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UP-2.193: Impact of the Examination Position on Cystometry Results
UNMODERATED POSTER SESSIONS
ity ⫾ SD increased from 131.7 ⫾ 79.6 to 594 ⫾ 387 ml. (p ⬍0.001) and mean maximum detrusor pressure decreased from 81 ⫾ 43 to 20 ⫾ 12 cm H20 (p ⬍0.01). Mean interval between catheterizations was 5 hours; with volumes ranging from 314 to 743 ml. Only 19 patients 10 % needed a low dose of oxybutynin or tolterodine postoperatively to maintain continence consistently. of the 119 patients 115 (96 %) reported no significant change in bowel function and nearly all patients expressed extreme satisfaction with urological management. A subsequent urological procedure was required in 26 patients (22%) at a mean of 4.4 years after initial surgery. Conclusions: Bladder augmentation provides durable clinical and urodynamic improvement for patients with neurogenic bladder dysfunction refractory to conservative therapy. Furthermore, there is a high level of patient satisfaction with bladder augmentation. UP-2.191 Urodynamic Evaluations of Silodosin, a Novel Selective ␣-1a Adrenoceptor Blocker, for Treatment of Benign Prostatic Hyperplasia Iuchi H1, Watanabe Y1, Hashimoto H1, Fijisawa M2, Saga Y2, Hou K2, Tsurukawa H3 1 Megumino Hospital, Eniwa, Japan; 2 Fukagawa General Hospital, Fukagawa, Japan; 3Hakodate Urological Clinic, Hakodate, Japan Introduction and Objective: A novel selective ␣1-adrenoceptor (AR) blockade, silodosin, has been used for BPH patients in Japan. The purpose of this study is to evaluate the efficacy of silodosin for the treatment of BPH urodynamically. Materials and Methods: A total of 16 patients with an International Prostate Symptom Score (IPSS) of ⱖ8 and a Quality of Life (QOL) index ofⱖ3 were included. Changes in the IPSS and QOL index were evaluated before and after 2 months of twice daily oral administration of 4 mg silodosin. Also, urodynamic evaluations of silodosin were performed including pressure-flow study. All values are expressed as the mean⫾standard error. Statistical comparisons before and after the administration were made using the Wilcoxson signed rank test. P⬍ 0.05 was considered statistically significant. Results: The mean total prostate volume was 35.3⫾4.8ml. IPSS and QOL index significantly improved from 12.6⫾1.3 and 4.4⫾0.9 at baseline to 6.3⫾0.8 and 2.1⫾0.3, respectively. Average flow rate
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(Qaverage), max flow rate (Qmax) changed from 3.9⫾0.4ml/s and 7.9⫾0.8 ml/s to 4.2⫾0.4 ml/s and 8.1⫾0.7 ml/s. Voided volume and residual urine changed from 161.6⫾21.0 ml and 19.7⫾11.2ml to 179.3⫾20.5ml and 24.3⫾11.8ml. Total bladder pressure at opening, total bladder pressure at Qmax, detrusor pressure at Qmax, and max detrusor pressure significantly decreased from 92.8⫾9.8cmH2O, 96.3⫾7.6cmH2O, 84.8⫾6.6cmH2O, and 100.1⫾8.0cmH2O to 68.4⫾6.8cmH2O, 73.4⫾6.0cmH2O, 71.6⫾5.4cmH2O and 84.3⫾6.3cmH2O, respectively. Shaefer’s nomogram grade significantly decreased from 3.8⫾0.3 to 3.0⫾0.4. Conclusions: The selective ␣1A-AR blockade silodosin significantly appears to improve bladder outlet obstruction and thus be effective LUTS in patients with BPH. This suggests that silodosin could relieve LUTS which did not decrease with administration of other ␣1-AR blockade in BPH patients. UP-2.192 Effect of Chronic Retention Under Low Pressure on the Upper Urinary Tract in Diabetic Patients Nale D1, Micic S1, Nebojsa B1, Predrag N1, Dejan D1, Srdjan P2, Milos Z2 1 Clinic of Urology, 2Clinic of Endocrinology, Institute of Urology and Nephrology, Belgrade, Serbia Introduction and Objectives: Diabetes mellitus (DM) is the most