URODYNAMICS PRES -rev 1- basic.ppt
- 1. PRINCIPLES OF URODYNAMICS URODYNAMICS consists of a group of diagnostic procedures that are performed to evaluate the voiding and storage functions of the lower urinary tract. It has two basic aims: 1. To reproduce the patient’s symptoms 2. To provide an explanation of the symptoms
- 2. MALE LOWER URINARY TRACT MALE URINARY TRACT 2
- 3. FEMALE LOWER URINARY TRACT 3
- 4. BLADDER: MUSCULAR "SACK" THAT RELAXES TO ACCOMODATE URINE (FILLING PHASE) AND CONTRACS TO EXPELL URINE THROUGH THE URETHRA (VOIDING PHASE) URETHRA: TUBE THAT CLOSES TO HOLD URINE IN BLADDER AND OPENS TO RELEASE URINE (MICTURITION) PHYSIOLOGY
- 5. BLADDER has a wall of smooth muscle fibres, called DETRUSOR. The bladder is capable of accepting large volumes of urine with little change in intravesical pressure. The detrusor is the source of mechanical power that pushes urine to flow through the urethra. URETHRA, i.e. the outlet of the bladder, is surrounded by muscle fibres from the wall of the bladder (bladder neck) which form the INTERNAL SPHINCTER. Then the urethra passes through the striated muscles of the Pelvic Floor which form the EXTERNAL SPHINCTER under conscious control. Normally, continence is obtained by the combined action of the sphincter and pelvic floor muscle which maintain urethral pressure greater than vesical pressure unless a detrusor contraction results in voluntary or involuntary micturition.
- 6. URODYNAMIC TECHNIQUES Urodynamic investigations must be carried out in a safe and scientific manner. Attention must be paid to : • Environment, i.e. privacy • Standardisation of the techniques according to ICS directives
- 8. URODYNAMIC INVESTIGATION • UROFLOWMETRY • CYSTOMETRY and PRESSURE FLOW STUDY ( CMG & PFS ) •URETHRAL PRESSURE PROFILE (UPP ) • LEAK POINT PRESSURE (LPP) Combined investigations: • ELECTROMYOGRAPHY of the PELVIC FLOOR •VIDEO URODYNAMICS
- 9. UROFLOWMETRY It is performed when the patient arrives at the lab with a full bladder and voids into a beaker that is placed on a weight transducer , called load cell. The uroflowmetry is a screening test only. An abnormal UROFLOW indicates a voiding dysfunction and should be followed by for further testing. The following parameters must be computed: •Delay time •Time to maximum flow •Maximum Flow Rate •Volume Voided •Flow time •Voiding Time •Average Flow Rate Maximum flow rate Delay time Time to maximum flow
- 10. Voiding time is defined as the total time from the on-set to the end of micturition. Flow time is defined as the total time when urine is actually flowing. VOIDING TIME and FLOW TIME
- 11. CYSTOMETRY It is performed by filling the bladder with saline ( CO2is rarely used ) by means of a peristaltic pump. The test requires the use either of two catheters or a double-lumen catheter. One catheter (or one lumen) is used for filling the bladder and the other one for recording the vesical pressure. A water filled balloon catheter is inserted into the rectum in order to record the abdominal pressure. By subtracting abdominal pressure from vesical pressure, the detrusor pressure is calculated. The detrusor pressure is the expression of the detrusor muscle function.
- 13. DETRUSOR PRESSURE = VESICAL PRESSURE – ABDOMINAL PRESSURE
- 14. CYSTOMETRY is basically performed to evaluate the COMPLIANCE and STABILITY of the detrusor muscle. COMPLIANCE is the capability of the bladder to accommodate urine inside. It must stretch" to "normal" capacity while maintaining low pressures. It is calculated dividing the volume by the pressure. STABILITY is evaluated by observing the detrusor while filling the bladder to normal capacity. The evaluation determines the presence or absence of DETRUSOR OVERACTIVITY Cystometry doesn’t give information about outlet function.
- 15. PRESSURE FLOW STUDY PRESSURE FLOW STUDY INVESTIGATES THE VOIDING PHASE A PRESSURE FLOW STUDY comprises simultaneous recording of bladder pressure and urinary flow rate. It usually includes recording of the abdominal pressure and often also sphincter EMG. The study is the golden standard of the urodynamics procedure since permits a complete evaluation of infravesical obstruction, detrusor contraction and a wide range of neurogenic bladder dysfunctions.
- 16. Catheter setting for Cystometry and Pressure Flow study
- 19. SCHAEFER NOMOGRAM Q on the y-axis and Pdet on the x-axis The screen is divided in: Seven sectors from left to right, named 0, I, II, ... VI. They show increasing obstruction degree. On these sectors lies the LinPURR line that represent the patient’s results. Six sectors, from the bottom to the top, marked VW, W-, W+, N-, N+, ST. They show the detrusor power that can vary from Very Weak to Strong. Three sectors from left to right named Unobstructed, Equivocal e Obstructed. They give a rough estimate about the presence or absence of urethral obstructions.
