Name of the Procedure:

Complex cystometrogram (CMG); with urethral pressure profile (UPP) studies, any technique

Summary

A Complex Cystometrogram combined with Urethral Pressure Profile studies is a diagnostic procedure that measures the function of the bladder and urethra. It uses calibrated electronic equipment to evaluate bladder pressure during filling and voiding, as well as to assess how well the urethra can retain urine.

Purpose

The procedure helps in diagnosing bladder and urethra dysfunctions, such as urinary incontinence, bladder obstruction, neurogenic bladder, and other urological conditions. The goals are to understand the underlying causes of urinary issues and guide the appropriate treatment plan.

Indications

• Urinary incontinence
• Bladder outlet obstruction
• Spinal cord injuries affecting the bladder
• Recurrent urinary tract infections
• Overactive or underactive bladder
• Unexplained urinary symptoms
• Patient criteria typically include persistent urinary problems that do not respond to initial treatments.

Preparation

• Patients may be advised to avoid caffeine and alcohol 24 hours before the procedure.
• Fasting is usually not required.
• Patients may need to adjust or temporarily stop certain medications as directed by their healthcare provider.
• A urinalysis or urine culture might be done prior to the procedure to rule out infections.

Procedure Description

1. Patient Positioning: The patient is usually positioned comfortably on an examination table.
2. Catheter Insertion: A small catheter is gently inserted into the bladder through the urethra to measure bladder pressure and fill the bladder with saline.
3. Data Collection: The bladder is gradually filled with saline solution, and the patient is asked to describe sensations, such as the first urge to urinate or fullness.
4. Pressure Measurements: The electronic device records bladder pressure during filling and voiding.
5. Urethral Pressure Profile: A separate catheter measures the pressure along the urethra at various points.
6. Void and Record: The patient may be asked to void, and the pressures are recorded to assess bladder and urethra function.

Tools involved include calibrated electronic urodynamics equipment and catheters. Anesthesia or sedation is typically not required as the procedure is minimally invasive.

Duration

The procedure typically takes about 30 to 60 minutes.

Setting

The procedure is usually performed in a hospital, outpatient clinic, or specialized urology center.

Personnel

• Urologist or urogynecologist
• Trained nurse or medical technician

Risks and Complications

• Mild discomfort or irritation during catheter insertion
• Risk of urinary tract infection
• Rarely, bladder injury or bleeding
• Temporary difficulty in urination post-procedure

Benefits

• Precise diagnosis of bladder and urethral dysfunction
• Informs treatment decisions, leading to better management of urinary symptoms
• Non-surgical, minimally invasive procedure

Recovery

• Patients can typically resume normal activities immediately.
• Increased fluid intake may be advised to help flush the bladder.
• Any discomfort usually resolves within a day.
• Follow-up appointments may be scheduled to discuss results and next steps.

Alternatives

• Simple cystometry without urethral pressure profile
• Voiding diary and symptom questionnaires
• Imaging studies like ultrasound or MRI The pros and cons of alternatives should be discussed with a healthcare provider, as they might offer different insights into the patient's condition.

Patient Experience

Patients might feel slight pressure or discomfort during catheter insertion and filling of the bladder, but the procedure is generally well-tolerated. Any discomfort can be managed with over-the-counter pain relievers if recommended by the healthcare provider. Most patients are able to return to their usual activities immediately post-procedure.