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Urodynamics and Voiding Dysfunction
1
What is an urodynamic study?
Urodynamic studies assess the functional aspects of the storage and emptying ability of the lower urinary tract (LUT). The principles of urodynamic studies originated from hydrodynamics. The components of urodynamic studies are cystometrogram, leak point pressures, urethral profile pressures, pressure-flow studies, uroflowmetry, and electromyography. These studies have evolved into videourodynamics with the addition of fluoroscopy (i.e., video).
2
What is uroflowmetry?
Uroflowmetry is the measurement of voided urine (in milliliters) per unit of time (in seconds). The important elements of the test are voided volume (which should be >150 mL), maximum flow rate (Qmax), and the curve of the flow (which should be bell shaped). In men, a Qmax >15 mL/s is considered normal, whereas a Qmax <10 mL/s is considered abnormal. Assigning normal values in females is more difficult. In women, uroflowmetry is characterized by the shorter urethra and no resistance, such as that caused by the prostate gland in the male. Normal values are described as a Qmax between 20 and 36 mL/s.
3
What is benign prostatic hyperplasia (BPH)?
BPH is benign enlargement of the prostate gland that may lead to bladder outlet obstructive symptoms in men. These symptoms have been termed lower urinary tract symptoms (LUTSs).
4
What is an American Urological Association (AUA) Symptom Score?
It is a self-reported questionnaire developed and popularized by the AUA for the assessment of bothersome LUTS in men. This questionnaire has seven questions with a maximum score of 35. The higher the score, the more bothersome; the AUA Symptom Score has become an index for both the diagnosis and evaluation of treatment outcome in patients with LUTSs.
5
What are the main functions of the LUT?
Storage and emptying of urine are the main functions. For practical purposes, all symptoms of LUT dysfunction can be categorized into the malfunction of either storing or emptying ability.
6
What are the control mechanisms for LUT function?
The control mechanisms for LUT function are recognized as central and peripheral. The central control mechanism consists of the cortical portion of the frontal lobe of the brain and pontine micturition center. The peripheral control mechanism includes the thoracic sympathetic and lumbar parasympathetic innervations and neuromuscular apparatus of the LUT organs.
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