Urodynamic Study

Download Instructions

Urodynamics is a series of tests that assess the function of your bladder and urethra. This test will help your provider evaluate any problems you may be having and determine the best treatment approach for you.

Common reasons to have a urodynamic study include:

.Urine incontinence (leaking of urine)

.Incomplete bladder emptying

.Urine frequency and/or urgency

.Weak or intermittent urine stream

.Persistent urinary tract infections

.Bladder prolapse (Cystocele)

.Assess bladder function prior to GYN surgery

What to expect

The urodynamic study takes about 30-45 minutes to complete. Please arrive with a FULL bladder. There are no restrictions on food or fluid intake prior to the appointment. You will be brought back to our procedure room, and asked to empty your bladder on a special chair in the room. Next, a small catheter will be inserted into your bladder, and any remaining urine will be drained from the bladder. Another small catheter will be placed in the vagina. Three small electrodes/sticky patches will be placed on the buttocks.

We will slowly fill your bladder with saline. We will ask you to tell us when you feel 3 sensations of fullness: a weak urge to urinate, a normal urge to urinate and a strong urge to urinate. We will also check for any urine leakage once the bladder is full by asking you to “cough” and “bear down.” Do not be afraid to leak urine – this is a normal and expected part of the test. After filling the bladder to capacity, we will take some pressure measurements of the urethra by slightly moving the catheter. Lastly, you will empty your bladder again on the special chair. Then, all catheters and patches will be removed, and the test is complete.

Urodynamic testing is an easy and painless procedure, and there is no restriction on activity following the study.

How to prepare:

.Take all regularly scheduled medications

.If you take medications for overactive bladder, such as Enablex, Detrol, Sanctura, Vesicare, Oxytrol, etc., ask your provider if you should take these prior to the urodynamic study.

.Bring your completed questionnaire and voiding diary

.Arrive with a comfortably FULL bladder

Voiding Diary

Name __________________________________________ Date of Birth _________________

Directions:

.Please complete as accurately as possible for 3 consecutive days (day & night)

.Record the time and amount of fluid that you consume during the day. Also, indicate the type of fluid (ie. Coffee, soda, water, etc.).

.Record each time you void and include an estimate of the amount voided (Small/Moderate/Large)

.If you experience urine leaking, mark the time this occurred, estimate the amount of leakage (Small/Moderate/Large) and note the activity you were engaged in at the time of leakage (ie. Running, coughing, laughing).

.Bring the completed diary with you to your next appointment or fax to our office

Day #1

TIME

FLUID INTAKE

VOIDED AMOUNT

LEAK

ACTIVTY DURING

 

(Type and

(S/M/L)

(S/M/L)

LEAK

 

Amount)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Day #2

TIME

FLUID INTAKE

VOIDED AMOUNT

LEAK

ACTIVTY DURING

 

(Type and

(S/M/L)

(S/M/L)

LEAK

 

Amount)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Day #3

TIME

FLUID INTAKE

VOIDED AMOUNT

LEAK

ACTIVTY DURING

 

(Type and

(S/M/L)

(S/M/L)

LEAK

 

Amount)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Urodynamic Questionnaire

Name ___________________________________ Age ______ Date of Birth _____________

Height __________

Weight _________

Age of Menopause _________

# Pregnancies ________

# Vaginal Births ________

# C-Sections __________

What is your most bothersome problem associated with your bladder function?

______________________________________________________________________________

______________________________________________________________________________

How often do you void during the

Every 4

Every 3

Every 2

Hourly

day?

hours

hours

hours

 

How often do you have to get up

0-1

1-2

2-3

>4

in the night to void?

 

 

 

 

How often do you leak urine?

Never

Monthly

Weekly

Daily

 

 

 

 

 

Please rate the following questions in each category according to degree of severity from 0 (Not a problem) to 3 (Severe problem).

 

0 or Not a

1 or Slight

2 or

3 or Severe

 

Moderate

 

Problem

Problem

Problem

 

Problem

 

 

 

 

Do you have accidental loss of

 

 

 

 

urine?

