Video-urodynamics

Diagnostic Procedures Exciuding MRi, Nuciear Medicine and Video Urodynamics... 

In a second step the video-urodynamic study itself is performed. Fluoroscopic video-cystourethrography is performed intermittently during the filling and storage phases. Fluoroscopy of voiding demands that micturition be performed in the erect position in older children, and for this a simple funnel-shaped device to fit the female perineum is utilized. 

Cases requiring video-urodynamic investigations are relatively infrequent in everyday radiologic and urologic practice. A need for video-urodynamic referral centers capable of performing such studies, however, exists. 

Fig. 1.4.1. Example of a video-urodynamic study. Blue line indicates total bladder pressure, red line rectal pressure, green line subtracted bladder pressure (detrusor pressure), white line electromyogram, dark blue line urinary flow. Vertical white line indicates time of fluoroscopic image...

Complete work-up of the lower urinary tract regarding the simultaneous assessment of morphology and functional disorders can be achieved by video-urodynamics, if available (see Chap. 1.4). Since the bladder outlet and urethral morphology are of particular interest in these patients at any time of the staged surgical correction, there is no role for a direct radionuclide cystogram and sonographic VCU. 

In the neonatal period ultrasound can be used for assessment of coexisting renal and spinal malformations. Modified VCU assesses both lower urinary tract function and morphology. Video-urodynamics, if available, allows complete work-up of the lower urinary tract. After antireflux surgery abbreviated IVU should be used for evaluation of urine transport in equivocal cases it should be completed by isotope studies. 

In a study on the utility of video-urodynamics in children with UTI and nonneurogenic bladder sphincter-dysfunction. Glazier et al. (1997) also found a majority of cases with unstable bladder and only 30% of patients with dysfunctional voiding. 

Glazier DB, Murphy DP, Fleisher MH et al (1997) Evaluation of the utility of video-urodynamics in children with urinary tract infections and voiding dysfunction. Br J Urol 80 806-808... 

Hoebeke P, Van Laecke E, Van Camp C et al (2001) One thousand video-urodynamic studies in children with non-neurogenic bladder sphincter dysfunction. BJU Int 87 575-580... 

Functional questions can be answered by urodynamics video-urodynamics provide simultaneous analysis of functional and morphologic findings. A modified VCU technique can also assess both functional disturbance and morphologic alterations. 

A standardized protocol for the evaluation of the urinary tract must be established in every radiological department caring for neonates, infants and children with myelodysplasia. Such a protocol might be as follows After the myelomeningocele has been repaired and the hydrocephalus has been relieved by a shunt device, ultrasound studies of the kidneys and the bladder should be performed. During the first 6 weeks of life, a video-urodynamic study, if available, or a modified VCU study must be performed. In hospitals where only urodynamics is available, we suggest a modified VCU study as well. 

A standardized protocol should include early ultrasound studies of the urinary tract and a VUD study, if available, or a modified VCU within the first 6 weeks of life. If VUD is not available a VCU study should be complemented by urodynamics. The follow-up protocol should include ultrasound studies every 6 months and video-urodynamics or a modified VCU study once a year. 

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