pressure and slow flow intermittent voiding d...
26. Figure 13.26 Free flow test in a woman, showing the interrupted stream chara...
27. Figure 13.27 Pressure‐flow study in a woman with severe detrusor underactivi...
28. Figure 13.28 Pressure‐flow study in another woman with severe detrusor under...
29. Figure 13.29 Pressure‐flow study (PFS) in a woman with severe detrusor under...
30. Figure 13.30 Impaired bladder compliance in a woman previously treated with ...
31. Figure 13.31 An analysis of the history and urodynamic findings for women wi...
Chapter 14
1. Figure 14.1 Filling cystometry illustrating detrusor overactivity (DO) witho...
2. Figure 14.2 Filling cystometry showing detrusor overactivity (open black arr...
3. Figure 14.3 Persisting detrusor overactivity (DO) incontinence after transur...
4. Figure 14.4 Composite bladder outflow obstruction index and bladder contract...
5. Figure 14.5 Correcting Q_max. In a free flow rate test, the machine documents...
6. Figure 14.6 Deriving Q_max and p_detQmax. The pressure‐flow study begins with ...
7. Figure 14.7 Adjustments if p_abd changes during the course of a pressure‐flow...
8. Figure 14.8 Cough tests are done after a pressure‐flow study to identify pre...
9. Figure 14.9 A free flow pattern suggestive of detrusor underactivity.
10. Figure 14.10 A pressure‐flow study in which corrected Q_max was 6 ml/s and p_d...
11. Figure 14.11 This man was filled in the supine position. When he was transfe...
12. Figure 14.12 A well‐recognised issue for younger men being catheterised is t...
13. Figure 14.13 A man with voiding lower urinary tract symptoms after transuret...
14. Figure 14.14 A man with voiding lower urinary tract symptoms after transuret...
15. Figure 14.15 Man who was very hard to catheterise for urodynamic assessment ...
16. Figure 14.16 A man with history of radical prostatectomy. A small amount of ...
17. Figure 14.17 A man with history of radical prostatectomy. His urethral press...
18. Figure 14.18 Men can often resist stress incontinence by pre‐contracting the...
19. Figure 14.19 Bladder neck stenosis at the site of vesico‐urethral anastomosi...
20. Figure 14.20 Man with severe sphincter failure (almost undetectable urethral...
21. Figure 14.21 Another patient with a penile clamp in place to enable filling ...
22. Figure 14.22 Plot of pad weights measured by a man over a nine‐month period ...
23. Figure 14.23 Several things need to be considered before recommending artifi...
24. Figure 14.24 A functioning artificial urinary sphincter (AUS). The top left ...
25. Figure 14.25 Another man with an artificial urinary sphincter, before and af...
26. Figure 14.26 Part of a filling cystometry in a man with an artificial urinar...
27. Figure 14.27 The artificial urinary sphincter balloon seen on ultrasound loo...
28. Figure 14.28 The artificial urinary sphincter balloon in this man with recur...
29. Figure 14.29 A man with incontinence after a male sling. The filling cystome...
Chapter 15
1. Figure 15.1 Picture demonstrating complete obliteration of the urethral meat...
2. Figure 15.2 A man with a ‘buried penis’ due to obesity. Attempts to retract ...
3. Figure 15.3 Lichen sclerosus affecting the urethral meatus in a woman. This ...
4. Figure 15.4 Endoscopic view of a severe bladder neck contracture (black arro...
5. Figure 15.5 Urethrogram demonstrating a membranous and bulbar urethral stric...
6. Figure 15.6 A 64‐year‐old man previously treated with radiotherapy for prost...
7. Figure 15.7 Recent pelvic trauma, with fractures of the pubis and ischia (bl...
8. Figure 15.8 Urethrogram demonstrating a stricture following a pelvic fractur...
9. Figure 15.9 A pubic fracture in a woman repaired with internal fixation (red...
10. Figure 15.10 Two cases of distal hypospadias, with a urethral meatus located...
11. Figure 15.11 Penoscrotal hypospadias (green arrow). This patient had previou...