 

 

 

 

Do you use pads to absorb urine

 

 

 

 

during the day?

 

 

 

 

Does the sound, sight or feel of

 

 

 

 

running water cause you to leak

 

 

 

 

urine?

 

 

 

 

Does a sudden urge to void cause

 

 

 

 

you to leak urine?

 

 

 

 

Do you leak urine before you can

 

 

 

 

get to the toilet?

 

 

 

 

Does coughing, sneezing or

 

 

 

 

laughing cause you to leak urine?

 

 

 

 

Does running, jumping or

 

 

 

 

changes in posture cause you to

 

 

 

 

leak urine?

 

 

 

 

 

0 or Not a

1 or Slight

2 or

3 or Severe

 

Moderate

 

Problem

Problem

Problem

 

Problem

 

 

 

 

Do you lose urine during

 

 

 

 

intercourse?

 

 

 

 

To what extent has your sex life

 

 

 

 

been affected by your

 

 

 

 

symptoms?

 

 

 

 

Do you leak urine when you are

 

 

 

 

sleeping?

 

 

 

 

Do you change your outer

 

 

 

 

clothing during the day because

 

 

 

 

of leakage?

 

 

 

 

Do you cut down on fluid intake

 

 

 

 

during the day to reduce

 

 

 

 

symptoms of urine leaking?

 

 

 

 

Do you leak urine for no apparent

 

 

 

 

reason? (Leaking isn’t associated

 

 

 

 

with an urge to void, coughing,

 

 

 

 

sneezing, posture change, etc.)

 

 

 

 

Does urine leaking interfere with

 

 

 

 

your ability to complete

 

 

 

 

household chores?

 

 

 

 

Does urine leaking interfere with

 

 

 

 

physical recreation?

 

 

 

 

Does urine leaking interfere with

 

 

 

 

your ability to enjoy leisure

 

 

 

 

activities?

 

 

 

 

Does urine leaking interfere with

 

 

 

 

your ability to travel be car of bus

 

 

 

 

for >30 minutes?

 

 

 

 

Does urine leaking interfere with

 

 

 

 

your ability to participate in social

 

 

 

 

activities outside your home?

 

 

 

 

Has urine leaking affected your

 

 

 

 

emotional health (anxiety,

 

 

 

 

depression, etc.)?

 

 

 

 

 

0 or Not a

1 or Slight

2 or

3 or Severe

 

Moderate

 

Problem

Problem

Problem

 

Problem

 

 

 

 

Do you notice dribbling of urine

 

 

 

 

after standing up from voiding?

 

 

 

 

Do you have difficulty starting

 

 

 

 

your urine stream?

 

 

 

 

Do you have to strain to urinate?

 

 

 

 

 

 

 

 

 

Do you often feel that your

 

 

 

 

bladder is NOT empty after

 

 

 

 

voiding?

 

 

 

 

Do you have any pain or

 

 

 

 

discomfort in your lower

 

 

 

 

abdomen or genital region?

 

 

 

 

Do you feel or see a bulging or

 

 

 

 

protrusion in the vaginal area?

 

 

 

 

Do you ever pass stool when you

 

 

 

 

think it is just gas?

 

 

 

 

Are you ever constipated?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

0 or Not a

1 or Slight

2 or

3 or Severe

 

Moderate

 

Problem

Problem

Problem

 

Problem

 

 

 

 

Do you have pain or discomfort in

 

 

 

 

your bladder?

 

 

 

 

Do you often feel that you have

 

 

 

 

Urinary Tract Infections, but no

 

 

 

 

infection is found on exam?

 

 

 

 

Have you taken medication for you bladder problems before?________ If yes, what medications have you tried?:______________________________________________________

______________________________________________________________________________

Have you had surgery for your bladder problems before? ________ If yes, what type of procedure and when?:

______________________________________________________________________________

______________________________________________________________________________

Phone: (404)352-2850     Fax: (404)352-0947
105 Collier Road, Suite 1080, Atlanta, GA 30309
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