common serious metabolic disease in the United States and is marked by hyperglycemia and complications of microvascular disease and neuropathy. Almost all diabetic patients show several kinds of complication (eg.cardiovascular disease, neuropathy, retinopathy, nephropathy). Diabetic cystopathy is part of a spectrum of autonomic dysfunctions, which include gastroesophageal atonia, hyperhydrosis, nocturnal diarrhea, postural hypotension, erectile dysfunction, and autonomic cardiac abnormalities. We analyzed the risk factors which are responsibile for the dilatation of the upper urinary tract (UTT) and occurrence of vesico-ureteral reflux (VUR). Materials and Methods: We examined 110 patients (cross sectional study) mean age 53 ⫾ 13yrs (range: 23-77). Median duration of diabetes mellitus (DM) was 9.88 ⫾ 6.95 yrs, SD. All the patients were investigated by : micturition cystography, urography, ultrasound examination and urodynamic investigation (urinflowmetry, cystometry, pressure-flow study, profilom-
etry (Brown-Wickham method) and electromyography (EMG) anal sphincter). Urodynamic investigation was done on Video uro-color system 1000 Dantec. We analyzed the risk factors : post voided residual urine (PVR), (bladder compliance) compliance of detrusor wall, intravesical pressure during the (maximum) cystometric capacity and intravesical pressure during PVR. (bladder outlet obstruction (BOO) and presence high-pressure contractions of the bladder). Results: In whole investigated group no dilatation of the UUT and VUR according to the urography and ultrasound examination were observed. Mean PVR was 104.76 ⫾ 148 ml, SD (range: 0-680ml). Mean bladder compliance was 56.97 ⫾ 35,1ml/cm H20, SD (range: 14-93). Mean intravesical pressure during PVR was 8.64 ⫾ 5.68 cmH20, SD (range: 10-38). Mean intravesical pressure during (maximum) cystometric capacity (BC) was 17.72 ⫾ 18.2 cmH20, SD (range: 0-36). Conclusions: If the intravesical pressure and compliance are normal or even higher, no dilatation of the UUT and VUR can occur despite the amount of the PVR. Chronical retention under the low pressure have no influence on the dilatation of the UUT and VUR development in diabetic patients.
UP-2.193 Impact of the Examination Position on Cystometry Results Persu C, Cauni V, Geavlete P Saint John Clinical Emergency Hospital, Bucharest, Romania Introduction and Objective: During urodynamics, it is essential to reproduce the patient’s symptoms. Most of the symptoms occur during daily activities, so examining the patient in the supine position may lead to negatively false results. Materials and Methods: On 28 patients (16 females and 12 males) with symptoms suggesting idiopathic detrusor overactivity, we performed filling cystometry, in a lying position. No reflex detrusor contractions were observed, even after using provocative maneuvers. The fill rate was 50ml/min. After emptying the bladder, a new cystometry was performed, with the patient standing. The fill rate remained 50ml/min. Results: In 11 of the 16 women (68%), and in 5 of the 12 men (42%), detrusor overactivity was diagnosed. Overall, the detection rate was 57% (16 out of 28 patients). The bladder contractions were associated with urgency, and, in 4 cases,
UROLOGY 74 (Supplment 4A), October 2009
UNMODERATED POSTER SESSIONS
leakage. In the rest of the group, detrusor overactivity could not be diagnosed. Conclusions: Urodynamic testing with the patient standing significantly improves the detection rate of detrusor overactivity when compared to the regular technique. If the symptoms cannot be reproduced during urodynamics, in a symptomatic patient, further testing might be necessary.
