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Zeng X, Liu MZ, Shen SH, Yang SQ, Zhang J, Shen H, Luo DY, Jin T. The design and evaluation of a quick checklist for urodynamic quality control: A prospective single-center small sample study. Neurourol Urodyn 2024; 43:382-389. [PMID: 38078752 DOI: 10.1002/nau.25357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 10/23/2023] [Accepted: 11/29/2023] [Indexed: 02/06/2024]
Abstract
PURPOSE To design a quick checklist for urodynamic study (UDS), aiming to reduce the occurrence of errors in the process, which may help to increase the quality of UDS. And further to analyze the effectiveness of this quick checklist for UDS quality control. METHODS First, a quick checklist for uroflow study and pressure-flow study was developed, based on the International Continence Society-Good Urodynamic Practice standards, our previous studies, and recent literature, as well as expert suggestions. Then, patients who underwent UDS between January 2023 to February 2023 were randomly assigned to a study group or a control group. For the study group, the quick checklist was used throughout the UDS process, while the control group did not. The main artefacts were chosen to verify the effectiveness of the quick checklist for improving the UDS quality. RESULTS The quick checklist comprised three subtypes: checklist for patients, checklist for environment and device, and checklist for UDS test process. 38 UDS traces per group were included. The incidence of missing the standard cough test decreased significantly from 18.4% to 0 (p = 0.012), with the checklist implementation. The baseline drift frequency rate also declined significantly from 39.5% to 5.3% (p < 0.05). Volume < 150 mL on uroflow study occurred in 68.4% of cases and its frequency rate decreased significantly with checklist implementation (p < 0.05). CONCLUSION A quick checklist for quality control of UDS was developed. The quick checklist as a convenient, quick, and easy used urodynamic quality control method, may help to reduce the technical artefacts and improve fundamental urodynamic quality control. Future research with a larger sample size is needed to confirm the effectiveness of the checklist.
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Affiliation(s)
- Xiao Zeng
- Laboratory of Reconstructive Urology, Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
- Pelvic Floor Diseases Center, West China Tianfu Hospital, Sichuan University, Chengdu, China
| | - Meng-Zhu Liu
- Laboratory of Reconstructive Urology, Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Si-Hong Shen
- Laboratory of Reconstructive Urology, Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Shi-Qin Yang
- Laboratory of Reconstructive Urology, Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Jie Zhang
- Laboratory of Reconstructive Urology, Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
- Pelvic Floor Diseases Center, West China Tianfu Hospital, Sichuan University, Chengdu, China
| | - Hong Shen
- Laboratory of Reconstructive Urology, Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
- Pelvic Floor Diseases Center, West China Tianfu Hospital, Sichuan University, Chengdu, China
| | - De-Yi Luo
- Laboratory of Reconstructive Urology, Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
- Pelvic Floor Diseases Center, West China Tianfu Hospital, Sichuan University, Chengdu, China
| | - Tao Jin
- Laboratory of Reconstructive Urology, Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
- Pelvic Floor Diseases Center, West China Tianfu Hospital, Sichuan University, Chengdu, China
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Zeng X, Xia Z, Peng L, Wu J, Li J, Yang J, Chen J, Jiang C, Zhong D, Shen Y, Niu J, Xiao X, Wen L, Shen H, Luo D. Quality of urodynamics: a national cross-sectional study in China. Chin Med J (Engl) 2023; 136:236-238. [PMID: 36952621 PMCID: PMC10106133 DOI: 10.1097/cm9.0000000000002203] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Indexed: 03/25/2023] Open
Affiliation(s)
- Xiao Zeng
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Ziyuan Xia
- Biotechnology Research Center, College of Architecture and Environment, Sichuan University, Chengdu, Sichuan 614001, China
| | - Liao Peng
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Jiapei Wu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Jiayi Li
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| | - Jianhui Yang
- Department of Urology, Yinzhou No. 2 Hospital, Ningbo, Zhejiang 315040, China
| | - Juan Chen
- Department of Urology, Shaanxi Provincial People's Hospital, Xi’an, Shaanxi 710068, China
| | - Changqin Jiang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, China
| | - Dewen Zhong
- Department of Urology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, Fujian 364000, China
| | - Yang Shen
- Department of Obstetrics and Gynecology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu 210009, China
| | - Jumin Niu
- Department of Obstetrics, Shenyang Women's and Children's Hospital, Shenyang, Liaoning 110005, China
| | - Xiao Xiao
- Department of Urology, Chongqing General Hospital, Chongqing 400014, China
| | - Li Wen
- Department of Urology, Central South University Xiangya School of Medicine Affiliated Haikou Hospital, Haikou, Hainan 570208, China
| | - Hong Shen
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Deyi Luo
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
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Zeng X, Shen SH, Shen H, Luo DY. Statistical process control for the analysis of quality control in urodynamics: A potential new approach for quality review of urodynamics. Neurourol Urodyn 2023; 42:289-296. [PMID: 36321794 DOI: 10.1002/nau.25081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 09/10/2022] [Accepted: 10/19/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE To analyze quality control in urodynamic studies, using a proportion control chart (p-chart) for statistical process control. MATERIALS AND METHODS This single-center study was conducted at the Urodynamic Center of West China Hospital, Sichuan University. We randomly selected 15 samples from each month in 2020, and 180 urodynamic traces were finally enrolled. We used the p-chart of statistical process control for analysis. We calculated the proportion of the incidence of a selected set of artefacts in the monthly urodynamic study process, including non-standard zero setting, no cough test, incomplete records of all measurements by urodynamicists, catheter displacement, and baseline drift. Through the specific calculation formula of statistical process control, we obtained the values of the center line, lower control limit, and upper control limit. RESULTS All data points of each artefact were within zone A. However, one outlier was found in the p-chart of all artefacts in October, which might have been caused by inexperienced operators. CONCLUSIONS Statistical process control may play an important role in the process control of urodynamic studies and guide us in identifying the cause of poor quality in process management.
