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Thread: Urodynamics Test

  1. #1

    Unhappy Urodynamics Test

    Yesterday, my husband and I went to the doctors office to do a urodynamics test. It was the most embarrassing thing I have went through with my husband. I felt like I could have done this test on him if I had the directions on a piece of paper like the nurse did.

    When we left I felt so AAAGHHHHH! I just wanted to cry and it wasn't me being proded.

    It was my understanding that urodynamics eval would cover these items: Post Void Residual, Cystometrogram, Electromyogram, Leak point pressure and Uroflow.

    It seems to me that none of these could accurately be done since he couldn't void on his own and can't feel sensations below injury. What exactly was this test suppose to tell us?

    They kept saying he was having bladder spasms. Is that a good thing? Is that why he is leaking? His bladder use to hold way more than he is getting out now. The doc put him on ditropan xl 25 mg a day to help with his leaking. It worked great to begin and we can still roll him over in bed without soaking bed, but now he cannot go more than 4 hours without cathing or he gets soaked.


    Any help would be greatly appreciated!
    Tonya

    Husband, Ron, is a T-7 complete as of Oct. 06

  2. #2
    Yeah...the urodynamics testing was terrible for me It is what put me in a ridiculous state from my CSA. That and my stupid cysto...

    Those tests, besides being VERY invasive....are suppose to see how much residual is in the bladder...and if there is any control down there. I believe all those wonderful probes register spasms, and muscle control.

    That was nice that you at least were allowed to go in with him, though.
    My boyfriend (now husband) would have passed out! But I was totally freaked out I totally understand how you were...and like you said, you weren't even the one recieving all the daggone probes.

    http://kidney.niddk.nih.gov/kudiseas...amic/index.htm

    I'm not sure if the above link will help..or if you can even access it, because I've never added a link yet, so sorry if it doesn't work for you.

    Take care. I hope your husband has recovered...and you, as well.

    bbs

  3. #3
    Ideally, urodynamics for a person with a SCI should be done using videourodynamics and a computer that coordinates the tests and collects and prints out the data. The tests should include a CMG (cystometrogram) and an external sphincter EMG. Uroflow is pretty much useless, as is a urethral pressure profile, for people with SCI. The videofluroscopy part of videourodynamics also shows what occurs with the intermal sphincter and shows any reflux of urine from the bladder up towards the kidneys (which is abnormal). If the person voids during the study (common) a PVR (post-void residual) can also be determined.

    It is certainly not the most fun test in the world, with a special catheter in place, a drape to collect any leaked urine, another catheter and balloon in the rectum, and either a surface or needle electrode in the perineum (to measure the external sphincter EMG). Done by the right technicians (GU techs, specially trained GU nurses or a urologist) it can provide invaluable information needed to custom design a bladder management program that is both effective and safe.

    Urodynamics is the ONLY test that can tell you what the intravesicular (inside the bladder) pressures are, what the true safe capacity is, and what happens to the internal and external sphincters when the bladder contracts. Of course the test results still have to be interpreted by a competent neurologic urologist.

    Not bladder spasms, but uninhibited bladder contractions (sometimes referred to as bladder spasms) are what is causing his leaking. If he is leaking and/or has high bladder pressures, and is put on medications to treat either or both, then the urodynamics should be repeated in another 3 months to be sure that the problem has been corrected, and should then be done every 1-2 years thereafter (more often if there are problems such as more leaking, AD, or frequent UTIs.). It is common for the bladder to become more spastic over the first year as spinal shock completely resolves (we never do urodynamics sooner than 3 months post injury) and it can continue to change neurologically over the person's life-span, which is why the tests are needed over and over.

    High bladder pressures can damage the bladder, and in the past, undiagnosed and untreated pressures were a major cause of renal failure in people with SCI.