12. Figure 15.12 Traumatic hypospadias due to an indwelling urethral catheter. T...
13. Figure 15.13 Endoscopic view of a midurethral tape which had become exposed ...
14. Figure 15.14 A woman who had previously undergone male‐to‐female gender conf...
15. Figure 15.15 A man who was awaiting female‐to‐male gender confirmation surge...
16. Figure 15.16 Another man who was awaiting female‐to‐male gender confirmation...
Chapter 16
1. Figure 16.1 Schematic illustration to distinguish straining from detrusor sp...
2. Figure 16.2 Pressure‐flow study (PFS) traces from two men with neurological ...
3. Figure 16.3 Asymmetry of the leg muscles due to neurological deficit in the ...
4. Figure 16.4 Filling cystometry showing neurogenic detrusor overactivity (DO)...
5. Figure 16.5 Filling cystometry in a man with sacral spinal cord injury, fill...
6. Figure 16.6 Image during video urodynamics of a reconstructed lower urinary ...
7. Figure 16.7 Video urodynamic study showing how a penile clamp (green arrow) ...
8. Figure 16.8 Filling cystometry showing detrusor sphincter dyssynergia during...
9. Figure 16.9 Non‐relaxing urethral sphincter causing partial obstruction in a...
10. Figure 16.10 Suprapubic ‘tapping’, i.e. sharp percussive thumps (purple arro...
11. Figure 16.11 Underactive/acontractile detrusor seen during pressure‐flow stu...
12. Figure 16.12 Considerable delay between the cough which provoked urodynamic ...
13. Figure 16.13 Filling cystometry in a male patient with Parkinson's disease s...
14. Figure 16.14 Initial assessment and therapy of neurogenic lower urinary trac...
15. Figure 16.15 Specialised assessment and therapy of neurogenic lower urinary ...
16. Figure 16.16 Manual suprapubic compression (Crede's manoeuvre) using both ha...
17. Figure 16.17 Queen's Square bladder stimulator. The vibratory surface (white...
18. Figure 16.18 Malpositioned urethral catheter, with the balloon inflated in t...
19. Figure 16.19 A sequence of pictures during video urodynamics for a person wi...
20. Figure 16.20 Filling cystometry in a woman before (above) and one year after...
21. Figure 16.21 Pressure‐flow study of a male patient with multiple sclerosis r...
22. Figure 16.22 A 56‐year‐old male multiple sclerosis patient with incontinence...
23. Figure 16.23 Management algorithm for patients with multiple sclerosis prese...
24. Figure 16.24 Bladder management options with progression of disabilities in ...
25. Figure 16.25 Neural circuitry in Parkinson's disease and its implications fo...
26. Figure 16.26 Filling cystometry and pressure‐flow study in a man with Parkin...
27. Figure 16.27 A 43‐year‐old man with longstanding mild lower urinary tract sy...
28. Figure 16.28 Management of NLUTD in SCI.SCI: spinal cord injury; IDC: in...
29. Figure 16.29 The upper illustration is from a urodynamics study done on a ma...
30. Figure 16.30 Tarlov cysts are perineural sacral nerve root cysts, representi...
31. Figure 16.31 Magnetic resonance imaging scan showing a myelomeningocoele (re...
32. Figure 16.32 Plain abdominal X‐ray of a patient with spina bifida, showing t...
33. Figure 16.33 The bladder can be very thick‐walled in spina bifida, resulting...
34. Figure 16.34 Patient with spinal bifida showing features that can be visible...
35. Figure 16.35 Filling cystometry (top image) for a patient with spina bifida,...
36. Figure 16.36 Urodynamic evaluation of a man awaiting spinal surgery to treat...
Chapter 17
1. Figure 17.1 Nocturia is a multifactorial problem which might reflect lower u...
2. Figure 17.2 Flowchart of evidence‐based self‐managed action given on the bas...
3. Figure 17.3 Considerations when treating incontinence in patients older than...
Chapter 18
1. Figure 18.1 This section of a trace shows poor transmission of pressure on p
2. Figure 18.2 A downward drifting p_abd (open red arrow) after a cough led to f...
3. Figure 18.3 Unequal resting pressures are present at the start of the trace ...