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Affiliation(s)
- Xiao Zeng
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Si-Hong Shen
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Hong Shen
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - De-Yi Luo
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
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Hüsch T, Reitz A, Schneidewind L, Kranz J. [32/f with lower urinary tract symptoms : Preparation for the medical specialist examination: part 19]. Urologe A 2021; 61:56-62. [PMID: 34613444 DOI: 10.1007/s00120-021-01655-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Tanja Hüsch
- Klinik und Poliklinik für Urologie und Kinderurologie, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland.
| | - André Reitz
- Kontinenz Zentrum Hirslanden, Zürich, Schweiz
| | - Laila Schneidewind
- Urologische Klinik und Poliklinik, Universitätsmedizin Rostock, Rostock, Deutschland
| | - Jennifer Kranz
- Klinik und Poliklinik für Urologie, Uniklinik RWTH Aachen, Aachen, Deutschland.,Universitätsklinik und Poliklinik für Urologie, Universitätsklinikum Halle (Saale), Halle (Saale), Deutschland
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Lee SM, Gammie A, Abrams P. Assessment of quality in urodynamics: Cough versus valsalva. Neurourol Urodyn 2021; 40:1021-1026. [PMID: 33792955 DOI: 10.1002/nau.24661] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 02/26/2021] [Accepted: 03/08/2021] [Indexed: 11/06/2022]
Abstract
INTRODUCTION To ensure quality, the International Continence Society recommends asking the patient to cough every minute or 50 ml of infused volume. However, on occasions, it was noticed that if cough transmission was poor, Valsalva maneuvers could show pressure transmission was satisfactory. Hence, a study was designed to compare the two methods. METHODS Cough and Valsalva maneuver pressures were compared in 40 patients, 20 consecutive men and 20 consecutive women, undergoing urodynamics at three time points: baseline (20 ml filling), prevoid and postvoid. RESULTS At baseline, the percentage difference between pabd and pves was significantly lower for Valsalva maneuvres compared with coughs for all patients (median 5.1% vs. 10.2%). This association was consistent in male patients, but not for female. At prevoid, this was reversed with coughs providing more consistent pressure spikes than Valsalva maneuvers (median 7.0% vs. 24.1%), for all patients. Postvoid, no difference was noted in either men or women. CONCLUSIONS Quality control during urodynamics is important to ensure diagnostic accuracy. This is the first study to compare two methods of quality control, coughs, and Valsalva maneuvers. Coughs are a useful indicator of pressure transmission quality at all time points throughout urodynamic studies. However, at low volumes, Valsalva maneuvers give a better indication of quality, with lower variability, whereas at cystometric capacity coughs performed better. Therefore, if poor pressure transmission occurs with cough during urodynamics, particularly at low volumes, it is recommended that a Valsalva maneuver is used to further assess whether pressure transmission and thus urodynamic quality is satisfactory.
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Affiliation(s)
- Su-Min Lee
- Bristol Urological Insitute, Southmead Hospital, Bristol, UK
| | - Andrew Gammie
- Bristol Urological Insitute, Southmead Hospital, Bristol, UK
| | - Paul Abrams
- Bristol Urological Insitute, Southmead Hospital, Bristol, UK
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Rosier PFWM. Good urodynamic practice: Pressure signal quality immediately after catheter insertion for cystometry with a water-filled pressure transducer system and its relevance for the ICS zero procedure. Neurourol Urodyn 2020; 40:319-325. [PMID: 33141486 PMCID: PMC7821252 DOI: 10.1002/nau.24561] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 10/09/2020] [Accepted: 10/19/2020] [Indexed: 12/02/2022]
Abstract
Aim This study aims to evaluate the intracorporeal pressures immediately after the insertion of the catheters for urodynamic testing with a water‐filled urodynamic pressure transducer system to determine the relevance of the International Continence Society (ICS) zeroing principles. Methods Here, a retrospective analysis of a random series of urodynamic recordings is performed. The initial pressures, immediately after the insertion of the catheters, have been compared with the pressures after some milliliters of filling and flushing away of the gel, used with insertion, and/or the mucus and debris from the inserted catheters. Differences of initially recorded intravesical and intrarectal pressures from those after flushing and filling are analyzed and associated with the ICS standard practice of zeroing. Results Statistically and clinically significant differences between the initial pressures and the pressures after filling and flushing are observed, with nonphysiological initial pressures in 62% of the studies. Some filling (20 ml or more in the bladder) and flushing of the pressure channels resulted in the registration of physiological pressures and synchronous response from both lines on abdominal pressure increases. Conclusions The pressure signal quality of a water‐filled urodynamic system immediately after catheter insertion is low with inaccurately displayed pressure values, but it changes to normal after flushing the pressure channels and some filling. Rezeroing of the intracorporeal pressures immediately after catheter insertion for cystometry is the inappropriate correction procedure that misleadingly modifies the false initial pressures, resulting in ongoing unrealistic urodynamic study pressures.
