Bladder function [Neurosurgery Wiki]

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====== Bladder function ======

===== Evaluation =====

==== Urodynamics (UDS) ====

Usually combined with X-ray (cystometrogram (CMG)) or fluoro (video urodynamics). Measures intravesicular pressures during retrograde [[bladder]] filling through a urethral catheter, usually combined with [[sphincter electromyography]]. Assesses intravesical pressures during filling and voiding. Objectively assesses detrusor muscle at the time of sensation to void. Most importantly, assesses bladder compliance, bladder storage pressures and risk for long term upper tract deterioration. Bladder pressures: < 40 cm H20 is the cut off for safe storage pressures
((McGuire EJ, Woodside JR, Borden TA, et al. Prognostic value of urodynamic testing in myelodysplastic patients. J Urol. 1981; 126:205–209)).
If bladder pressure > 40 cm H20 during the storage of urine, there is a high risk of progressive CKD. Routine UDS can help ensure the safe management of a neurogenic bladder. UDS can also be used in the neurologically intact patient to determine if urinary retention is secondary to obstruction versus bladder areflexia
((Nitti VW. Pressure flow urodynamic studies: the gold standard for diagnosing bladder outlet obstruction. Rev Urol. 2005; 7 Suppl 6:S14–S21)).

==== Voiding cystourethrogram and intravenous pyelography (IVP) ====

Voiding cystourethrogram (VCUG) detects urethral pathology (diverticula, strictures...), abnormalities of the bladder (diverticula, detrusor trabeculations associated with longstanding contractions against high resistance...), and vesical-ureteral reflux. VCUG can be performed at the time of UDS (video urodynamics).

==== Urologic follow-up ====

Routine follow-up is needed to ensure bladder pressures < 40 cm H2O, and subsequently for periodic renal imaging and monitoring of serum creatinine.

Changes in voiding symptoms should trigger prompt reevaluation.

NB: patient with indwelling catheters (Foley, suprapubic tube...) or intermittent catheterization will have colonization of their urine. Treatment for positive urine cultures is only indicated when related symptoms develoop or when undergoing instrumentation.