UP-2.194 Variability of the Urodynamic Profile in Healthy Males Persu C, Cauni V, Geavlete P Saint John Emergency Clinical Hospital, Bucharest, Romania Introduction and Objective: Urodynamic tests are frequently used as the most powerful diagnostic tool in the evaluation of several conditions. We present the data from a prospective study aiming to assess the differences that can occur between different urodynamic evaluations in the same healthy person. Materials and Methods: Between January 2006 and August 2007 we performed pressure-flow studies in males in which no urological pathology was found. We reevaluated the patients after 4 months using the same protocol for lower urinary tract symptoms and we included 45 patients in which no pathological condition could be found. The mean age in our group was 68 years old (51-73). We compared the data obtained after the pressure flow study with data from the first examination in each patient-Maximum bladder capacity, Qmax, Pdet at Qmax. Results: The maximum bladder capacity had a mean variance of 45ml (20-120ml). Qmax value increased with a mean of 4ml/ sec (1.5-8ml/sec) or decreased with a mean of 6.8ml/sec (2-11.5ml/sec). Maximum pressure at the moment of Qmax increased with a mean value of 65cm water (10-125cm water) or decreased with a mean value of 40cm water (15-165cm water). Conclusions: The result of the urodynamic evaluation should be carefully interpreted considering the clinical context of the patient due to the variance of the parameters in one individual. Free uroflowmetry alone leads to many false results.
UP-2.195 Radian of the Wire-Electrodes and Its Influence on the Amplitude and Quality of Electromyogram for Patients with Detrusor Stable Lower Urinary Tract Dysfunction
Cui X1, Xu D1, Zhu F1, Jiang H2, Ren J1, Lv C1, Yao Y1, Qu C1 1 Department of Urology, Changzheng Hospital, Second Military Medical University, Shanghai, China; 2Department of Biomedical Engineering, Lerner Research Institute & Glickman Urological and Kidney Institute, The Cleveland Clinic, Cleveland, OH, USA Introduction and Objective: We studied the role of radian distance of the wireelectrodes and its influence on the amplitude and quality of electromyogram for patients with detrusor stable lower urinary tract dysfunction. Materials and Methods: We used two needle-guided wire electrodes to record the anal sphincter electromyogram in the course of multichannel urodynamics for more than eight years and gained excellent results thus far. Between September 2008 and January 2009, a total of 152 patients with detrusor stable lower urinary tract dysfunction underwent comprehensive urodynamic study. Each patients underwent cystometrogram and pressureflow study three times. Each time the two electrodes were placed at one of different radian distance: 0.25, 0.75, or 1.0. The order was randomized according to the randomized number. The electro-potentials during storage and voiding phases were measured separately, recorded and analyzed as their disclosed radians. Mean patient age was 54.5 years (range 16 to 86) and male to female ratio was 1:1. Results: Mean electro-potentials during storage phase were 13.6⫾6.20, 23.20⫾11.82, 30.57⫾14.18V at 0.25, 0.75, or 1.0 respectively (F⫽86.94, P⫽0.000) as to the whole group. When the data were further analyzed according to their gender, age or original disease (bladder outlet obstruction, sphincter overactivity, detrusor underactivity and stress urinary incontinence), this gradually increased trend still remained as below: male (14.86⫾6.90, 25.84⫾14.01, 32.49⫾16.61V, F⫽36.14, P⫽0.000), female (12.24⫾5.06, 20.35⫾8.04, 28.48⫾10.70V, F⫽70.49, P⫽0.000), less than 30 (14.36⫾4.58, 26.96⫾11.54, 35.74⫾14.62V, F⫽16.95, P⫽0.000), and 50⬃(13.81⫾6.24, 24.05⫾15.34, 31.21⫾11.41V, F⫽20.42, P⫽0.000). Whereas mean electro-potentials of the patients without sphincter overactivity during voiding phase were 14.54⫾6.78, 15.55⫾7.90, 16.91⫾6.93V, F⫽1.76, P⫽0.174), those with sphincter overactivity were 87.18⫾66.31, 95.40⫾70.26, 102.79⫾80.55 V, F⫽0.66, P⫽0.52). Conclusions: The mean electro-potentials
UROLOGY 74 (Supplment 4A), October 2009
of the anal sphincter of the patients during storage phase increased gradually when the radians increased from 0.25to 1.0as whole or as divided by gender, age or original disease. Nevertheless, this trend did not exist during voiding phase for patients with or without sphincter overactivity.