    (KLD)

  4. #4
    Senior Member jccarolina's Avatar
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    I had one done last July when I started loosing bladder control.
    My doctor suggested I get Monarch Sling surgery to help me gain some control for a little while longer but didn't know how long.
    It wasn't the most pleasent test.
    What was bad was, I was the first SCI pt thay had run one on so both doctors and half the staff was in the room and I was the guinea pig

    They ran the Urodynamics and an updated EMG to make sure it was my SCI that was causing the lack of control. The surgery helped some, at least I don't pee on myself anymore if I sneeze , LOL
    If the Army & the Navy ever look on heavens scenes, they will see the streets are guarded by United States Marines!


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  5. #5
    I had one performed about 20 years ago and that was one too many! Maybe if I could have one done at a SCI center I might reconsider.... but never at a "regular" urologist's office. The plastic "throne chair" was hilarious... my butt was too skinny for it and I kept almost falling through it. That balloon was a trip too!

    Bob.
    "Be kind, for everyone you meet is fighting a great battle." - Philo of Alexandria

  6. #6
    Thanks to everyone for your replies!

    KLD Your info is great and I will be printing it out to take to the doc when we go back for our appointment. I have a question for you though. Everyone keeps saying a neurological urologist. I have searched every method possible to find such a person but can't seem to. Do I have to call every one of the urologist and ask if they are one? Could there be an easier way?

    Thanks JC for your info! I too got the impression he was their first SCI patient. They were clueless. The meds my husband is on seems to be helping out for now. I feel better now knowing that leaking could be result of the fact he is still coming out of shock.

    Bob, I could agree with you but I know it something that he has to have done. I would just like it to be done right atleast by people who are professionals at it.

    Thanks again! I always need everyones comments for my own mental status and to try and do what is best for him.
    Tonya

    Husband, Ron, is a T-7 complete as of Oct. 06

  7. #7
    No, there is no easy way to find this out. There is no separate board certification for this (although a few urologists have also taken the SCI Medicine board exam). There is a AUA special interest group for neurologic urology, so you can ask if they are a member of AUA and if they belong to this group. Mainly, you want to ask them if this is their specific specialty, and if it is, where they received their training in this area. A clinical rotation during residency or fellowship at a VA SCI Center, or Model System Center or other major SCI center would be a big indicator of having at least basic preparation in this area. Usually the front office staff will be able to tell you the urologist's subspecialties, which might include cancer, female incontinence, pediatrics, etc. I also suggest interview them to make a selection, either by phone or in person.

    I would also want to know if the nurse or GU tech doing the test (if not the physician) are certified in urology by the SUNA (formerly the AUAA).

    (KLD)

  8. #8

    Question Urodynamics Test 1st time

    Can anyone give me some info on what they felt during a Urodynamics Test? My Doctor wants me to get one after have a large kideny stone removed from my bladder a few months back as my flow has not been that great on average (sometimes great like a race horse, other times just dribbles or I have to push to evacuate). Or I also go like 5-8 times a day too other times. Don't wake up at night anymore though as I used to, can hold it all night now which is nice.

    I have had scopes up there before and they tried to do a large catheter to get a clot out after the surgery, that did not go over well at all, they never got more than a 1/2 inch in and I was screaming! The scope to remove the stent, I needed to get heavily relaxed on a couple Valium in order for them to pull the stent out, guess I'm just too sensitive down there?!

    Doctor told me the cath is only spaghetti thin, so it is smaller then other things I've had and the other contraption (Camera??) for the rectum was smaller too for the invasive part.

    What does the procedure feel like to anyone that has had this done? That is my biggest concern at the moment....

    Thanks
    UROMAN

  9. #9
    Uroman

    did you have your urodynamics test done yet? if not, let me know...
    Although, I'm female, so... it may be different.... but my experience wasn't good, so maybe you don't want to know it


    bbs

  10. #10
    Just to put another spin on this- the information that KLD posted regarding the importance of this test is still true. While they are not too much fun - if you can find someone who is experienced in providing it to someone with a sci, it isn't the worst test in the world. The key is finding someone who you are comfortable with in doing it.

    Please don't postpone this test if you are having any problems with your bladder. As KLD says, it is the only test that we have that provides us with the information that is needed to develop a solid bladder program.

    Happy New Year!

    CKF

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