Study day clinical cases 2012

2nd Seminar Clinical cases in urodynamics. One morning with Paul Abrams

Presented by:

Dr. Jose Emilio Batista Urodynamics cooridator Centro Médico Teknon Barcelona,Spain

Study day clinical cases 2012

Detailed clinical hystory • 45 years old man.

• Multiple Sclerosis diagnosed 8 years p • Urgency incontinence.

• Daytime urinary frequency : 2-3 hours • Nocturia: 1.

Study day clinical cases 2012

Detailed clinical hystory • Unsatisfactory urination, constant feeling to urinate.

• Treatment: interferon.

• No previous urologic complaints.

• Treated with Solifenacine 5 mg without improvement

Flujometría#1

Vura Vol Qura ml/s 10 Qura 5 0 200 100 0 20 15

Study day clinical cases 2012

Urodynamic test: Uroflowmetry Tracing Voided volume. 195 ml Qmax. 13.7ml/s Post void residual. 71 ml 13,7 IM 00:25 FM 00:35 00:45 00:55 01:05 01:15 TM 01:25 5 s

Study day clinical cases 2012

Urodynamics: Cystometry • Tracing 8 0 6 0 Pa b d cm H 2 O Pabd 4 0 0 4 0 Pve s cm H 2 O Pves 2 0 0 4 0 Pd e t cm H 2 O Pdet Vi n fu s m l 2 0 0 6 0 0 3 0 0 Vu ra m l 0 2 0 0 1 0 0 Qu ra m l /s 2 0 0 1 0 5 0 00:00 IN 3 0 s 01:00 7 2 7 9 -7 6 9 0 ,5 0 ,5 CC IM FM 02:00 MT

Study day clinical cases 2012

Urodynamics: Cystometry Infused Vol Cysto cap. 140 ml P ves P det 33 cmH2O 40 cmH2O

Study day clinical cases 2012

Urodynamic test: Cystometry •

Comment

: – Bladder with diminished capacity.

– Low compliance.

– Un-inhibited detrusor contractions – High detrusor leak poing pressure > 40 cm H2O.

• Filling phase dysfunction .

Study day clinical cases 2012

Urodynamics: Pressure/Flow Study • Tracing Pa b d Pve s Pabd Pves cm H 2 O Pd e t Vi n fu s m l Vu ra m l Qu ra m l /s Pdet Vol Qura 6 0 4 0 2 0 0 4 0 2 0 0 4 0 2 0 0 6 0 0 3 0 0 0 2 0 0 1 0 0 0 1 0 5 0 7 2 7 9 -7 6 9 2 3 0 8 0 ,5 0 ,5 1 0 s 01:40 CC IM FM MT 02:00

Study day clinical cases 2012 Método ICS

Pdet [cmH2O] 80 60 40 20 180 160 140 120 100

P/Q Plot

p al comernzar a orinar p en flujo máximo Q en flujo máximo Cuesta desc.

Retardo de flujo A/G# 39 49 8,4 4,7 0,7 32,3 cmH2O cmH2O ml/s cmH2O/ml/s s Obstruido Equivocado No obstruido

2 4 6 8 10 12 14 16 18 20 22 24 26 Qura [ml/s]

Study day clinical cases 2012

Urodynamic test: Pressure/Flow Study •

Voiding phase results

– Qmax – Pdet at Qmax – Voided volume – Post voided residual 10.7

51 56 80 ml/s cmH2O ml ml

Study day clinical cases 2012

Urodynamic test: Pressure/Flow Study •

Comment

– Low Qmax (10.7 ml/s).

– Post voided residual: 80 ml.

– Micturition by detrusor contraction.

– Interrupted flow, probably dyssynergia.

Study day clinical cases 2012

Therapeutic approach • Filling phase: – Neurogenic overactive detrusor with a high point pressure leakage.

• Voiding phase: – No obstruction.

– Contractile detrusor; post voided residual probably because of dyssynergia.

Study day clinical cases 2012

Recommendations • Anticholinergic treatment (10mg /d solifenacine vs 40mg Trospium chloride 12h).

• If post voided residual is confirmed, we indicate intermittent self-catheterism after urination.

• We recommend annual urodynamics and ultrasound tests.