RUMAH SAKIT IBU & ANAK YPK MANDIRI Jl. Gereja Theresia No.22 Jakarta 10350 Telp.

(021)3909725, Fax (021)3903806

URODYNAMIC REPORT
Name Ages Date of Birth Date of study Uroflowmetri Q-max (ml/s) Volume voided (ml) Calculated Residual Urine Filling Phase First sensation filling (ml) Second sensation/strong sensation (ml) Max.rise in Pdet Compliance Detrusor instability Number of Detrusor instability : : : : Sex Medical Record Clinical Diagnosis Physician : : : :

normal reduced yes no

Contraction no Vol at contraction Max.rise in Pdet Incontinence due to cough Incontinence with detrusor stability End-filling Pdet (cmH20) Cystometric capacity (ml)

yes no yes no

RSIA YPK MANDIRI 2013-urodynamic report

RUMAH SAKIT IBU & ANAK YPK MANDIRI Jl. Gereja Theresia No.22 Jakarta 10350 Telp. (021)3909725, Fax (021)3903806

Voiding Phase Opening Pdet (cmH20) Pdet. Max (cmH20) (Not Pdet.iso) Pdet. At at peak flow (ml/s) Peak flow/Qmax (ml/s) After contraction (0=no; 1=yes) (Pdet (cmH20)) Volume voided Residual urine (ml) Calculated initial residual urine (ml) Uretral Pressure Profile 1. Rest Profile Evaluation a. Functional Length b. Total Length c. P Closure Max (Pclo.max) 2. Stress Profile Evaluation a. Pclo stress b. Tramission factor c. Stress Test

yes no

Reproducibility of the patients symptom

yes no

RSIA YPK MANDIRI 2013-urodynamic report

RUMAH SAKIT IBU & ANAK YPK MANDIRI Jl. Gereja Theresia No.22 Jakarta 10350 Telp. (021)3909725, Fax (021)3903806

Conculsion(s) ( ) Urodynamic stress incontinence Detrusor overactivity incontinence Urodynamic mixed incontinence Detrusor overactivity Others, explain:

Advice(s) ( ) Anti-muscarinic Pelvic Floor Training Behavioral therapy Surgery Others, explain

Examination objectives ( ) Pre-treatment diagnosis Post-treatment diagnosis Single-visit diagnosis Jakarta,

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RSIA YPK MANDIRI 2013-urodynamic report