Urology & Urogynecology > Education and Reference

CLINICAL APPLICATION NOTES
Introduction to Urodynamics II: Clinical Indications and Preparation
Pediatrics - Children are not small adults!

Urodynamic testing on young children requires:

  1.   A special environment
  2.   Appropriate supplies
  3.   Ability to meet special “social” needs

If you don’t normally do pediatrics, recruit the assistance of staff from a pediatric floor, or office, social services, etc.

Most pediatric urodynamics are done for spina bifida – these children typically undergo urodynamics at birth and at least annually thereafter. They will be an “experienced” patient population. GREAT care needed with latex precautions (all Life-Tech consumables are latex free).

Small children (less than 9-10 years of age) should have a parent in the room and toddlers can be held in a parent’s lap. Explanation, demonstration with dolls, teddy bears, etc. is helpful. Show videos during studies, provide lots of toys.

Spinal Cord Injury

It is IMPERATIVE that clinicians performing studies on quadriplegics with a cervical spine injury at C-6 or above be prepared to recognize and treat Autonomic Dysreflexia.

In summary, the best way to handle patients with infections is a facility/practice based decision. The best references available are the policies and procedures of peer resources and the recommendations made by speakers at Urologic meetings, seminars and conferences.

Symptoms of autonomic dysreflexia include:

  • Rapid, increase in B/P of 20-40 mmHg or greater
  • Pounding headache
  • Heavy sweating (usually above the level of the SCI)
  • Goose bumps (usually above the level of the SCI)
  • Stuffy nose
  • Tightness in the chest
  • Palpitations
  • Dyspnea
  • Anxiety
  • Jitters
  • Blurred or spotty vision

Most urodynamic reference books provide information on the assessment and treatment of autonomic dysreflexia. The Paralyzed Veterans Association has published excellent information and it is readily available on their website…www.pva.org

When doing urodynamics on a patient with potential risk for autonomic dysreflexia:

1. Monitor B/P and pulse continuously through the procedure.
2. Instill 2% xylocaine before catheterization.
3. Use body temperature fluids to fill the bladder.
4. Be prepared to:

    • Empty the bladder immediately if B/P elevating or episode imminent.
    • Raise the patient’s head if not already sitting.
    • Reduce sustained systolic B/P greater than 150mmHg pharmacologically with rapid acting antihypertensive agents, such as Nitropaste 2%, 1” applied to skin above level of SCI
      ~ Or ~
      Nifedipine, immediate release – “bite and swallow”

5. Reverse symptomatic hypotension caused by sudden bladder decompression or meds. To do this:

    • Lower head and raise legs.
    • Administer IV fluids and anit-hypotensives.

6. Monitor the patients at least 2 hours after resolution of the episode.
7. Admit the patient to the hospital if there is poor response to treatment.
8. Document the episode according to recommended guidelines.

Do you remember?
There are no urodynamic emergencies!
When unsure of the safety of the situation, always consider rescheduling

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Sectional References

  1. Schafer W, Abrams P, et al: Good Urodynamic Practices: Uroflowmetry, Filling Cystometry, and Pressure-Flow Studies, 2002 Wiley-Liss, Inc.
  2. Abrams P, et al, The Standardisation of Terminology of Lower Urinary Tract Function: Report from the Standardisation Sub-committee of the International Continence Society, 2002, Wiley-Liss, Inc. Available @ www.continet.org.
  3. Lecture by George Webster, MD (Professor of Urology and Director of Urodynamic Lab @ Duke University, Raleigh, NC) at the Life-Tech Clinical Urodynamics Workshop (1980 – 2006).
    Abrams P, Urodynamics, 2nd edition. Springer-Verlag London Ltd. 1997, p 144.
  4. AbramsP, Urodynamics, 2nd edition. Springer-Verlag London Ltd. 1197, p 144.
  5. Nitti V, Practical Urodynamics. Philadelphia, WB Saunders Company. 1998, pp 244, 256.
  6. Dajani A S, et al. Prevention of Bacterial Endocarditis: Recommendations by the American Heart Association. Circulation. 1997; 96:358-366 Available for download at htttp://circ.ahajournals.org/cgi/content/full/96/1/358#T5.
  7. The American Academy of Orthopaedic Surgeons Bulletin, Volume 48, No. 1, February 2000. Available for download at http://www.aaos.org/wordhtml/bulletin/feb00/fline7.htm
  8. American Academy of Orthopedic Surgeons & American Association of Orthopedic Surgeon Advisory Statement: Antibiotic Prophylaxis for Dental Patients with Total Joint Replacements. Available for download at http://www.aaos.org/wordhtml/papers/advistmt/denta.htm.
  9. MCW & FMLH Antibiotic Guide for Froedtert Hospital: AHA Prophylaxis Guidelines…Available for download at http://www.intmed.mcw.edu/drug/AHAguidelines.html.

Additional Resouces:

  • Ostergard D, Bent A, ed:  Urogynecology and Urodynamics, Theory and Practice.    Baltimore:  Williams & Wilkins, 1989, pp 258-259.
  • Lecture  by Kathy Davis, RN at seminar:  Quest for Excellence in continence Care, Emory University School of Medicine, 1997
  • O’Donnell P, Urinary Incontinence.  St. Louis: Mosby, 1997, Chapter 62, pp 440—441.
  • Lecture by Anne Weber, MD and Pat Clouse, PT , Bladder Training and Behavioral Modification,  at the Cleveland Clinic Foundation:  Advances in Female Voiding Dysfunction and Pelvic Disorders, 3/16/96
  • Karlowicz K, ed:  Urologic Nursing, Principals & Practice.  Philadelphia:   Saunders, 1995, p. 51.
  • Consortium for Spinal Cord Medicine, Acute Management of Autonomic Dysreflexia, Paralyzed Veterans of America, Feb 1997.

GO TO INTRODUCTION TO URODYNAMICS III: URODYNAMIC PROCEDURES >>>

Intro to Urodynamics TOC
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