Name of the Procedure:

Complex cystometrogram with voiding pressure studies and urethral pressure profile studies (Cysto - VPP & UPP)

Summary

A complex cystometrogram with voiding pressure studies and urethral pressure profile studies is a diagnostic procedure to evaluate how well the bladder and urethra are storing and releasing urine. The procedure involves using calibrated electronic equipment to measure bladder pressures during filling, storage, and voiding, and to assess the closure pressure of the urethra.

Purpose

This procedure is performed to diagnose issues related to bladder function, such as incontinence, urinary retention, or other types of bladder dysfunction. It helps to identify abnormalities in bladder pressure during storage and voiding and to assess the competency of the urethral closure mechanism.

Indications

• Symptoms of urinary incontinence or urinary retention
• Chronic bladder pain
• Incomplete emptying of the bladder
• Frequent urinary tract infections
• Pre-operative evaluation for certain types of surgery involving the bladder or urethra

Preparation

• Patients may be asked to refrain from urinating for a few hours before the test.
• Fasting is typically not required.
• Specific instructions on medication adjustments, particularly diuretics or bladder medications, will be provided.
• A urine sample may be taken to check for infections prior to the procedure.

Procedure Description

1. Bladder Filling: A catheter is inserted through the urethra into the bladder. Saline or water is slowly infused to fill the bladder while measuring the bladder pressures.
2. Voiding Pressure Studies: The patient may be asked to urinate, and the pressures during voiding are recorded.
3. Urethral Pressure Profile Studies: A catheter equipped with pressure sensors is withdrawn slowly from the urethra to measure the closure pressure along the urethra.
   • Tools: Catheters with pressure sensors, calibrated electronic equipment, and monitoring systems.
   • Anesthesia: Local anesthesia may be applied to the urethra to minimize discomfort.

Duration

The entire procedure typically takes about 30 to 60 minutes.

Setting

This procedure is usually performed in an outpatient clinic or specialized diagnostic center.

Personnel

• Urologist or specialized physician
• Nurses or medical assistants

Risks and Complications

• Mild discomfort or pain during catheter insertion
• Urinary tract infection
• Temporary difficulty in urinating following the procedure
• Rare possibilities of bladder or urethral injury

Benefits

• Accurate diagnosis of bladder dysfunction and urethral incompetence
• Helps to tailor specific treatments based on precise underlying issues
• Immediate relief in understanding the problem can lead to prompt treatment planning

Recovery

• Patients can usually go home right after the procedure.
• Temporary discomfort during urination is common.
• Drink plenty of fluids to help flush out the bladder.
• Any specific medications or instructions will be provided for post-procedure care.
• Follow-up appointments may be scheduled based on the results or additional treatment needs.

Alternatives

• Non-invasive urodynamic studies
• Imaging studies such as ultrasound or MRI
• Medication trials or conservative management
• Each alternative has its own set of pros and cons, often less precise in diagnostics compared to complex cystometry.

Patient Experience

• During the procedure: Mild to moderate discomfort may be felt, especially during catheter insertion and bladder filling.
• After the procedure: Mild urinary discomfort or a burning sensation during urination, which usually resolves within a day. Pain management includes over-the-counter pain relievers and proper hydration for comfort.