Urodynamics Made Easy

Appendix 3 Example traces

Table A3.1

	Storage phase	Voiding phase
Detrusor function	Normal, although rectal contractions give the misleading appearance of phasic detrusor overactivity	Overactive (high pressure)
Urethral/bladder outlet function	Normal; increased EMG activity due to rectal contractions and recruitment (See Chapter 9)	Prolonged, low flow (obstructive): appropriate decrease in EMG activity with voiding
Quality	Dampening of intra-vesical line, rectal contractions throughout, artefactual movements to flowmeter during storage phase
Diagnosis	Bladder outlet obstruction

Table A3.2

	Storage phase	Voiding phase
Detrusor function	Detrusor overactivity following coughing	Not shown
Urethral/bladder outlet function	Urinary incontinence due to detrusor overactivity	Not shown
Quality	Acceptable
Diagnosis	Cough induced detrusor overactivity with incontinence

Table A3.3

	Storage phase	Voiding phase
Detrusor function	Normal	High pressure (overactive)
Urethra/bladder outlet function	Normal	Low flow rate (<9 ml/s)
Quality	Subtraction appears acceptable, although no quality control coughs
Diagnosis	BOO and superimposed screening image shows a urethral stricture

Table A3.4

	Storage phase	Voiding phase
Detrusor function	Overactive; recurrent contractions with ‘stepping’ pattern	High pressure involuntary void (overactive)
Urethral/bladder outlet function	Competent	Intermittent flow with corresponding rises in detrusor pressure. EMG shows intermittent sphincter activity
Quality	No quality control coughs but subtraction appears acceptable
Diagnosis	Neurogenic detrusor overactivity and DSD

First sensation	925 ml infused volume
MCC	1182 ml infused volume
Q_max	29 ml/s
pDet @ Q_max	24 cm H₂O
Voided volume	585 ml

Table A3.5

	Storage phase	Voiding phase
Detrusor function	Hypo-sensitive with late first sensation at 925 ml filling and large cystometric capacity of 1182 ml	Low pressure (P_det@ Q_max = 24 cm H₂O)
Urethra/bladder outlet function	Competent	Normal peak flow (29 ml/s), incomplete emptying (voided only 585 ml); increased EMG activity during voiding
Quality	Acceptable
Diagnosis	Hypo-sensitive, large capacity bladder Possibly low detrusor pressure secondary to overdistension or developing poor detrusor contractility (detrusor failure) Increased EMG activity compatible with DSD or pelvic floor dyssynergia

Table A3.6

	Storage phase	Voiding phase
Detrusor function	Normal	Low pressure void associated with abdominal straining
Urethral/bladder outlet function	Competent	Low flow rate with incomplete emptying; increased EMG activity compatible with abdominal straining
Quality	Acceptable
Diagnosis	Poor detrusor contractility (detrusor failure)

Table A3.7

	Storage phase	Voiding phase
Detrusor function	Overactive	High pressure, although the subtraction does not appear to be accurate
Urethral/bladder outlet function	Competent	Low flow rate with additional abdominal straining
Quality	Quality control coughs not present, poor subtraction during voiding phase
Diagnosis	Bladder outlet obstruction and detrusor overactivity

Table A3.8

	Storage phase	Voiding phase
Detrusor function	Phasic detrusor overactivity	High pressure
Urethral/bladder outlet function	Leakage associated with detrusor overactivity	Low flow rate
Quality	Few quality control coughs, intra-abdominal line dampening
Diagnosis	Gross detrusor overactivity with incontinence, unable to interpret voiding phase as void is initiated during a terminal contraction; the appearance of obstruction in this case may be due to the abnormally high pressures present at the start of voiding. Patient should have the voiding phase repeated to accurately define the voiding function

Table A3.9

	Storage phase	Voiding phase
Detrusor function	Overactive	High pressure
Urethral/bladder outlet function	Competent	Intermittent low flow rate with incomplete emptying and prostatic obstruction visible on screening image
Quality	Dampening in abdominal line. No coughs.
Diagnosis	Detrusor overactivity and BOO secondary to prostatic obstruction

Table A3.10

	Storage phase	Voiding phase
Detrusor function	Overactive and oversensitive with first sensation at 61 ml filling and MCC at 116 ml filling. Possible overactivity but poor subtraction makes identification difficult.	Uninterpretable. Due to loss of urethral catheter.
Urethral/bladder outlet function	Competent	Poor flow with some abdominal straining
Quality	Dampening in abdominal line throughout study. Intra-vesical catheter voided out at the beginning of voiding phase.
Diagnosis	Oversensitivity and possible detrusor overactivity; study needs repeating to determine detrusor function during voiding and storage phases with better quality control.

Table A3.11

	Storage phase	Voiding phase
Detrusor function	Overactive	Normal pressure (P_det falsely elevated at end of filling due to drop in rectal pressue; voiding pressure appears normal based on P_ves)
Urethral/bladder outlet function	Competent	Normal flow pattern, slightly low Q_max. Need to perform free uroflowmetry to determine Q_max without an in situ catheter
Quality	High P_abd at baseline causing a negative detrusor pressure. Dampening of intra-abdominal line throughout study. Immediately prior to voiding patient changed position to sitting with no alteration in reference height. Poor quality assessment
Diagnosis	Detrusor overactivity

Table A3.12

	Storage phase	Voiding phase
Detrusor function	Normal	Uninterpretable due to loss of intra-abdominal line although possibly poor detrusor contractility
Urethral/bladder outlet function	Competent	Poor flow
Quality	Intra-abdominal catheter passed out at the beginning of voiding
Diagnosis	Study needs repeating to determine subtracted detrusor function during voiding once intra-abdominal line is replaced.

Table A3.13

	Storage phase	Voiding phase
Detrusor function	Rectal contractions only	Overactive (high pressure)
Urethral/bladder outlet function	Competent (flow readings are artefacts)	Negligible flow despite additional abdominal straining
Quality	Impaired subtraction throughout study noticeable on quality control coughs
Diagnosis	High pressure BOO

Table A3.14

	Storage phase	Voiding phase
Detrusor function	Early bladder sensations suggesting some oversensitivity	Severely hypo-contractile, with a prolonged time before commencing any voiding. Intermittent voiding with a negligible amount passed
Urethra/bladder outlet function	Competent	Low pressure, low flow voiding despite abdominal straining
Quality	Slight dampening in abdominal line throughout study. Intra- abdominal pressure is artefactually negative during parts of the study leading to artefactual rise in detrusor pressure
Diagnosis	Detrusor failure (possibly some oversensitivity)

Table A3.15

	Storage phase	Voiding phase
Detrusor function	Poor detrusor compliance Overactive with associated incontinence	No voluntary void, voided off an overactive contraction
Urethral/bladder outlet function	Leakage associated with DO	No voluntary void
Quality	Occasional dampening in intra-abdominal line
Diagnosis	Detrusor overactivity and poor bladder compliance

Table A3.16

	Storage phase	Voiding phase
Detrusor function	Overactive, with several small involuntary contractions followed by a large terminal contraction	Voided during a terminal contraction
	Early sensations suggesting some oversensitivity
Urethral/bladder outlet function	Incompetent on coughing	Normal flow pattern
Quality	Dampening in abdominal line throughout study
Diagnosis	Mixed incontinence, with some degree of oversensitivity; cannot interpret voiding phase as voided off an overactive contraction