Ambulatory Urodynamics

Conventional or laboratory urodynamic studies are unphysiologic and conducted under unfavorable conditions for the patient and for a brief duration of time. Conventional studies typically involve artificial bladder filling with a specified liquid at a specific rate. Ambulatory uro-dynamics were developed to measure lower urinary tract function under more physiologic conditions (utilizing natural filling and during the subject's everyday activities), and to improve the sensitivity and accuracy of the urody-namic diagnosis. Ambulatory urodynamics systems have three main components: transducers, a recording unit, and an analyzing system. The transducers measure the pressures. The recording system is portable and battery powered, and the information collected is downloaded onto a personal computer for analysis. Two techniques are used to detect urine leakage: electrical conduction or temperature change. The urine loss sensors on the transducer catheter detect leakage, and the patient uses an events marker and voiding diary to record their activities so that leakage episodes can be correlated with physical activities. Comparative studies of office and ambulatory urodynamic techniques have indicated that continuous monitoring during activity significantly increases the diagnosis of detrusor instability.26,27 Ambulatory urodynamics also shows lower pressure increases during filling and increased amplitude of voiding pressures.28,29 Ambulatory urody-namics is time consuming, and it requires considerable interpretative skill. Its use is limited because there are no standardized parameters for normal or abnormal voiding.

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