The Urogynaecology department offers a multidisciplinary approach to assessment and treatment of women with Pelvic Floor Dysfunction.
Our team includes two consultant urogynaecologists – Dr Barry O’Reilly (head of department), and Dr Suzanne O’Sullivan; Elaine Dilloughery (clinical nurse manager, investigations). We liase closely with our colleagues in physiotherapy, colorectal and urological surgery. Our department provides assessment and management of Female Pelvic Floor Dysfunction. This includes Lower Urinary Tract Symptoms, Pelvic Organ Prolapse, Lower Bowel Dysfunction and Perineal disorders following childbirth.
What is urodynamics?
Urodynamic studies are performed to examine and assess the function and/or dysfunction of the lower urinary tract. Urinary assessment takes about 30-45 minutes to perform, and causes little discomfort. If cystoscopy is also performed the assessment takes approximately 60 minutes.
Urodynamic investigation usually includes:
- Urinary flow study (to assess urine flow rate, voided volume and voiding pattern)
- Bladder and perineal ultrasound (to assess residual urinary volume and urethral mobility)
- Cystometry (to assess bladder filling, storage and bladder pressures; to diagnose unstable bladder contractions)
- Urethral pressure profile (to measure maximal urethral pressure)
- Stress testing (to diagnose urodynamic stress incontinence)
Which patients should be referred for urodynamics?
- Patients with a complex picture of stress incontinence and urge incontinence.
- Women who have failed conservative treatment.
- Prior to surgery for stress incontinence.
- Women who have had previous continence surgery.
- Patients with symptoms of impaired bladder emptying.
- Prior to surgery for marked pelvic organ prolapse to exclude occult stress incontinence or impaired bladder emptying.
- Women with underlying neurological problems.
How is urodynamics performed?
Urodynamics is performed using computerised equipment and ultrasound imaging. The purpose of the examination is explained to the patient. The patient is asked to complete a bladder diary prior to urodynamics assessment. The patient is instructed to attend with a comfortably full bladder.
The patient voids in private, into a toilet attached to a urodynamics computer. Initial flow rate and voided volume are recorded. Residual urine volume is measured by bladder ultrasonography. Measuring catheters are then inserted into the bladder and vagina(or rectum). These catheters are very fine (5-French) and generally do not cause the patient discomfort. All catheters used are disposable. Bladder and urethral pressures are calculated using water-perfused catheters that measure the change in intravesical pressure during bladder filling (cystometry). The bladder is filled with sterile water at room temperature at a constant rate (usually 80 mls per minute, but reduced if the patient presents with symptoms of urethral or bladder pain syndromes) to a maximum bladder volume of 500 mls.
Urethral function is also assessed. The maximum urethral closure pressure is calculated. The calculation of this figure may influence the type of surgery recommended.
At the end of the study voiding studies are repeated, to assess voiding efficiency and residual urinary volume. Voiding pressure is also measured to exclude bladder outlet obstruction.
The results are then tabulated and urodynamics diagnosis made.