Urodynamic Testing

 Examples of conditions where urodynamic testing is helpful include:

1)  A man underwent successful prostate cancer surgery one year ago.  Unfortunately, he continues to have incontinence requiring several protective garments (pads) each day.  Urodynamic testing objectively assesses the extent of urinary sphincter dysfunction and provides information that allows us to choose the best treatment option.  Usually the choice is between placement of a urethral sling or an artificial urinary sphincter.  Patients such as this one usually have markedly improved continence following surgical treatment.  

Urodynamic testing is the definitive method to identify problems of voiding or continence.  Many of the conditions that we see will never improve without surgical intervention.  Example conditions are intrinsic sphincter dysfunction (ISD) where the urinary muscular sphincter does not squeeze hard enough to prevent the loss of urine and medication unresponsive bladder overactivity where the bladder contracts when it is supposed to be quiet.  Urodynamic testing is one of the tools we use to identify and direct treatment of the most important underlying conditions.  Urodynamic testing often identifies which patients are likely or unlikely to benefit from surgical treatment.

2)  A 40 year old man has a ten year history of what had been diagnosed as "prostatitis."  In addition to pelvic pain he has a slow urinary stream, increased urinary frequency, and having to urinate several times at night.  Urodynamic testing showed that the bladder had to generate very high pressure in order to empty.  A diagnosis of primary bladder neck obstruction is made. The results showed that his symptoms would likely never improve without surgical intervention.  A same day surgical procedure was performed leading to a 75%  improvement in objective symptoms. 

3) A patient with spinal cord injury who faithfully empties his bladder by 5 times daily intermittent catheterization begins to develop recurrent febrile urinary tract infections. He has been hospitalized two times in the past six months.  Urodynamic testing shows that the bladder, which used to be very elastic and stored urine at low pressure between catheterizations has now become less elastic.  Pressures measured during urodynamic testing are markedly elevated at normal bladder volume.  Surgical intervention that lowers bladder storage pressure is indicated.  We expect this to decrease the rate of febrile urinary tract infection about 80%.  Surgery would also be protective for the kidneys.

Details of the Urodynamic Testing Procedure

Urodynamic testing is performed in the urologic office suites at both the Vanderbilt Clinic and Cool Springs office locations.  There are no restrictions on food intake on the day of the test. Considering check-in, set-up, testing, and a possibly extensive consultation following the test, you should plan to spend a half day in the office.  This is a very thorough evaluation.  Please plan your schedule accordingly. Our goal is to identify and quantify the extent of voiding dysfunction or incontinence.  If surgical intervention is needed, we hope to complete all the urologic testing including the consultation on the day of the urodynamic visit.  During urodynamic testing a small catheter will be inserted into your urinary tube (urethra) to fill the bladder with sterile water.  The same catheter is used to measure pressure in your bladder during both filling and urination.  Examination of the urine tube and bladder with a flexible telescope (cystoscope) may also be part of the examination. By performing both of these tests, we gain a thorough understanding of your lower urinary tract and can offer specific intervention based on the problems identified.  

Patients may experience burning with urination for a day or two after the test.  Those symptoms typically resolve quickly without the need for medication. 

Frequently Asked Questions

1) Can I eat or drink before the procedure?   Yes, you will be in the office at least a couple hours.  We encourage you to eat before hand.

2) Can I have the procedure done with anesthesia?  No, anesthesia eliminates our ability to evaluate your lower urinary tract.  We need you to be able to respond during the procedure.

3) Do I need someone to drive me home? No

4) How long will I be in the office?  We will take as long as needed to identify what is causing your problems.  Between the procedures and the consultation, you will be in the office most of a half day.