Betsy Omeis, RN, BSN
Assessment ?History
?Bladder Record (Bladder diary)?General Physical Exam
?Abdominal Examination
?Genitalia
?Anorectal Examination
?Neurological Examination
History
?Do you leak when:–sneeze, cough, laugh –get up from a chair ?Do you leak when:–strong urge –running water ?How many times do you urinate:
–daytime
–once asleep ?Do you feel you are not finished?–strain ?Do you wear pads?–how many –what types ?Medications ?Surgeries ?Previous treatments ?Bowels
Female Anatomy
Rectal Exam
Sample Voiding Diary
Urological Testing
?Urinalysis
?Postvoid Residual Urine Volume ?Pad Test
?Cough Test
?Uroflow
?Urodynamics
?Cystoscopy
?Ano-rectal Physiology
Urinalysis
?Microorganisms,
RBC, glucose,
specific gravity
?clean mid-stream
?Urine Culture &
Sensitivity when
symptomatic
?Catheterize for C&S
?>100,000 bacteria-
UTI
Post-Void Residual Urine ?Amount of fluid remaining in bladder immediately following urination
?<10% or <100cc
?Performed by:
–Abdominal Palpation
–Catheterization
–Pelvic Ultrasound
–Radiographic imaging
Catheterizing a Female
Foley Catheter
?urinary retention
?urethral obstruction
?14-18 fr size catheter
?5cc balloon
?drainage bag
?irritation, urgency
?urosepsis
?erosions
?stones
30cc Balloon vs 5cc balloon
Drainage bags
Cough Stress Test Pad Test
Why do we need to test?
?Q Tip Test
–Test for mobility
–>30 degree
–zylocaine jelly Simple Tests
?
Q Tip Test
–Test for mobility
–>30 degree
?Simple CMG
–Urethral catheter
–Manometer or
–Toomey Syringe Simple Tests
Urodynamics
?A series of diagnostic studies used to evaluate a patient’s ability to store and eliminate urine.
?The goal is to reproduce bladder filling/storage and voiding/emptying symptoms to identify underlying causes
Uroflowmetry ?Measures how much
and how fast the urine
comes out
?Provides a pattern
?Measure the PVR
?prep-full bladder
Normal Flow
Explosive Flow
Low Flow Intermittent Flow
Urodynamic Machine
Urethral and Rectal Catheters Complex Urodynamics
Normal Study
Cystoscopy
?Diagnose urinary tract
disorders
?Provide direct view of
urethra and bladder
?Flexible instrument
?Needs water to fill
?Local anesthetic Cystoscopy of Female Urethra
Cystoscopy of Bladder Neck
Cystoscopy
Glomerulations
Trabeculated Bladder
Voiding Cystourethrogram
Exams of the Urinary System
?Non fluoroscopic
?Antegrade studies
–intravenous pyelogram
(IVP)
–contrast media
?iodine compound
injected into
bloodstream
–Timed set of
exposures
Ano-rectal Physiology Tests
?Ano-rectal Manometry
?Pudendal Nerve Latency Test ?Endorectal Ultrasonography ?Defecotography
?Prep-enemas x2 one hour prior
Anorectal manometry
?Measures resting
tone of the internal
sphincter
?measures contractility
of external sphincter
?Measures functional
length of the anal
canal
Anorectal Manometry
Tracings
Pudendal Nerve Latency Test ?Assess nerve
innervation of
external sphincter
?How fast does the
muscle (motor unit)
react to electrical
stimulation
Defecotography
?Fluoroscopic
examination of
changes that occur in
the pelvic floor during
defecation
Rectal Ultrasound ?Assess pelvic floor
function
?assess the internal
and external sphincter
?look for any defects