Urodynamics and the Evaluation of Female Incontinence

1. Front Matter

   Pages i-x

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2. Routine Office Evaluation

   1. Front Matter

      Pages 1-1

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   2. The Female Urologic History

      • Peter K. Sand, Donald R. Ostergard

      Pages 3-4

   3. Voiding Diaries

      • Peter K. Sand, Donald R. Ostergard

      Pages 5-5

   4. Uroflowmetry in the Female

      • Peter K. Sand, Donald R. Ostergard

      Pages 6-10

   5. The Lumbosacral Neurologic Examination

      • Peter K. Sand, Donald R. Ostergard

      Pages 11-13

   6. The Gynecologic Pelvic Examination

      • Peter K. Sand, Donald R. Ostergard

      Pages 14-15

   7. The Q-tip Test

      • Peter K. Sand, Donald R. Ostergard

      Pages 16-17

   8. Urethral Calibration

      • Peter K. Sand, Donald R. Ostergard

      Pages 18-18

   9. Stress Testing

      • Peter K. Sand, Donald R. Ostergard

      Pages 19-19

   10. Pad Testing

       • Peter K. Sand, Donald R. Ostergard

       Pages 20-23

3. Cystourethroscopy and Cystometry

   1. Front Matter

      Pages 25-25

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   2. Dynamic Urethroscopy

      • Peter K. Sand, Donald R. Ostergard

      Pages 27-28

   3. Supine Urethroscopic Cystometry

      • Peter K. Sand, Donald R. Ostergard

      Pages 29-30

   4. Cystoscopy

      • Peter K. Sand, Donald R. Ostergard

      Pages 31-31

   5. Standing Single Channel Cystometry

      • Peter K. Sand, Donald R. Ostergard

      Pages 32-34

4. Multichannel Urodynamics: Normal Studies

   1. Front Matter

      Pages 35-35

      PDF

   2. Who Needs Urodynamics?

      • Peter K. Sand, Donald R. Ostergard

      Pages 37-38

   3. Urethral Closure Pressure Profiles

      • Peter K. Sand, Donald R. Ostergard

      Pages 39-42

   4. Augmenting Urethral Closure Pressure Profiles

      • Peter K. Sand, Donald R. Ostergard

      Pages 44-45

Urodynamic evaluation of the incontinent female has come of age. It is no longer accept­ able to subject women to surgical procedures for urinary incontinence based solely on the physician's clinical impression of the cause of the urine loss. Multiple studies in the uro­ gynecological literature have told us that the error rate for stress incontinence is about 25% and the error rate for the unstable bladder is 50% when these diagnoses are based solely on historical data obtained from the patient. Unfortunately the patient is a poor witness to her bladder's activities and diagnoses arrived at without further evaluation are subject to error. Urodynamic testing allows the establishment of precise diagnoses using procedures that have been proven to be accurate. For the physician who has not had the opportunity to have fellowship training, the uro­ dynamic tracing is sometimes more of a mystery than a diagnostic aid. Physician training in the reading of urodynamic tracings is limited to piecing together information from the literature, textbooks and postgraduate courses. Unfortunately none of these sources can provide the experience necessary to become an expert in the interpretation of the physio­ logical and pathophysiological events depicted on the tracing. Artifacts occur commonly and may lead to misinterpretation of these events and even misdiagnosis if the reader of the tracing is not careful and fully informed on the nuances of the testing procedures. This is why this text was conceived as an atlas of urodynamic testing procedures.

• Female Incontinence
• age
• care
• diagnosis
• dynamics
• evaluation
• incontinence
• lead
• patients
• pelvic floor
• stress
• training
• treatment
• urinary incontinence
• women

• Division of Urogynecology, Evanston Continence Center, Evanston Hospital, Northwestern University Medical School, Evanston, USA

  Peter K. Sand

• Division of Urogynecology, Long Beach Memorial Hospital, University of California at Irvine, Long Beach, USA

  Donald R. Ostergard

Policies and ethics