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Incontinence (cont.)

More Urinary Incontinence Diagnosis

Urodynamic Studies

Urodynamics uses physical measurements such as urine pressure and flow rate as well as clinical assessment. These studies measure the pressure in the bladder at rest and while filling. These studies range from simple observation to precise measurements using specialized equipment.

  • Uroflowmetry
    • Uroflowmetry, or uroflow, is used to identify abnormal voiding patterns. This is a noninvasive test to measure the volume of urine voided (urinated), the velocity or speed of the urination, and its duration.
    • This is used as a screening test to evaluate bladder outlet obstruction. Consistently low flow rates generally indicate a bladder outlet obstruction but also may indicate decreased contraction of the bladder wall muscle. To properly diagnose bladder outlet obstruction, pressure-flow studies are performed.
  • Cystometry
    • Cystometry is a procedure that measures the capacity and pressure changes of the bladder as it fills and empties. The evaluation determines the presence or absence of detrusor overactivity (or instability).
    • Simple cystometry detects abnormal detrusor compliance (a bladder that does not expand enough).
    • The multichannel, or subtracted, cystometrogram simultaneously measures intra-abdominal, total bladder, and true detrusor (muscle) pressures. With this technique, the doctor can distinguish between involuntary detrusor (bladder) contractions and increased intra-abdominal pressure.
    • The voiding cystometrogram, or pressure-flow study, detects outlet obstruction in patients who are able to urinate at will. The voiding cystometrogram is the only test able to provide information about bladder contractility and the extent of a bladder outlet obstruction.
    • A filling cystometrogram assesses the amount the bladder can hold (bladder capacity), how much the bladder can expand (bladder compliance), and the presence of contractions. This test may be performed using either gas or liquid to fill the bladder through a catheter (a small tube inserted into the bladder through the urethra).

Assessment of Urethral Function

  • Urethral pressure profilometry is a test that measures the resting and dynamic pressures in the urethra.
  • Abdominal leak point pressure (ALPP)
    • Determining the ALPP, which is also known as Valsalva leak point pressure, is important. First, the bladder is filled with 250 mL of fluid by a catheter. Then, the patient is instructed to bear down (Valsalva maneuver) in gradients (mild, moderate, severe) to demonstrate leakage. The lowest amount of pressure required to generate leakage is recorded as ALPP.
    • By determining ALPP, the doctor can determine whether stress urinary incontinence is due to urethral hypermobility, intrinsic sphincter deficiency, or both in combination.
    • Cough leak point pressure (CLPP) is determined in a similar way.

Cystogram

A cystogram is a radiograph (X-ray image) of the bladder. In this procedure, a solution containing a radioisotope (contrast media) is instilled into the bladder via a catheter until the bladder is full (or the patient indicates that the bladder feels full). X-ray images are then taken of the bladder while full and during or after urination.

A cystogram helps to confirm a diagnosis of stress incontinence, the degree of mobility of the urethra, and the presence of cystocele (a condition occurring in women in which the wall between the bladder and vagina weakens and allows the bladder to droop into the vagina, which may cause discomfort and problems with emptying the bladder). These radiographs (X-rays) also may demonstrate problems with the sphincter muscle (intrinsic sphincter deficiency). The presence of an abnormal connection between the bladder and the vagina (vesicovaginal fistula) also may be documented in this fashion.

Electromyography

Electromyography is a test to evaluate potential nerve damage. This test measures the muscle activity in the urethral sphincter using sensors placed on the skin near the urethra and rectum. Sometimes the sensors are on the urethral or rectal catheter. Muscle activity is recorded on a machine. The patterns of the impulses will show whether the messages sent to the bladder and urethra are coordinated correctly.

Cystoscopy

Cystoscopy, examination of the inside of the bladder, also is indicated for patients experiencing persistent irritative urinary symptoms or blood in the urine (hematuria). The cystoscope has lenses like a telescope or microscope which allow the doctor to focus on the inner surfaces of the urinary tract. Bladder abnormalities, such as a tumor, stone, and cancer (carcinoma in situ) can be diagnosed with cystoscopy. Urethroscopy can be performed to assess the structure and function of the urethral sphincter mechanism.

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Incontinence, Urinary: Surgical Therapies »

Urinary incontinence is a medical condition that has significant negative effects on quality of life and may cause social stigma, financial hardship, and associated medical problems.

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