Urodynamic

The most important measurements refer to:

• intraabdominal pressure
• intracystic pressure
• exector muscle pressure
• urocyst capacity
• urethra pressure
• pelvic floor electromyogram
• uroflow curve
• urine residue, after urination

This recording is in the form of mathematical curves diagrams. It is a urination imitation, an artificial cyst repletion, during which we observe the muscles and nerves’ reaction relating to the urination. The procedure of urodynamic control does not last more than 20 minutes and it is painless. The patient feels some “discomfort”, but no pain.

Types of urinary incontinence

• Effort incontinence: this is the most common type. It is estimated that 23% of women aged >55 suffer of this condition. It may develop in every situation where intra-abdominal pressure is temporarily increased, such as in the case of cough, laughter, sneezing, weight- lifting, body position change from sitting down to standing up. It is attributed to loss of sphincter mechanisms responsible for continence. The loss may be caused by a patient’s advanced age, surgical operations or radiotherapy of the pelvis, by multiple childbirths or prolapse of pelvic organs (in the case of women), or more rarely by neurological conditions.
• Imperative type incontinence: It is attributed to involuntary and intense constriction of a muscle, whose normal function consists in pushing the urine out of the cyst during urination. Often, there is only a sense of urgency, not accompanied by urine loss, but by sudden and intense wish to urinate, which cannot be easily suppressed by the patient. The causes of this type of incontinence may be neurological conditions, urinary infections, injuries to the pelvis or spinal medulla, congenital abnormalities, diabetes mellitus, overwhelming stress.

Mixed type incontinence (combination of the above two types)
Incontinence caused by cyst overfilling: this type of incontinence is practically attributed to urine retention which results in the complete repletion of the cyst and by consequence, the loss of urine due to overflow. This is caused by conditions which lead to atony (paralysis) of the exector muscle, such as neurological conditions, use of pharmaceutical drugs, persistent diabetes mellitus, spinal injuries or conditions which cause constriction of the urine drainage route, such as prostate hypertrophy and urethra stenosis.
Other less common incontinence types are nocturnal urination, extra-urethral incontinence (attributed to fistula or ectopic ureter) and non-conscious incontinence.

Incontinence treatment
Urination disorders can be treated conservatively (drug treatment, pelvic floor exercises) or surgically, depending on the case. For the optimal choice of treatment, an accurate diagnosis of the type of incontinence which can be reached through urodynamic control and the taking of the patient’s clinical history is necessary.

Urodynamic control indications
Urodynamic control should be undertaken with persons who present:

• incontinence of any type
• persistent symptoms of the lower urinary system
• constriction of the uriniferous route – hypocystic obstacle
• urination disorders in children

Urodynamic control procedure
The urodynamic control consists in the continuous recording of the urinary system’s parameters, related to the cyst’s phase of repletion and depletion, by computers.