- 20. URETHRAL PRESSURES PROFILE ( UPP) It studies the Urethral function i.e. the competence of the urethra to hold on urine and to let it pass when required Two ways to perform UPP • - Static • -Dynamic or stress STATIC UPP It records the intraluminal pressure along the length of the urethra with the bladder at rest. It is performed with a catheter being pulled out at a constant rate by the mechanical withdrawer
- 21. UPP SETTING
- 22. PARAMETERS OF STATIC UPP
- 23. Maximum urethral pressure Maximum urethral closure pressure is the difference between the maximum urethral pressure and the intravesical pressure Functional profile length is the length of the urethra along which the pressure exceeds intravesical pressure
- 24. DYNAMIC UPP It assesses the efficiency of the pressure transmission to the urethra from the abdominal cavity A simultaneous measurement of the bladder pressure and urethral pressure is made by means of a suitable dual lumen catheter . This is withdrawn at a slow rate ( 1mm/s) with the patient coughing at regular interval
- 26. PARAMETERS OF DYNAMIC UPP •Trasmission coefficient = 100 x Urethral pressure increment/Bladder pressure increment • Pura at the onset of the peak
- 27. LEAK POINT PRESSURE LPP LPP is the bladder pressure at which urine leaks from the bladder. LPP is done during cystometry and PFS when the bladder is filled with 250 ml of saline. The patient is invited to strain slowly and increasingly i.e. to perform the so called Valsalva maneuver. (VLPP) Alternately the patient is invited to cough repeatedly . This is called Cough Leak Point Pressure CLPP .
- 28. VIDEO URODYNAMICS The urodynamic system is connected to a video output of an X-ray unit or image intensifier and captures images while performing a urodynamic test This feature allows the physician to visualize events in the lower urinary tract along with pressure, flow and EMG data.
- 30. UROLOGISTS GYNECOLOGISTS PEDIATRICIANS (SURGEONS) REHABILITATION SPECIALISTS WHO IS INTERESTED IN URODYNAMICS
- 31. MENFIS’ PRODUCT RANGE Pico Flow2 FlowZig Pico Bright Pico Compact Pico Smart Urodynamic catheters and lines
- 32. PICO FLOW2 • two channels: Uroflow and EMG • touch screen user interface •Large display 5” 1/4 • tests stored on a MC •tests can be reviewed •Wireless or cabled uroflowmeter
- 33. FLOWZIG Wireless trasmission to a PC by Zig Bee technologies Stand-alone or combined with Pico urodyanmic system Competitive price
- 34. PICO BRIGHT • Basic Urodynamic system • Full range of urodynamic tests (except Video-urodynamics) • 15” touch screen user interface • Up to 8 channels • Portable • Designed for small clinics
- 35. PICO COMPACT •Entire spectrum of urodynamic tests •Modular configuration •Fully expandable • 8 pressure channels •1 uroflow •2 EMG •1 volume • Sampling rate: 50 Hz
- 36. PICO SMART Same software with a state of art Acquisition unit : ACQ3000 • 12 plug-and-play channels • Sampling rate up to 1KHz per channel • Wireless link with the PC
- 38. Urodynamic catheters are made by MEDICA on Menfis design Sterile and single use • Wide range of single , double and triple lumen catheters. • Balloon catheter for abdominal pressure measurement. • Cannula made mainly of PEBAX® . It is a polyether-amide, biocompatible material with smooth surface
- 39. Parameters Materials Polyu rethan es P.V.C. Silicones PEBAX® Friction coefficient 1.35 2.0 3.0 0.95 Humidity absorption 0.9 0.75 0.1 0.5 Max temperature of sterilization 60 °C 60 °C 120 °C 60 °C Steam sterilizing NO NO YES NO Shape memory HIGH HIGH LOW HIGH Inner diameter / outer diameter ratio LOW LOW VERY LOW HIGH
- 40. SHAPE MEMORY It is fitted with a stiletto in order to straighten the tip. Then the catheter is passed transurethrally and the stiletto is removed .The tip resumes the pigtail shape thus avoiding expulsion of the catheter.
- 43. PHOENIX PLUS Standard system • 3way foot pedal
- 44. HERMES • New hardware •Old software •Fully expandable
- 46. ELIPSE • Small display • Optional Computer link • Nice system •No manometry expansion
- 47. HELIX Small and Compact system Fixed no of pressure channels (max 3) Optional link with a PC Very small display No manometry expansion
- 48. LABORIE MEDICAL TECHNOLOGY www.laborie.com •Urocap III •Aquarius •Triton •Delphis •Dorado •Catheters
- 49. TRITON •Flexible system •Many different configurations • Very aggressive marketing
- 50. LIFE-TECH www.life-tech.com •MICROFLO • UROLAB SYSTEM V •Catheters
- 51. UROLAB Life-Tech: long experience •The system takes several names: Novus, Opus, Primus, Janus, Maximum • Reliable system
- 53. LOGIC G2 Ex Medtronic , ex Dantec Dedicated Keyboard Flowmeter with Spinning disk
- 54. SPINNING DISK • A DISK IS KEPT ROTATING AT A CONSTANT SPEED • THE URINE JET STREAM DECELERATED THE DISK • A FEEDBACK CONTROL INCREASES THE ENGINE POWER TO KEEP THE ROTATION CONSTANT •THE POWER CONSUMPTION IS A FUNCTION OF THE FLOW RATE • ADVANTAGE : THE URINE CAN BE DRAINED TO THE SEWER •DISADVENTAGE: MORE LIABLE TO TECHNICAL FAILURE
- 55. Sensicclinic Ergonomic system Full set of Urodynamic tests Wireless Uroflowmeter No Anorectal Manometry
- 56. MMS - Medical Measurements Systems www.mmsinternational.com •Flowmaster •Flowstar •Alpha & Alpha Plus •Solar Blue •Solar • Catheters
- 57. SOLAR • Fully upgradeable system •DICOM and HL7 connectivity
- 58. SOLAR BLUE Fully wireless system Uroflowmeter, PC, puller linked by Bluetooth Portable system ******* •Only for urodynamics •No GI manometry expansion
- 59. THANK YOU