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Affiliation(s)
- Peter F W M Rosier
- Department of Urology, University Medical Centre Utrecht, Utrecht, The Netherlands
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Millner RO, Preece J, Salvator A, McLeod DJ, Ching CB, Becknell B. Albuminuria in Pediatric Neurogenic Bladder: Identifying an Earlier Marker of Renal Disease. Urology 2019; 133:199-203. [DOI: 10.1016/j.urology.2019.08.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 08/05/2019] [Accepted: 08/12/2019] [Indexed: 10/26/2022]
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Sheng W, Kirschner-Hermanns R. Comparison of air-filled and water-filled catheters for use in cystometric assessment. Int Urogynecol J 2019; 30:2061-2067. [PMID: 30888456 DOI: 10.1007/s00192-019-03914-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 02/23/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION AND HYPOTHESIS To determine whether pressure readings measured with air-filled catheter (AFC) and water-filled catheter (WFC) systems are equivalent during cystometric assessment, especially in case of pressure measurements at Valsalva manoeuvres and coughs. METHODS Twenty-five subjects were recruited. The commercially available 7-Fr TDOC AFC, which simultaneously reads water and air pressures in the bladder and rectum, was used to compare filling and voiding data recordings. Data were compared using paired t-tests, Bland-Altman plots and linear correlation methods, respectively. RESULTS Pressure readings measured by the two systems showed a good correlation at Valsalva manoeuvres [R2 = 0.988, 0.968 for vesical pressure (Pves) and abdominal pressure (Pabd), respectively] and at coughs (R2 = 0.972, 0.943 for Pves and Pabd, respectively). There was a statistically significant difference between the two different measurement modalities at coughs (p < 0.01), initial resting pressure (p < 0.01) and the maximum pressure at detrusor overactivity (p < 0.01). This indicated that the difference between the two measurement modalities during Valsalva manoeuvres could reach up to 5.2 cmH2O and 8.1 cmH2O in Pves and Pabd measurements, respectively. During coughs, the difference could reach up to 20 cmH2O and 19.5 cmH2O in Pves and Pabd measurements, respectively. CONCLUSIONS Pressure recordings from AFC and WFC systems appear to be interchangeable for some urodynamics parameters such as Pves at Valsalva manoeuvres if the baseline pressure is compensated, but not for fast-changing pressure signals such as coughs. This has to be considered when pressures are being taken with the AFC.
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Affiliation(s)
- Wei Sheng
- Department of Urology/Neuro-Urology, University Clinic, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany.
| | - Ruth Kirschner-Hermanns
- Department of Urology/Neuro-Urology, University Clinic, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany.,Neuro-Urology, Neurological Rehabilitation Center, Godeshoehe, Bonn, Germany
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9
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Valdevenito JP, García-Mora A, Rodriguez J, Gammie A. Correlation of Xiphopubic Distance, Body Weight, Height and Body Mass Index with Intravesical and Abdominal Initial Resting Pressures in Urodynamic Testing in the Sitting Position. Low Urin Tract Symptoms 2017; 10:271-276. [PMID: 28707318 DOI: 10.1111/luts.12179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 02/06/2017] [Accepted: 03/07/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To compare the initial resting intravesical pressure (pves ) and abdominal pressure (pabd ) in the sitting position with the typical range of values, to assess the correlation between such pressures and patient xipho-pubic distance, body weight, height and body mass index (BMI), and to estimate if xipho-pubic distance can be a guide to interpret initial resting pressures in urodynamic testing. METHODS Women with lower urinary tract symptomatology referred for urodynamic testing were consecutively enrolled in a prospective study. Conventional cystometry was done following "good urodynamic practices". The correlation between initial resting pves and pabd and xipho-pubic distance, body weight, height and BMI were studied using simple and multiple linear regression analysis. Statistical significance was defined as P < 0.05. RESULTS One hundred women aged (mean ± SD) 59.2 ± 13.3 were studied. There was a significant correlation between both pves and pabd , and xipho-pubic distance, body weight and BMI and no correlation with height. Over the multiple analysis, xipho-pubic distance and body weight correlated independently with pves ; body weight correlated independently with pabd . Three patients had pves and/or pabd out of typical range, with BMIs values of 18.48, 18.72 and 35.81 kg/m2 . There was a wide range of difference between xipho-pubic distance and initial resting pressures. CONCLUSIONS Out of range initial resting pressures occur in underweight (or close to) or severely obese patients. Xipho-pubic distance and body weight correlated independently with pves . Body weight correlated independently with pabd . Xipho-pubic distance cannot be a guide to interpret the initial resting pressures.
