Bladder and UDS

UDS s/o obstructive pattern . so proceed for TURP.

In a patient with a functionally normal neobladder, typical urodynamic findings

during voiding are:
A. Pabd t , Pves .t , Purethra T .
6. Pabd 1, Pves T , Purethra 1.
C. Pabd *, Pves 1, Purethra 1.
D. Pabd ++Pv,e s f , Purethra T .
E. Pabd ++P, ves , Purethra 1 .
++

After orthotopic urinary reconstruction, patients may develop new voiding

difficulties or
incontinence,and a urodynamic evaluation is appropriate to evaluate storage
function and
bladder outlet. Micturition following orthotopic neobladder diversion i s
accomplished
 through abdominal straining. On a urodynamic study, this would be indicated by
increased
abdominal and vesical pressure accompanied by a relaxation of the external
urinary
sphincter and a decrease in urethral pressure

An eight-year-old boy with prior ileocystoplasty reports catheterizing six times daily.
Ultrasound shows new onset of bilateral moderate hydroureteronephrosis.
Videourodynamics demonstrate detrusor pressures of 10 cm Hz0 at 300 mL and 40
cm H20 at 575 mL without VUR or detrusor overactivity. The next step is:
A. increase catheterization frequency.
B. placement of an indwelling catheter.
C. diuretic nuclear renal scan.
D. antimuscarinics.
E. bilateral percutaneous nephrostomy tubes.

ANSWER=B

A. Increasing the frequency of catheterization does not address the concern of

poor adherence to a catheterization schedule.

B. In this patient, the most common reason for development of bilateral

hydronephrosisafter successful ileocystoplasty is poor compliance with his
catheterization schedule or technique.

With poor catheterization compliance or technique, placement of an indwelling

catheter, with subsequent renal ultrasound after a week or two, should
demonstrate improved hydronephrosis.

It will also permit easier determination of 24-hour urine volume if high urine
output is expected.

C. If hydronephrosis persists, the next step may be to do DMSA

D. The urodynamic study demonstrates good bladder capacity and compliance

for his age, and there should be no need to begin anticholinergics.

An 80-year-old man with severe coronary artery disease has bothersome nocturia.
DRE reveals a large, smooth prostate. Urinalysis is normal and PVR is 140 mL. The next
step is:
A. observation.
B. voiding diary.
C. serum PSA.
D. oxybutynin.
E. initiate desmopressin

ANSWER=B

A.Given that the symptoms are bothersome, observation is not

appropriate.

There are several therapies that are non-invasive and safe even in an
elderly man with significant comorbidities.

B. When the predominant urinary symptom is nocturia, AUA

Guidelineson BPH recommend that a voiding diary (frequency-
volume chart) be completed. /

One should consider that nocturia may represent nocturnal polyuria

or nocturnal frequency, with two different treatment pathways.

One pathway would be to reduce fluid consumption in the

evening, but it is premature to recommend that without first
performing a voiding diary.

C. Serum PSA is part of the guideline-recommended evaluation of

LUTS, but is not indicated when life expectancy is less than ten years.

D. Desmopressin and oxybutynin should not be instituted without

first performing a voiding diary.

E. In addition, oxybutynin would be a suboptimal choice in a patient

of this age and with an elevated PVR

A 63-year-old man has persistent urinary retention and fails a voiding trial four days
after artificial urinary sphincter implantation. The 4 cm cuff is confirmed to be
deactivated. The next step is:
A. CIC.
B. replace 10 Fr urethral catheter.
C. suprapubic tube.
D. cystoscopy.
E. surgical revi

In the immediate postoperative period, retention should be managed

by placement of a small, transurethral (10 or 12 Fr) catheter for 24 to
48 hours.

At four days after surgery, this patient should no longer continue to

have a urethral catheter or be performing CIC immediately after cuff
placement.

Cuff deactivation should be done at the time of the

initial surgery and also confirmed to be deactivated if catheter
placement is necessary.

If the patient fails a voiding trial a t 48 hours, suprapubic tube

placement under ultrasound or fluoroscopic guidance is
recommendedto reducethe risk for urethral erosion associated
with prolonged urethral catheter drainage.

Retention that persists beyond several weeks implies that the cuff
may be too small and, in such cases, re-operation and cuff upsizing
may be required.

Late-onset urinary retention necessitates cystoscopy and

urodynamicsto rule-out proximal urethral obstruction, cuff erosion,
or detrusor failure.