UP-2.196 A Long-Term Observation on Technique Remoulding and Accessory Modification for Gaining Precise High Quality Results in Urodynamic Examination Xu D1, Lu L2, Cui X1, Wang R1, Qu C1 Depts. of 1Urology, 2Microinvasive Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China Introduction and Objective: We review the technique remoulding and accessory modification in the course of multichannel urodynamic examination. Three main measures were undertaken. The effect was inspected and compared with before or without them. Materials and Methods: Between May 2002 and March 2009, a total of 4500 patients underwent multichannel urodynamic examination (Life-Tech Urovision Janus V) in this institute. We have made some modification to the equipment and procedure: in time position change from supine to sitting for better recording of the voiding phase parameters when female patients were involved; tight fixation of the anal balloon catheter with two pair tapes around the thighs for monitoring abdominal pressure in order to avoid tube escape from the anus; electromyogram wire electrode manipulation: the wire endpoint inserted the needle hole from outside inside, not from inside to outside. Results: After these measures were undertaken, the quality of the urodynamics improved significantly. Before the position change was undertaken, the success rate of pressure-flow study for 150 women was only 26.7%, whereas this rate for 250 women increased to 96.0% after the measure was undertaken with chisquare⫽44.04, P⬍0.001. The rate of balloon catheter escape decreased from 40% to 5% in patients with detrusor underactivity or necessity of standing position. The electromyograms became easily adjusted, more clearly shown and intermittent wave artifact disappeared thereafter in late 1500 patients. Conclusions: In order to make patients play their voiding behavior as naturally as possible and thus to gain better test results, these measures were mandatory and rational in clinical urodynamics.
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ity ⫾ SD increased from 131.7 ⫾ 79.6 to 594 ⫾ 387 ml. (p ⬍0.001) and mean maximum detrusor pressure decreased from 81 ⫾ 43 to 20 ⫾ 12 cm H20 (p ⬍0.01). Mean interval between catheterizations was 5 hours; with volumes ranging from 314 to 743 ml. Only 19 patients 10 % needed a low dose of oxybutynin or tolterodine postoperatively to maintain continence consistently. of the 119 patients 115 (96 %) reported no significant change in bowel function and nearly all patients expressed extreme satisfaction with urological management. A subsequent urological procedure was required in 26 patients (22%) at a mean of 4.4 years after initial surgery. Conclusions: Bladder augmentation provides durable clinical and urodynamic improvement for patients with neurogenic bladder dysfunction refractory to conservative therapy. Furthermore, there is a high level of patient satisfaction with bladder augmentation. UP-2.191 Urodynamic Evaluations of Silodosin, a Novel Selective ␣-1a Adrenoceptor Blocker, for Treatment of Benign Prostatic Hyperplasia Iuchi H1, Watanabe Y1, Hashimoto H1, Fijisawa M2, Saga Y2, Hou K2, Tsurukawa H3 1 Megumino Hospital, Eniwa, Japan; 2 Fukagawa General Hospital, Fukagawa, Japan; 3Hakodate Urological Clinic, Hakodate, Japan Introduction and Objective: A novel selective ␣1-adrenoceptor (AR) blockade, silodosin, has been used for BPH patients in Japan. The purpose of this study is to evaluate the efficacy of silodosin for the treatment of BPH urodynamically. Materials and Methods: A total of 16 patients with an International Prostate Symptom Score (IPSS) of ⱖ8 and a Quality of Life (QOL) index ofⱖ3 were included. Changes in the IPSS and QOL index were evaluated before and after 2 months of twice daily oral administration of 4 mg silodosin. Also, urodynamic evaluations of silodosin were performed including pressure-flow study. All values are expressed as the mean⫾standard error. Statistical comparisons before and after the administration were made using the Wilcoxson signed rank test. P⬍ 0.05 was considered statistically significant. Results: The mean total prostate volume was 35.3⫾4.8ml. IPSS and QOL index significantly improved from 12.6⫾1.3 and 4.4⫾0.9 at baseline to 6.3⫾0.8 and 2.1⫾0.3, respectively. Average flow rate