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Affiliation(s)
- Juan P Valdevenito
- Urodynamics Unit, Department of Urology, Hospital Clinico Universidad de Chile, Santiago, Chile
| | - Arturo García-Mora
- Urodynamics Unit, Department of Urology, Instituto Nacional de Ciencias Medicas y Nutricion "Salvador Zubiran", Tlalpan, Distrito Federal, Mexico
| | - Jorge Rodriguez
- Biostatistics Program, School of Public Health, University of Chile, Santiago, Chile
| | - Andrew Gammie
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
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Rosier PF, Schaefer W, Lose G, Goldman HB, Guralnick M, Eustice S, Dickinson T, Hashim H. International Continence Society Good Urodynamic Practices and Terms 2016: Urodynamics, uroflowmetry, cystometry, and pressure-flow study. Neurourol Urodyn 2016; 36:1243-1260. [DOI: 10.1002/nau.23124] [Citation(s) in RCA: 257] [Impact Index Per Article: 32.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 05/13/2016] [Indexed: 01/11/2023]
Affiliation(s)
- Peter F.W.M Rosier
- Department of Urology; University Medical Center Utrecht; Utrecht The Netherlands
| | - Werner Schaefer
- Department of Medicine (Geriatrics); University of Pittsburgh; Pittsburgh Pennsylvania
| | - Gunnar Lose
- University of Copenhagen Herlev Hospital; Herlev Denmark
| | - Howard B. Goldman
- Glickman Urologic and Kidney Institute Cleveland Clinic; Lerner College of Medicine; Cleveland Ohio
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Typical Value Ranges and Typical Signal Patterns in the Initial Cough in Patients With Neurogenic Bladder: Quality Control in Urodynamic Studies. Int Neurourol J 2016; 20:214-223. [PMID: 27706014 PMCID: PMC5083832 DOI: 10.5213/inj.1632556.278] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 04/04/2016] [Indexed: 11/10/2022] Open
Abstract
Purpose The goal of this study was to establish typical value ranges (TVRs) and to analyze typical signal patterns (TSPs) of the initial cough (cough before bladder filling) for quality control in urodynamic studies. Methods A total of 539 urodynamic traces from patients with neurogenic bladder obtained over the course of a year were retrospectively reviewed. The TVRs for cough amplitude in measurements of the intravesical pressure (Pves), abdominal pressure (Pabd), and detrusor pressure (Pdet) during the initial cough were established. We used the 95% range as a reference range for all parameters. Cough spikes in Pdet were described and classified, and the reasons for different patterns of cough spikes were established. The quality of all the cystometry traces was checked, and we also present remedial actions for inappropriate cough spikes. Results The cough amplitudes in the measurements of Pves and Pabd were similar, with 95% of measurements falling within the following ranges: 4–62 cm H2O and 3–70 cm H2O, respectively, in supine position and 9–95 cm H2O and 8–98 cm H2O, respectively, in sitting position. For Pdet, the cough amplitude ranged from −38 to 25 cm H2O in supine position and from −44 to 41 cm H2O in sitting position. The cough spikes for Pdet were classified as follows: type I, Pdet pressure exhibited a minimal change (<5 cm H2O) during the cough; type II, a monophasic spike (>5 cm H2O) was observed for Pdet; and type III, biphasic spikes were observed for Pdet. Type I coughs were found to have more high-quality traces (P<0.01). Conclusions TVRs for the initial cough test among neurogenic patients were established in order to provide guidelines for quantitative quality control. The TSPs for the initial cough signal were described, and the presence of a high-quality cough signal may be recommended as a component of quality control in urodynamic measurements.
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Liao L, Schaefer W. Quantitative quality control during urodynamic studies with TVRs for cystometry in men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia. Int Urol Nephrol 2014; 46:1301-8. [PMID: 24557685 DOI: 10.1007/s11255-014-0668-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Accepted: 02/07/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To establish typical value ranges (TVRs) and to outline their role in urodynamic quality control. METHODS Five hundred and eighty-two data sets of free flow, filling cystometry, and voiding from 181 males in a strictly quality-controlled study were analyzed for intravesical pressure (Pves), abdominal pressure (Pabd), and detrusor pressure (Pdet) before, at the beginning and end of filling, and after voiding. Cystometric capacity, maximum flow rate (Qmax), voided volume (Vvoid), and compliance were determined. Mean value, standard deviation, median, and various TVRs were calculated. Technical errors related to the TVRs are classified and examples given. RESULTS TVRs for initial resting Pves, Pabd, and Pdet were 31-42, 28-39, and 0-4 cmH₂O, respectively. Various technical errors are classified as type I: normal initial Pdet, both Pves and Pabd are incorrect; type II: negative initial Pdet; and type III: initial Pdet too high. The incidences of I, II, and III errors were 9.8, 4.5, and 1.4%, respectively. The TVRs for maximum cystometric capacity and compliance were 157-345 mL and 26.7-70.8 mL/cmH₂O; Qmax, Pdet, and Vvoid were 5.5-9 mL/s, 57-92 cmH₂O, and 167-315 mL, respectively; Qmax and Vvoid in free flow were 8-9.2 mL/s and 167-301 mL, respectively. After voiding, two errors were found: type V (Pves and Pdet after voiding still high) and type VI (Pves and Pdet negative). CONCLUSIONS TVRs in urodynamics are indispensable and effective tools for quantitative plausibility checks and quality control. They are sensitive and reliable indicators for correct measurement and a relevant contribution to a collection of normal values.
