Urogynecology Procedures: Urodynamic Testing
Urodynamic testing (also called bladder testing) allows us to see how your bladder and urethra react while your bladder is filled and emptied. This information is important for your doctor to know prior to any surgery related to urinary incontinence and/or prolapse. By fixing one problem you might have (i.e. prolapse ), you may develop other problems (incontinence). Your doctor wants to try and see this prior to surgery so s/he can fix all of your problems at the same time. This test can also tell your doctor whether medication, pelvic floor physical therapy, or perhaps a bladder pacemaker might be beneficial. Urodynamic testing can also show if your bladder has difficulty emptying, or if there are problems with your urethra which affect your voiding function.
You will first be asked to undress from the waist down and urinate while sitting in a special chair. There is a sensor under the chair that monitors the rate and flow of your urine. Once finished we will lie you back in the same chair, clean the urethra off with some Iodine (if not allergic) and pass a catheter through the urethra into to bladder to see how much urine is left over (PVR-post void residual). Once that catheter is removed, smaller catheters will be placed for the testing procedure. These catheters have sensors on them which give information information about how your bladder behaves. One is placed in the bladder and the other is in the vagina or rectum (depending on you body structure). Two small sticky pads are placed on the skin around the anus to monitor nerve and pelvic muscle function. Another sticky pad is placed on the inner thigh, as a grounding pad for the other two.
Once all the catheters are in place, the chair will be adjusted to sit you up, and we will start to fill the bladder with some sterile saltwater. There will be a nurse watching the urethra carefully for any unintentional urinary leakage. Throughout filling we will stop and ask you to cough and bear down. This is done to check for urinary leakage while exerting pressure on the bladder from the abdomen (stress incontinence). We will do this several times throughout filling. During the filling, you will be asked to note 3 sensations (1st urge to urinate, Strong urge to urinate, & maximum capacity). The nurses will give you clear instructions on how to recognize these sensations. If you have prolapse, then a round, sterile instrument will be placed into the vagina to hold your prolapse back up to where it should be. This may help to determine if incontinence will be a problem when the prolapse is repaired. This should not be uncomfortable.
When your bladder is filled to maximum capacity (i.e., when you are unable to take anymore fluid in the bladder), we will do one more short test before you urinate. This test is called the urethral pressure profile, and is designed to measure the strength of your urethral closure muscles. The catheter that is in the bladder has two sensors on it. One that sits in the bladder and the other one in the urethra. We will slide the sensor in the urethra from the bladder to the outside opening (the catheter does not come out and usually is not uncomfortable). This will be done twice and then the catheters will be repositioned. Once repositioned you will be asked to urinate with all the catheters in place.
When you are done with this, all the catheters and sticky pads will be removed. We will pass one more catheter to check what is left in the bladder. If you do not have prolapse, this will be the end of the test. You might experience some burning with urination and some irritation for up to 24-48 hours after the procedure. If it lasts past that, you need to notify the office. If you have prolapse, then your doctor or nurse will measure the length and position of the vagina using a special ruler. This measurement will take about 5 minutes after the catheters are removed. The entire procedure will take about 45-60 minutes.
After the testing is complete, your doctor will need some time to interpret the results before you are offered options on the management of your pelvic floor problem. We may ask you to return for one short visit to discuss the results of your testing and offer you a plan for management.
We appreciate your time and patience, and it is our intention to have your results available as soon as possible.