S292
(Qaverage), max flow rate (Qmax) changed from 3.9⫾0.4ml/s and 7.9⫾0.8 ml/s to 4.2⫾0.4 ml/s and 8.1⫾0.7 ml/s. Voided volume and residual urine changed from 161.6⫾21.0 ml and 19.7⫾11.2ml to 179.3⫾20.5ml and 24.3⫾11.8ml. Total bladder pressure at opening, total bladder pressure at Qmax, detrusor pressure at Qmax, and max detrusor pressure significantly decreased from 92.8⫾9.8cmH2O, 96.3⫾7.6cmH2O, 84.8⫾6.6cmH2O, and 100.1⫾8.0cmH2O to 68.4⫾6.8cmH2O, 73.4⫾6.0cmH2O, 71.6⫾5.4cmH2O and 84.3⫾6.3cmH2O, respectively. Shaefer’s nomogram grade significantly decreased from 3.8⫾0.3 to 3.0⫾0.4. Conclusions: The selective ␣1A-AR blockade silodosin significantly appears to improve bladder outlet obstruction and thus be effective LUTS in patients with BPH. This suggests that silodosin could relieve LUTS which did not decrease with administration of other ␣1-AR blockade in BPH patients. UP-2.192 Effect of Chronic Retention Under Low Pressure on the Upper Urinary Tract in Diabetic Patients Nale D1, Micic S1, Nebojsa B1, Predrag N1, Dejan D1, Srdjan P2, Milos Z2 1 Clinic of Urology, 2Clinic of Endocrinology, Institute of Urology and Nephrology, Belgrade, Serbia Introduction and Objectives: Diabetes mellitus (DM) is the most common serious metabolic disease in the United States and is marked by hyperglycemia and complications of microvascular disease and neuropathy. Almost all diabetic patients show several kinds of complication (eg.cardiovascular disease, neuropathy, retinopathy, nephropathy). Diabetic cystopathy is part of a spectrum of autonomic dysfunctions, which include gastroesophageal atonia, hyperhydrosis, nocturnal diarrhea, postural hypotension, erectile dysfunction, and autonomic cardiac abnormalities. We analyzed the risk factors which are responsibile for the dilatation of the upper urinary tract (UTT) and occurrence of vesico-ureteral reflux (VUR). Materials and Methods: We examined 110 patients (cross sectional study) mean age 53 ⫾ 13yrs (range: 23-77). Median duration of diabetes mellitus (DM) was 9.88 ⫾ 6.95 yrs, SD. All the patients were investigated by : micturition cystography, urography, ultrasound examination and urodynamic investigation (urinflowmetry, cystometry, pressure-flow study, profilom-
etry (Brown-Wickham method) and electromyography (EMG) anal sphincter). Urodynamic investigation was done on Video uro-color system 1000 Dantec. We analyzed the risk factors : post voided residual urine (PVR), (bladder compliance) compliance of detrusor wall, intravesical pressure during the (maximum) cystometric capacity and intravesical pressure during PVR. (bladder outlet obstruction (BOO) and presence high-pressure contractions of the bladder). Results: In whole investigated group no dilatation of the UUT and VUR according to the urography and ultrasound examination were observed. Mean PVR was 104.76 ⫾ 148 ml, SD (range: 0-680ml). Mean bladder compliance was 56.97 ⫾ 35,1ml/cm H20, SD (range: 14-93). Mean intravesical pressure during PVR was 8.64 ⫾ 5.68 cmH20, SD (range: 10-38). Mean intravesical pressure during (maximum) cystometric capacity (BC) was 17.72 ⫾ 18.2 cmH20, SD (range: 0-36). Conclusions: If the intravesical pressure and compliance are normal or even higher, no dilatation of the UUT and VUR can occur despite the amount of the PVR. Chronical retention under the low pressure have no influence on the dilatation of the UUT and VUR development in diabetic patients.