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Affiliation(s)
- Limin Liao
- Department of Urology, China Rehabilitation Research Center, Rehabilitation School of Capital Medical University, 10 Jiaomen Beilu, Fengtai District, Beijing, 100068, China,
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Liao L, Schaefer W. Qualitative quality control during urodynamic studies with TSPs for cystometry in men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia. Int Urol Nephrol 2013; 46:1073-9. [PMID: 24375436 DOI: 10.1007/s11255-013-0633-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 12/11/2013] [Indexed: 10/25/2022]
Abstract
The aim of this study was to describe typical signal patterns (TSPs) by amplitude and pressure gradients and indicate the role and significance of them in quality control. A total of 582 measurements from a multicenter urodynamic study on males (mean age, 65.3 years) were re-analyzed. Using manual graphical analysis, we identified signal patterns by typical amplitude (A) and typical pressure gradient (PG). TSPs were classified into four types: I: fine structure (A < 3 cm H2O); II: minor dynamic changes (A < 5 cm H2O); III: major changes due to cough tests (A > 50 cm H2O, PG > 100 cm H2O/s); IV: typical major changes due to muscular activity: detrusor overactivity (A > 3 cm H2O, PG > 1-5 cm H2O/s), rectal contractions (A = 5-10 cm H2O, PG = 5-10 cm H2O/s), and straining (A > 5 cm H2O, PG ≥ 30 cm H2O/s). At beginning of and during filling, 91.8 and 98.3 % of traces showed the identical fine structure and minor changes between P ves and P abd tracings, and P det tracing was quiet. 92.3 % of P ves and P abd traces had equal pressure changes at test coughs. During filling, 8.3 % traces showed straining, 17.4 % showed rectal contractions, and 33.7 % showed detrusor overactivity. Before voiding, 94 % of P ves and P abd traces had equal cough response. During voiding, 91.2 % of traces showed the same fine structure, 53.3 % of traces showed straining, and 15.3 % showed relaxation of the pelvic floor. After voiding, 91.2 % of traces had the same fine structure, and 87.5 % had an equal cough response. TSPs are a powerful tool for qualitative plausibility and quality control and are an indispensable pre-condition for good urodynamic practice.
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Affiliation(s)
- Limin Liao
- Department of Urology, China Rehabilitation Research Center, Capital Medical University, 100068, Beijing, China,
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Ellis-Jones J, Swithinbank L, Abrams P. The bridges and barriers to ‘good’ urodynamic practice: a regional perspective. INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2013. [DOI: 10.1111/j.1749-771x.2012.01154.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Hsieh PF, Chang CH, Lien CS, Wu HC, Hsiao PJ, Chou ECL. Remote monitoring of videourodynamics using smart phone and free instant messaging software. Neurourol Urodyn 2013; 32:1064-7. [PMID: 23450801 DOI: 10.1002/nau.22387] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 01/23/2013] [Indexed: 11/06/2022]
Affiliation(s)
- Po-Fan Hsieh
- Department of Urology; China Medical University Hospital; Taichung Taiwan
| | - Chao-Hsiang Chang
- Department of Urology; China Medical University Hospital; Taichung Taiwan
- School of Medicine; China Medical University; Taichung Taiwan
| | - Chi-Shun Lien
- Department of Urology; China Medical University Hospital; Taichung Taiwan
| | - Hsi-Chin Wu
- Department of Urology; China Medical University Hospital; Taichung Taiwan
- School of Medicine; China Medical University; Taichung Taiwan
| | - Po-Jen Hsiao
- Department of Urology; China Medical University Hospital; Taichung Taiwan
| | - Eric Chieh-Lung Chou
- Department of Urology; China Medical University Hospital; Taichung Taiwan
- School of Medicine; China Medical University; Taichung Taiwan
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Kim KS, Song CG. Availability of a newly devised ambulatory urodynamics monitoring system based on personal device assistance in patients with spinal cord injury. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2012; 106:260-273. [PMID: 21071108 DOI: 10.1016/j.cmpb.2010.10.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2009] [Revised: 10/07/2010] [Accepted: 10/14/2010] [Indexed: 05/30/2023]
Abstract
Conventional urodynamics systems have been widely used for the assessment of bladder functions. However, they have some drawbacks due to the unfamiliar circumstances for the patient, restrictive position during the test, expense and immovability of the instrument as well as the unphysiological filling of the bladder. To mitigate these problems, we developed a fully ambulatory urodynamics monitoring system, which enables the abdominal pressure to be measured in a non-invasive manner, as well as the manual recording of various events such as the bladder sensations or leakage of urine. Conventional (CMG) and furosemide-stimulated filling cystometry (FCMG) were performed for 28 patients with neurogenic bladders caused by spinal cord injury (24 males and 4 females, age: 49.4 ± 13.9 years, BMI: 23.5 ± 2.4). There were high correlation coefficients (r=0.97 ± 0.02) between the clinical parameters measured by the conventional rectal catheter and those measured by our non-invasive algorithm in the FCMG studies. Also, 10 of the patients (36%) were diagnosed as having different reflexibility of the bladder between conventional CMG and FCMG (p<0.05). In the patients with detrusor overactivity, the average volume and detrusor pressure at bladder sensation in FCMG were lower than those in CMG, while the average compliance was higher (p<0.05). In the patients with areflexic bladders, the number of patients with detrusor overactivity was higher in FCMG and leakage was observed more frequently. These results showed that our system could be a useful additional tool in the clinical assessment of patients in which conventional cystometry failed to explain their symptoms.
