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Paediatric Surgery
Urodynamic Studies of the Urinary Tract
Built from Puri — Pediatric Surgery and Pediatric Urology
What’s inside
7 sections · 61 slides
Overview
- What this topic will teach you
- Why children need their own urodynamics
Before the Test
History, examination and the 'urodynamic question'
- Start with a question, not a machine
- What the history and exam look for
- Supporting tests gathered before UDS
- The frequency/volume chart (voiding diary)
- A child's frequency/volume voiding chart
- Preparing the study: reading the diary
- Why ultrasound informs the plan
Non-Invasive Testing
What you can learn without a catheter
- The non-invasive tier
- Testing infants: the 4-hour voiding observation
- What the 4-hour observation can and cannot do
- Uroflowmetry: the first-line flow test
- Parameters recorded during uroflowmetry
- Doing uroflowmetry well
- Making uroflowmetry reliable
- The five uroflowmetry curve shapes
- Why the curve shape beats the raw number
- Reading the uroflowmetry patterns
- The patterns explained in plain terms
- The limit of flow alone
Invasive Urodynamics
Adding pressure catheters to see inside the bladder
- When invasive UDS is justified
- Timing baseline studies in neurogenic bladder
- What invasive UDS actually measures
- Positioning and videourodynamics
- Keeping the child calm and cooperative
- Placing the catheters
- When the catheter will not go in easily
- Avoiding artifacts
Cystometry and the Storage Phase
Filling the bladder and watching it store urine
- How filling cystometry is done
- Estimating expected bladder capacity
- When to end a filling cycle
- The four things measured during storage
- Bladder sensation
- Detrusor function during filling
- Bladder compliance
- Bladder capacity
- Assessing the storage phase at a glance
- Urethral function during filling
- Types of leakage during filling
- Cystometrogram tracings: normal versus abnormal storage
The Voiding Phase
Pressure-flow studies and how the bladder empties
- What normal voiding looks like
- Bladder function during voiding
- Underactive versus acontractile detrusor
- Reading obstruction from pressure-flow
- Finishing the study: post-void residual
Putting It Together
Key takeaways and the road ahead
- Three ideas to carry away
- The essential thresholds and rules
- Why UDS matters and where it is going
- Viva: a child leaks urine with a sudden rise in belly pressure but no bladder contraction. Name it and its measure.
- References (1/3)
- References (2/3)
- References (3/3)
- Pediatric Surgery and Pediatric Urology