4. Figure 18.4 Within this section of a filling cystometry, there is a gradual ...
5. Figure 18.5 The loss of live signal can occur at any point during a urodynam...
6. Figure 18.6 Problems arising when the catheters became trapped under the leg...
7. Figure 18.7 The remarkable similarity of p_ves and p_abd readings on this stud...
8. Figure 18.8 A p_ves catheter that was inadvertently recording from a ureter. ...
9. Figure 18.9 The trace resulting when the measuring jug was not put on the gr...
10. Figure 18.10 An error caused by attaching the connection tubing wrongly so t...
11. Figure 18.11 During voiding is a common time for errors to occur due to auto...
12. Figure 18.12 Pressure‐flow studies are common time for errors to occur due t...
13. Figure 18.13 A flowchart for troubleshooting during urodynamics.
Chapter 19
1. Figure 19.1 Two examples of the ‘cruising’ artefact, when the urine stream i...
2. Figure 19.2 The ‘squeeze and release’ artefact. Interruption of flow (black ...
3. Figure 19.3 An extreme example of how an artefactually high Q_max can grossly...
4. Figure 19.4 Q_max on this trace is recorded as 15 ml/s (red arrow), because t...
5. Figure 19.5 When the pump is started (at the green arrow), a noisy signal is...
6. Figure 19.6 The patient has moved from a standing (red arrow) to a seated po...
7. Figure 19.7 A patient who was standing was asked to crouch in order to test ...
8. Figure 19.8 A poor‐quality cough signal resolved into a good‐quality cough s...
9. Figure 19.9 The pressure changes seen on p_abd (red trace) are reflected on p
10. Figure 19.10 Pressure spikes generated when charging air‐filled catheters (r...
11. Figure 19.11 A patient with both air‐filled (upper three lines) and water‐fi...
12. Figure 19.12 The p_abd line has dropped by 14 cmH₂O during voiding; thus, p_de...
13. Figure 19.13 A void where two different catheters are measuring abdominal pr...
14. Figure 19.14 Despite repeated flushes (black arrows), the p_abd line did not ...
15. Figure 19.15 The p_ves catheter was voided during the flow (at the red arrow)...
16. Figure 19.16 The p_ves catheter reading lost live signal and maintained an el...
Chapter 20
1. Figure 20.1 The anorectum.
2. Figure 20.2 This picture shows a water‐perfused system, with the 10‐channel ...
3. Figure 20.3 This image shows the original line graphs produced from standard...
4. Figure 20.4 Here, we are able to visualise a short squeeze, a recovery perio...
5. Figure 20.5 This image is a stark contrast to Figure 20.4. The lighter green...
6. Figure 20.6 During simulated defaecation through straining, the patient prod...
7. Figure 20.7 A reduction in anal canal pressure occurs in response to the bal...
8. Figure 20.8 Proctogram showing the rectum (black arrow), anal canal (orange ...
9. Figure 20.9 Position of mesh in laparoscopic ventral mesh rectopexy.
Chapter 21
1. Figure 21.1 One of the urodynamics rooms in Bristol. On the left is the couc...
2. Figure 21.2 The flowmetry room. On the left is the flow rate meter (here set...
Chapter 23
1. Figure 23.1 A wooden frame holding two vertical water tubes that could be us...
2. Figure 23.2 A schematic diagram of the $100 urodynamics system.
3. Figure 23.3 Face‐to‐face discussion is an important aspect of learning the i...
4. Figure 23.4 A simple teaching aid for the set‐up of a fluid‐filled p_ves cath...
5. Figure 23.5 Small group urodynamics teaching in Sindh Institute of Transplan...

Guide

Cover Page
Title Page
Copyright Page
Abbreviations
Contributors
Preface
First Foreword
Second Foreword
Table of Contents
Begin Reading
Appendix A Key Patient Assessment Metrics from the International Consultation on Incontinence Questionnaires (ICIQ)
Appendix B Fundamentals Documents from the International Continence Society
Appendix C Patient Information Leaflets from the Bristol Urological Institute
Appendix D Practice, Standards, and Equipment Recommendations
Index
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