2nd Seminar Clinical cases in urodynamics. One morning with Paul Abrams

1. 2nd Seminar Clinical cases in urodynamics. One morning with Paul Abrams Presented by: Dr. Jose Emilio Batista Urodynamics cooridator Centro Médico Teknon Barcelona,Spain

2. 45 years old man. Multiple Sclerosis diagnosed 8 years p Urgency incontinence. Daytime urinary frequency : 2-3 hours Nocturia: 1. Detailed clinical hystory

3. Unsatisfactory urination, constant feeling to urinate. Treatment: interferon. No previous urologic complaints. Treated with Solifenacine 5 mg without improvement Detailed clinical hystory

4. Tracing Urodynamic test: Uroflowmetry Voided volume. 195 ml Qmax. 13.7ml/s Post void residual. 71 ml Vol Qura

5. Tracing Urodynamics: Cystometry Pabd Pves Pdet

6. Infused Vol P ves P det Cysto cap. 140 ml 33 cmH2O 40 cmH2O Urodynamics: Cystometry

7. Comment: Bladder with diminished capacity. Low compliance. Un-inhibited detrusor contractions High detrusor leak poing pressure > 40 cm H2O. Filling phase dysfunction. Urodynamic test:Cystometry

8. Tracing Urodynamics: Pressure/Flow Study Pabd Pves Pdet Vol Qura

9. P/Q Plot

10. Voiding phase results Qmax 10.7 ml/s Pdet at Qmax 51 cmH2O Voided volume 56 ml Post voided residual 80 ml Urodynamic test:Pressure/Flow Study

11. Comment Low Qmax (10.7 ml/s). Post voided residual: 80 ml. Micturition by detrusor contraction. Interrupted flow, probably dyssynergia. Urodynamic test:Pressure/Flow Study

12. Filling phase: Neurogenic overactive detrusor with a high point pressure leakage. Voiding phase: No obstruction. Contractile detrusor; post voided residual probably because of dyssynergia. Therapeutic approach

13. Anticholinergic treatment (10mg /d solifenacine vs 40mg Trospium chloride 12h). If post voided residual is confirmed, we indicate intermittent self-catheterism after urination. We recommend annual urodynamics and ultrasound tests. Recommendations