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Affiliation(s)
- Keo Sik Kim
- School of Electronics and Information Engineering, Chonbuk National University, 664-14, 1Ga, Deokjin-dong, Jeonju, Jeonbuk 561-756, Republic of Korea
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Hogan S, Gammie A, Abrams P. Urodynamic features and artefacts. Neurourol Urodyn 2012; 31:1104-17. [DOI: 10.1002/nau.22209] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Accepted: 01/11/2012] [Indexed: 11/09/2022]
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Sullivan JG, Swithinbank L, Abrams P. Defining achievable standards in urodynamics-a prospective study of initial resting pressures. Neurourol Urodyn 2012; 31:535-40. [DOI: 10.1002/nau.21229] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2010] [Accepted: 09/19/2011] [Indexed: 11/09/2022]
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Preoperative voiding detrusor pressures do not predict stress incontinence surgery outcomes: reply to Digesu et al. Int Urogynecol J 2011. [DOI: 10.1007/s00192-011-1577-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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20
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Kirby AC, Nager CW, Litman HJ, Fitzgerald MP, Kraus S, Norton P, Sirls L, Rickey L, Wilson T, Dandreo KJ, Shepherd J, Zimmern P. Perineal surface electromyography does not typically demonstrate expected relaxation during normal voiding. Neurourol Urodyn 2011; 30:1591-6. [PMID: 21560157 DOI: 10.1002/nau.21080] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Accepted: 01/27/2011] [Indexed: 11/10/2022]
Abstract
AIMS To describe perineal surface patch electromyography (EMG) activity during urodynamics (UDS) and compare activity between filling and voiding phases and to assess for a relationship between preoperative EMG activity and postoperative voiding symptoms. METHODS 655 women underwent standardized preoperative UDS that included perineal surface EMG prior to undergoing surgery for stress urinary incontinence. Pressure-flow studies were evaluated for abdominal straining and interrupted flow. Quantitative EMG values were extracted from 10 predetermined time-points and compared between fill and void. Qualitative EMG activity was assessed for the percent of time EMG was active during fill and void and for the average amplitude of EMG during fill compared to void. Postoperative voiding dysfunction was defined as surgical revision or catheterization more than 6 weeks after surgery. Fisher's exact test with a 5% two-sided significance level was used to assess differences in EMG activity and postoperative voiding dysfunction. RESULTS 321 UDS had interpretable EMG studies, of which 131 (41%) had EMG values at all 10 predetermined and annotated time-points. Quantitative and qualitative EMG signals during flow were usually greater than during fill. The prevalence of postoperative voiding dysfunction in subjects with higher preoperative EMG activity during void was not significantly different. Results were similar in the 42 subjects who had neither abdominal straining during void nor interrupted flow. CONCLUSIONS Perineal surface patch EMG did not measure expected pelvic floor and urethral sphincter relaxation during voiding. Preoperative EMG did not predict patients at risk for postoperative voiding dysfunction.
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Affiliation(s)
- Anna C Kirby
- Department of Reproductive Medicine, University of California San Diego, San Diego, California, USA
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Kirby AC, Nager CW, Litman HJ, FitzGerald MP, Kraus S, Norton P, Sirls L, Rickey L, Wilson T, Dandreo KJ, Shepherd JP, Zimmern P. Preoperative voiding detrusor pressures do not predict stress incontinence surgery outcomes. Int Urogynecol J 2010; 22:657-63. [PMID: 21153471 PMCID: PMC3097343 DOI: 10.1007/s00192-010-1336-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2010] [Accepted: 11/15/2010] [Indexed: 11/26/2022]
Abstract
Introduction and hypothesis The aim of this study was to determine whether preoperative voiding detrusor pressures were associated with postoperative outcomes after stress incontinence surgery. Methods Opening detrusor pressure, detrusor pressure at maximum flow (pdet Qmax), and closing detrusor pressure were assessed from 280 valid preoperative urodynamic studies in subjects without advanced prolapse from a multicenter randomized trial comparing Burch and autologous fascia sling procedures. These pressures were compared between subjects with and without overall success, stress-specific success, postoperative detrusor overactivity, and postoperative urge incontinence using independent sample t tests. Results There were no clinically or statistically significant differences in mean preoperative voiding detrusor pressures in any comparison of postoperative outcomes. Conclusions We found no evidence that preoperative voiding detrusor pressures predict outcomes in women with stress predominant urinary incontinence undergoing Burch or autologous fascial sling procedures.
