urodynamic study workshop 2014 hong kong continence society
TRANSCRIPT
Urodynamic Study Workshop 2014
Hong Kong Continence Society
Presented by:
Dr. Toby Chan
Associate Consultant
O & G Dept, QEH
Introduction
O Urodynamic study is one of the most
commonly employed investigations for
objective diagnosis
Case Study
O 51 yo/F
O Chinese woman
O Good past health
O Parity 1, history of normal spontaneous
vaginal delivery of a 3.6 kg baby with
episiotomy made
O No perineal tear
O Pre-menopausal
Case Study O Presented with pelvic organ prolapse and voiding
dysfunction for 1 year
O Occasional dragging sensation, no vaginal bleeding
O Stress incontinence +ve before symptoms of POP but
no more since after detection of POP
O No irritative urinary symptom
O On and off weak stream requiring straining / manual
reduction of prolapse for better voiding
O Sense of incomplete emptying +ve
Case Study O Physical examination findings:
O BW = 48kg, BH = 1.60m
O Abdominal examination: unremarkable
O Pelvic examination:
O Stress leak test –ve
O Vulva and vagina normal looking
O First degree Uterovaginal prolapse with mark
cystocele
O No rectocele / enterocele
• Genital Prolapse Assessment:
POP-Q –
0 0 -2
5 3 8
-3 -3 -6
Case Study
O Urodynamic Study arranged for voiding
symptom associated with genital prolapse /
History of stress incontience
O Preparation:
O MSU for C/ST –ve
O Consented for procedure
Case Study O Filling phase tracing with ring pessary:
Stress leak + ve
Case Study O Filling phase measurement:
Filling cystometry:
Measurement Detrusor pressure
Filling rate 80 ml/min
First desire to void 180 ml 0 cmH2O
Strong desire to
void
422 ml 0 cm H2O
Max. cystometric
capacity:
450 ml 0 cm H2O
Bladder sensation Normal
Case Study O Filling phase measurement:
Detrusor Overactivity No
Urodynamic stress
incontinence
Yes
-Amount: small
-Posture: supine
-Leaking at coughing 2 times;
at volume MCC ml, Pdet 0
cmH2O
-Valsalva leak point pressure
>120 cmH2O, at volume
MCC
Case Study O Voiding Cystometry Tracing (Without ring pessary):
Case Study O Voiding Cystometry Measurement (Without ring pessary):
Qmax: 16 ml/s
Voided volume 400 ml
Pdet at Qmax
28 cmH2O
Residual Urine
50 ml
Detrusor activity during voiding
normal
Strain to void Yes
Urine flow
Intermittent
Case Study O Voiding Cystometry Tracing (With ring pessary):
Pvec cmH2O
Pabd cmH2O
Pdet cmH2O
Qura ml/s
Case Study
O Voiding Cystometry Measurement (With ring
pessary):
Qmax: 35.4 ml/s
Voided volume 456 ml
Pdet at Qmax 40 cmH2O
Residual Urine 0 ml
Detrusor activity during voiding
normal
Strain to void No
Urine flow continuous, smooth
Case Study
Diagnosis:
1. Urodynamic Stress Incontinence
2. Straining at voiding and intermittent flow
likely to be caused by anterior
compartment prolapse obstruction
Case Study
O Management:
O Advised patient to have Vaginal
hysterectomy + pelvic floor repair
O Option of one stage continence surgery
(Tension free vaginal tape) discussed,
patient prefers to have incontinence surgery
at the same setting
Questions?