UP-2.193 Impact of the Examination Position on Cystometry Results Persu C, Cauni V, Geavlete P Saint John Clinical Emergency Hospital, Bucharest, Romania Introduction and Objective: During urodynamics, it is essential to reproduce the patient’s symptoms. Most of the symptoms occur during daily activities, so examining the patient in the supine position may lead to negatively false results. Materials and Methods: On 28 patients (16 females and 12 males) with symptoms suggesting idiopathic detrusor overactivity, we performed filling cystometry, in a lying position. No reflex detrusor contractions were observed, even after using provocative maneuvers. The fill rate was 50ml/min. After emptying the bladder, a new cystometry was performed, with the patient standing. The fill rate remained 50ml/min. Results: In 11 of the 16 women (68%), and in 5 of the 12 men (42%), detrusor overactivity was diagnosed. Overall, the detection rate was 57% (16 out of 28 patients). The bladder contractions were associated with urgency, and, in 4 cases,
UROLOGY 74 (Supplment 4A), October 2009
UNMODERATED POSTER SESSIONS
leakage. In the rest of the group, detrusor overactivity could not be diagnosed. Conclusions: Urodynamic testing with the patient standing significantly improves the detection rate of detrusor overactivity when compared to the regular technique. If the symptoms cannot be reproduced during urodynamics, in a symptomatic patient, further testing might be necessary.
UP-2.194 Variability of the Urodynamic Profile in Healthy Males Persu C, Cauni V, Geavlete P Saint John Emergency Clinical Hospital, Bucharest, Romania Introduction and Objective: Urodynamic tests are frequently used as the most powerful diagnostic tool in the evaluation of several conditions. We present the data from a prospective study aiming to assess the differences that can occur between different urodynamic evaluations in the same healthy person. Materials and Methods: Between January 2006 and August 2007 we performed pressure-flow studies in males in which no urological pathology was found. We reevaluated the patients after 4 months using the same protocol for lower urinary tract symptoms and we included 45 patients in which no pathological condition could be found. The mean age in our group was 68 years old (51-73). We compared the data obtained after the pressure flow study with data from the first examination in each patient-Maximum bladder capacity, Qmax, Pdet at Qmax. Results: The maximum bladder capacity had a mean variance of 45ml (20-120ml). Qmax value increased with a mean of 4ml/ sec (1.5-8ml/sec) or decreased with a mean of 6.8ml/sec (2-11.5ml/sec). Maximum pressure at the moment of Qmax increased with a mean value of 65cm water (10-125cm water) or decreased with a mean value of 40cm water (15-165cm water). Conclusions: The result of the urodynamic evaluation should be carefully interpreted considering the clinical context of the patient due to the variance of the parameters in one individual. Free uroflowmetry alone leads to many false results.