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Affiliation(s)
- Anna C Kirby
- Reproductive Medicine, University of California San Diego, San Diego, CA, USA
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Implementation of a Multi-functional Ambulatory Urodynamics Monitoring System Based on Newly Devised Abdominal Pressure Measurement. J Med Syst 2010; 34:1011-21. [DOI: 10.1007/s10916-009-9318-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2009] [Accepted: 05/11/2009] [Indexed: 10/20/2022]
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Moore K, Emery S, Lucas M. Quality and quantity: An audit of urodynamics practice in relation to newly published National Standards. Neurourol Urodyn 2010; 30:38-42. [DOI: 10.1002/nau.20942] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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24
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Singh G, Lucas M, Dolan L, Knight S, Ramage C, Hobson PT. Minimum standards for urodynamic practice in the UK. Neurourol Urodyn 2010; 29:1365-72. [DOI: 10.1002/nau.20883] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Renganathan A, Duckett J, Nayak K. Female urinary incontinence – urodynamics: Yes or no? J OBSTET GYNAECOL 2010; 29:473-9. [DOI: 10.1080/01443610903003142] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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26
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Kraus SR, Dmochowski R, Albo ME, Xu L, Klise SR, Roehrborn CG. Urodynamic standardization in a large-scale, multicenter clinical trial examining the effects of daily tadalafil in men with lower urinary tract symptoms with or without benign prostatic obstruction. Neurourol Urodyn 2010; 29:741-7. [DOI: 10.1002/nau.20825] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Renganathan A, Cartwright R, Cardozo L, Robinson D, Srikrishna S. Quality control in urodynamics: Analysis of an international multi-center study. Neurourol Urodyn 2008; 28:380-4. [DOI: 10.1002/nau.20679] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Affiliation(s)
- Timothy J Wilt
- Center for Chronic Disease Outcomes Research, 1 Veterans Drive (111-0), Minneapolis, MN 55417, USA.
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Nager CW, Albo ME, Fitzgerald MP, McDermott S, Wruck L, Kraus S, Howden N, Norton P, Sirls L, Varner E, Zimmern P. Reference urodynamic values for stress incontinent women. Neurourol Urodyn 2007; 26:333-40. [PMID: 17315221 DOI: 10.1002/nau.20348] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To determine reference urodynamic values for preoperative urodynamic studies in women undergoing surgery for pure or predominant stress urinary incontinence (SUI). MATERIALS AND METHODS Six hundred fifty-five women with pure or predominant SUI were enrolled in a multicenter surgical trial and were randomized to undergo a Burch or autologous fascia sling procedure as part of the Urinary Incontinence Treatment Network (UITN) Stress Incontinence Surgical Treatment Efficacy Trial (SISTEr). Preoperative free uroflowmetry, filling cystometry, and pressure flow studies were performed in all women using a standardized research protocol and standardized urodynamic interpretation guidelines. We define the normal range of urodynamic values in this population as the values that encompass 95% of the results. RESULTS In 655 women undergoing filling cystometry in the standing position, baseline vesical and abdominal pressures were between 12 and 60 cm H(2)O. The upper limit of detrusor pressure increase during bladder filling to maximum cystometric capacity was 16 cm H(2)O. Ten percent of women who qualified for stress incontinence surgery with a positive cough stress test on physical exam did not demonstrate urodynamic stress incontinence (USI) and less than 10% of subjects in this study demonstrated detrusor overactivity. CONCLUSIONS Results from a large cohort of women with SUI are now available for quantitative plausibility assessments or as reference values when interpreting urodynamic studies.
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Affiliation(s)
- C W Nager
- UCSD Women's Pelvic Medicine Center, La Jolla, California.
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Nager CW, Albo ME, Fitzgerald MP, McDermott SM, Kraus S, Richter HE, Zimmern P. Process for development of multicenter urodynamic studies. Urology 2007; 69:63-7; discussion 67-8. [PMID: 17270617 PMCID: PMC1855147 DOI: 10.1016/j.urology.2006.08.1118] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2006] [Revised: 05/21/2006] [Accepted: 08/30/2006] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To describe our experiences with a continuous quality improvement process for the standardization of multicenter urodynamic studies (UDSs) in a multi-institutional network. Multicenter UDSs can have considerable variations in testing procedures, training, equipment, and reviewer biases. METHODS A quality control process was developed that included protocol development, certification of urodynamic testers, central review to assess compliance with protocol and quality, protocol modifications, standardization of equipment and signal configuration, development of an electronic signal repository, and the development of UDS Interpretation Guidelines. RESULTS We describe our experience and process in the development and implementation of a standardized UDS protocol in a multicenter surgical trial for stress urinary incontinence. The process included our protocol development, quality control measures, standardization processes, electronic signal repository, and the need for UDS Interpretation Guidelines. A urodynamic testing procedures protocol was implemented successfully by 20 urodynamic testers at nine continence treatment centers. The protocol provides explicit and detailed guidelines for equipment, calibration, patient position, specific annotations, lay language bladder sensation parameters, visual leak point pressure techniques, modifications for prolapse, and data recording. A UDS Interpretation Guidelines document provides specific suggestions for validity and plausibility determination, expected ranges of urodynamic variables, and reasonable agreement of measuring systems. Both documents are available to urodynamic investigators on the Urinary Incontinence Treatment Network website (http://www.uitn.net/resourcesforphysicians.htm). CONCLUSIONS Multicenter UDSs require a continuous quality improvement process and the development of UDS testing procedures and interpretation guidelines.
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Affiliation(s)
- Charles W Nager
- University of California, San Diego, Women's Pelvic Medicine Center, San Diego, California, USA.
