Urodynamic

A 2-week diary of wet and dry nights prior to intervention is useful in that it can be used to monitor the response to treatment. A first-morning urine specific gravity may help to predict response to desmopressin therapy. Polysymptomatic presentation may require a more elaborate work-up, including voiding cystourethrogram, renal and/or bladder ultrasound, urodynamics, and sleep studies. 

For UUI, the preferred diagnostic tests are urodynamic studies. Urinalysis and urine culture should be performed to rule out urinary tract infection. 

In open trials, estrogens were administered orally, intramuscularly, vagi-nally, or transdermally. Regardless of the route, estrogens exerted variable effects on urodynamic parameters, such as maximum urethral closure pressure, functional urethral length, and pressure transmission ratio. 

Results of four placebo-controlled comparative trials have not been as favorable, finding no significant clinical or urodynamic effect for oral estrogen compared with placebo. 

Many open trials support the use of a variety of a-adrenergic receptor agonists in SUI. Combining an a-adrenergic receptor agonist with an estrogen yields somewhat superior clinical and urodynamic responses compared with monotherapy. 

Maintenance Depending on the urodynamics and BPH symptomatology, dosage may then be increased to 2 mg and thereafter to 4 and 8 mg once daily, the maximum recommended dose for BPH. The recommended titration interval is 1 to 2 weeks. Evaluate blood pressure routinely. 

Early urodynamic effect. Permixon was administered to 75 patients with lower urinary tract symptoms resulting from mild-to-moderate BPH (mean IPSS 8.2), aged 52-78 years, at a dose of 160 mg twice daily for 9 weeks. Maximum urinary flow rate increased 6% (p < 0.001), and there was a reduction in detrusor pressure at maximum flow (12.8%, p < 0.001), opening detrusor pressure (12.6%, p < 0.001), and residual urine volume (12.6%, p < 0.05). The IPSS... 

Kuzmin, and R. R. Amdiy. Early urodynamic effects of the lipido-ste-rolic extract of Serenoa repens (Permixon ) in patients with lower urinary tract symptoms due to benign prostatic hyperplasia. Prostate Cancer Prostatic Dis 2000 3(3) 195-199. 

Geirsson, G., Fall, M., Sullivan, L. Clinical and urodynamic effects of intravesical capsaicin treatment in patients with chronic traumatic spinal detrusor hyperreflexia, J. Urol. 1995, 154, 1825-1829. 

In a 12-year-old boy taking desmopressin for nocturnal enuresis, hyponatremia and cerebral edema developed after high fluid intake before a urodynamic procedure... 

Placebo-controlled urodynamic studies in men with BPH have unequivocally demonstrated that finasteride produces objective improvement in bladder oudet obstruction (Tammela and Kontturi, 1993 Kirby et al., 1992 Abrams et al., 1999 Schaffer et al., 1999). Singlecenter studies using detrusor pressure to measure outflow obstruction demonstrated that the majority of finasteride-treated patients were shifted out of the obstructed range as compared with placebo patients over a 3- to 6-month study period (Tammela and Kontturi, 1993 Kirby et al., 1992). Similar results were reported in a 1-year multicenter study in men with BPH (Abrams et al., 1999). Moreover, this study demonstrated that the magnitude of the improvement in bladder oudet obstruction and maximal urinary flow rate with finasteride over placebo increases with increasing prostate volume. Long-term (1-year), open-label follow-up evaluation for this study demonstrated further reductions in bladder oudet obstruction with chronic finasteride therapy (Schaffer etal, 1999). 

Current evidence suggests that the urodynamic effects of epidural morphine are not dose-related, and the incidence is similar to that reported after intramuscular injections. Urinary retention is more frequent after the use of epidural opioids in volunteers compared with patients... 

Widman B. An experimental study of urodynamic effects of epidural morphine and of naloxone reversal. Anesth Analg 1983 62(7) 641-7. 

Castleden CM, Duffin HM, Briggs RS, Ogden BM. Clinical and urodynamic effects of ephedrine in elderly incontinent patients. J Urol 1982 128(6) 1250-1252. 

Hellstrom P, Lukkarinen O, Kontturi M. Bladder neck incision or transurethral electroresection for the treatment of urinary obstruction caused by small prostate A randomized urodynamic study. Scand J Urol Nephrol 1986 20 187-192. 

Urodynamic studies are the gold standard for diagnosis. Also urinalysis and urine culture should be negative (rule out urinary tract infection as cause of frequency). 

In a systematic review and pooled analysis of 32 controlled trials of anticholinergic therapy for overactive bladder (January 2002 database), the above agents were found to be modestly effective clinically and urodynamically. While the clinical relevance of the small improvements in clinical and urodynamic parameters were questioned, the effects of these agents were still considered positive. ... 

Several studies have evaluated whether the clinical and urodynamic effects of a combination of estrogen and an a-adrenergic receptor agonist exceed those of the individual therapies in SUI. In general, combination therapy has resulted in somewhat superior clinical and urodynamic responses compared with monotherapy, including severity of complaints, amount of urine lost per episode, number of daily voluntary micturitions, number of leakage episodes per day, patient preference, pad use, maximum urethral closure pressure, functional urethral length, and pressure transmission ratio. 

Jonas U, Hofner K, Madersbacher H. Efficacy and safety of two doses of tolterodine versus placebo in patients with detrusor overactivity and symptoms of frequency, urge incontinence, and urgency Urodynamic evaluation. World J Urol 1997 15 144-151. 

Kiesswetter H, Hennrich F, Englisch M. Clinical and urodynamic assessment of pharmacologic therapy of stress inconhnence. Urol Int 1983 38 58-63. 

On September 4th 1998, in the Urodynamic Testing Laboratory, Subject 2 had his sacral roots (S3 and 4) bilaterally stimulated intermittently. This showed on three occasions the bladder contracted with recorded pressures of between 45 and 50 cm of water. On December 14th 1998, urodynamic testing again showed consistent results from S3 and 4 sacral root stimulation producing three sustained bladder contractions... 

Imaging surveillance is needed for the renal tract as these patients can develop calculi, reflux or obstruction. This is done by means of regular ultrasound and urodynamic assessment. Pressure sores may need contrast sinography or MR imaging to define the extent prior to surgery. 

The male urethra can be the site of frequent and serious primitive diseases that may affect the quality of life of patients. Diagnostic imaging has an important role to play since it can detect lesions that are inaccessible to urethroscopy and can help identify the extraurethral spread of the process. Ultrasonography, in particular, provides adjunct information that cannot be obtained either by traditional radiological examination, urethroscopy or urodynamics (Pavlica et al. 2003b Yekeler et al. 2004 Sepulveda et al. 2005 Salam 2006). 

Case series Seven men and three women, aged 20-30 (mean 25) years, who had all abused ketamine for 1-4 years, developed dysuria, increased frequency (having to void once every 15 minutes), urgency, urge incontinence, and painful hematuria [58 ]. None had positive urine cultures. Functional bladder capacities were 30-100 ml. Urodynamic tests showed detrusor overactivity, with urinary leakage when the bladder was filled to a capacity of 30-50 ml. There was bilateral reflux in one case and unilateral reflux in two seven had bilateral hydronephrosis. [The title of this paper is confusing, since street ketamine is a term that is used to refer to phencyclidine however, in the paper the authors refer to ketamine.]... 

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