UP-2.195 Radian of the Wire-Electrodes and Its Influence on the Amplitude and Quality of Electromyogram for Patients with Detrusor Stable Lower Urinary Tract Dysfunction
Cui X1, Xu D1, Zhu F1, Jiang H2, Ren J1, Lv C1, Yao Y1, Qu C1 1 Department of Urology, Changzheng Hospital, Second Military Medical University, Shanghai, China; 2Department of Biomedical Engineering, Lerner Research Institute & Glickman Urological and Kidney Institute, The Cleveland Clinic, Cleveland, OH, USA Introduction and Objective: We studied the role of radian distance of the wireelectrodes and its influence on the amplitude and quality of electromyogram for patients with detrusor stable lower urinary tract dysfunction. Materials and Methods: We used two needle-guided wire electrodes to record the anal sphincter electromyogram in the course of multichannel urodynamics for more than eight years and gained excellent results thus far. Between September 2008 and January 2009, a total of 152 patients with detrusor stable lower urinary tract dysfunction underwent comprehensive urodynamic study. Each patients underwent cystometrogram and pressureflow study three times. Each time the two electrodes were placed at one of different radian distance: 0.25, 0.75, or 1.0. The order was randomized according to the randomized number. The electro-potentials during storage and voiding phases were measured separately, recorded and analyzed as their disclosed radians. Mean patient age was 54.5 years (range 16 to 86) and male to female ratio was 1:1. Results: Mean electro-potentials during storage phase were 13.6⫾6.20, 23.20⫾11.82, 30.57⫾14.18V at 0.25, 0.75, or 1.0 respectively (F⫽86.94, P⫽0.000) as to the whole group. When the data were further analyzed according to their gender, age or original disease (bladder outlet obstruction, sphincter overactivity, detrusor underactivity and stress urinary incontinence), this gradually increased trend still remained as below: male (14.86⫾6.90, 25.84⫾14.01, 32.49⫾16.61V, F⫽36.14, P⫽0.000), female (12.24⫾5.06, 20.35⫾8.04, 28.48⫾10.70V, F⫽70.49, P⫽0.000), less than 30 (14.36⫾4.58, 26.96⫾11.54, 35.74⫾14.62V, F⫽16.95, P⫽0.000), and 50⬃(13.81⫾6.24, 24.05⫾15.34, 31.21⫾11.41V, F⫽20.42, P⫽0.000). Whereas mean electro-potentials of the patients without sphincter overactivity during voiding phase were 14.54⫾6.78, 15.55⫾7.90, 16.91⫾6.93V, F⫽1.76, P⫽0.174), those with sphincter overactivity were 87.18⫾66.31, 95.40⫾70.26, 102.79⫾80.55 V, F⫽0.66, P⫽0.52). Conclusions: The mean electro-potentials
UROLOGY 74 (Supplment 4A), October 2009
of the anal sphincter of the patients during storage phase increased gradually when the radians increased from 0.25to 1.0as whole or as divided by gender, age or original disease. Nevertheless, this trend did not exist during voiding phase for patients with or without sphincter overactivity.
UP-2.196 A Long-Term Observation on Technique Remoulding and Accessory Modification for Gaining Precise High Quality Results in Urodynamic Examination Xu D1, Lu L2, Cui X1, Wang R1, Qu C1 Depts. of 1Urology, 2Microinvasive Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China Introduction and Objective: We review the technique remoulding and accessory modification in the course of multichannel urodynamic examination. Three main measures were undertaken. The effect was inspected and compared with before or without them. Materials and Methods: Between May 2002 and March 2009, a total of 4500 patients underwent multichannel urodynamic examination (Life-Tech Urovision Janus V) in this institute. We have made some modification to the equipment and procedure: in time position change from supine to sitting for better recording of the voiding phase parameters when female patients were involved; tight fixation of the anal balloon catheter with two pair tapes around the thighs for monitoring abdominal pressure in order to avoid tube escape from the anus; electromyogram wire electrode manipulation: the wire endpoint inserted the needle hole from outside inside, not from inside to outside. Results: After these measures were undertaken, the quality of the urodynamics improved significantly. Before the position change was undertaken, the success rate of pressure-flow study for 150 women was only 26.7%, whereas this rate for 250 women increased to 96.0% after the measure was undertaken with chisquare⫽44.04, P⬍0.001. The rate of balloon catheter escape decreased from 40% to 5% in patients with detrusor underactivity or necessity of standing position. The electromyograms became easily adjusted, more clearly shown and intermittent wave artifact disappeared thereafter in late 1500 patients. Conclusions: In order to make patients play their voiding behavior as naturally as possible and thus to gain better test results, these measures were mandatory and rational in clinical urodynamics.
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