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Schaefer W. Re: Is the bladder a reliable witness for predicting detrusor overactivity? H. Hashim and P. Abrams. J Urol, 175: 191-195, 2006. J Urol 2006; 176:1255-7; author reply 1256-7. [PMID: 16890743 DOI: 10.1016/j.juro.2006.04.058] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2006] [Indexed: 11/26/2022]
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Mitterberger M, Pinggera GM, Mueller T, Frauscher F, Pallwein L, Gradl J, Peschel R, Bartsch G, Strasser H. Dynamic transurethral sonography and 3-dimensional reconstruction of the rhabdosphincter and urethra: initial experience in continent and incontinent women. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2006; 25:315-20. [PMID: 16495491 DOI: 10.7863/jum.2006.25.3.315] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate the female urethra and the striated urinary sphincter, the rhabdosphincter (RS), by means of dynamic transurethral sonography and sonographic 3-dimensional (3D) reconstructions. METHODS In 15 female patients with urinary stress incontinence (mean age, 67.5 years) and 5 continent women (mean age, 48.3 years), morphologic characteristics and function of the RS and urethra were examined with a 10-MHz transurethral ultrasound transducer. With the help of a mechanical pullback system, the transducer was slowly retracted to scan the whole urethra and the RS from the bladder neck to the urethral orifice. Subsequently, 3D reconstructions of the urethra using an integrated computer system were performed. The RS as well as the length of the urethra were investigated under contracted and noncontracted conditions to measure contractility of the RS and dynamic changes of the lower urinary tract. RESULTS Partial or complete loss of RS function was detected in patients with stress incontinence. The findings on sonography were found to correlate well with the grade of incontinence. Furthermore, under contraction of the RS, a median increase in urethral length was observed. In incontinent patients, the increase in the urethral length was statistically significantly less (P = .04), which was related to the reduced contractility of the RS. CONCLUSIONS Dynamic transurethral sonography with subsequent 3D reconstructions allows for assessment of function and morphologic characteristics of the RS and urethra. Normal contraction of the RS results in an elongation of the urethra.
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Affiliation(s)
- Michael Mitterberger
- Department of Urology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria.
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Hashim H, Ellis-Jones J, Swithinbank L, Woodward M, Small D, Frank JD, Abrams P. Trying to predict 'dangerous' bladders in children: the area under the curve concept. J Pediatr Urol 2005; 1:343-7. [PMID: 18947566 DOI: 10.1016/j.jpurol.2005.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2004] [Accepted: 03/16/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Children with neurological and non-neurological lower urinary tract dysfunction normally undergo video urodynamics. One reason is to try to diagnose 'dangerous' bladders. Currently, bladder compliance is used to predict 'dangerous' bladders; however, in children there are no standardized methods of measurement and thus no 'cut-off' values. Compliance may also be normal even though high-pressure detrusor overactivity waves may exist during the filling phase of urodynamics. We tried to determine whether measuring the area under the detrusor pressure curve (AUC) during the filling phase of urodynamics would be a useful parameter in predicting 'dangerous' bladders. PATIENTS AND METHODS Children referred to the urodynamics unit at Southmead Hospital, a tertiary referral centre, from 2000 to 2004 were investigated. Although 130 patients were identified, only 15 patients had raw data which were analysable using the available computer software. RESULTS There was no correlation between the AUC and predicting 'dangerous' bladders possibly due to limitations in the computer software. CONCLUSION Although the study did not reveal any correlation between the AUC and 'dangerous' bladders, it revealed the limitations of the available computer software in determining AUC, and highlighted the need for new standardized software and multinational, multi-centre trials to look into the concept of AUC. There is also a need for the International Continence Society to standardize methods and terminology in predicting 'dangerous' bladders.
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Affiliation(s)
- H Hashim
- Bristol Urological Institute, Southmead Hospital, Westbury on Trym, Bristol BS10 5NB, UK.
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Dolan LM, Dixon WE, Brown K, Ord T, Hilton P. Randomized comparison of vaginal and rectal measurement of intra-abdominal pressure during subtracted dual-channel cystometry. Urology 2005; 65:1059-63. [PMID: 15913717 DOI: 10.1016/j.urology.2004.12.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2004] [Revised: 11/04/2004] [Accepted: 12/07/2004] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To compare the rectal (Prec) and vaginal (Pvag) measurement of intra-abdominal pressure during cystometry in women by assessment of patient acceptability and cystometrogram quality control. METHODS Of 136 consecutive women undergoing cystometrography, 100 were randomized to measurement of Prec or Pvag. The patients' experience was measured using visual analogue scales of anticipated and actual discomfort and embarrassment before and after the procedure. The setup time was recorded, and quality control was assessed by the number of catheter events (pressure lines falling out, requiring flushing, or repositioning), and quality of the cough signal. RESULTS A total of 136 consecutive patients were approached. Of those eligible, 50 were randomized to Prec and 50 to Pvag; 23 women declined randomization because of preference for a vaginal line. Overall, 81 line events occurred in 29 women with a vaginal line and 117 occurred in 34 women with a rectal line. No difference was found in patient acceptability nor in trace quality for the two routes. Despite catheter repositioning and flushing, only 13% of traces showed optimum trace quality throughout the entire investigation; the cough signal quality was worse after provocation, during voiding, and in women with prolapse. CONCLUSIONS A significant proportion of patients undergoing cystometry expressed a preference for the vaginal line. The quality of output from cystometry was limited by the conditions of the investigation rather than the method of intra-abdominal pressure measurement.
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Affiliation(s)
- Lucia M Dolan
- Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
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