Simple Cystometry and Uroflowmetry

To objectively confirm a diagnosis, simple cystometry and uroflowmetry can be performed in most gynecology offices. The patient begins the testing with a full bladder. She voids in the most natural way possible, and the voiding time and volume are documented. She should be asked if this represents a typical void. If she indicates it was not, the test should be repeated.

The patient is then placed in the lithotomy position, a sterile preparation is performed, and a catheterized postvoid residual (PVR) is obtained. We consider a PVR of more than 100 mL to be abnormal, but it should be kept in mind that standardized normal values have not been established and a "normal" PVR in elderly individuals could be more than 100 mL. A large syringe is then attached to the catheter and the patient is asked to sit up or stand. The bladder is slowly filled with sterile water. Care must be taken not to fill the bladder too quickly or with cold water because these cause artifactual detrusor contractions even in normal women. A typical filling rate is 50 to 70 mL/min. Initial filling sensation, normal desire (when the patient would first consider voiding), and maximum cystometric capacity is recorded. Normal bladder capacity is 400 to 650 mL although asymptomatic women are not infrequently outside this range. The water level in the syringe should be closely monitored. A bladder contraction will cause the level to increase and may induce urgency and leakage. At capacity the catheter is removed, and provocative maneuvers, such as coughing, heel-bouncing, or running water are done to induce an incontinence episode. Communication throughout testing is important to determine whether the patient's symptoms are replicated, especially during a urine-loss event.

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