Ambulatory urodynamics monitoring - a video demonstration.

AIMS

To present a narrated video designed to demonstrate the steps involved in performing and interpreting ambulatory urodynamics monitoring (AUM).

METHODS

This video provides an overview of the role of AUM in clinical practice and describes the process of performing AUM using solid state microtip transducers and the MMS / Laborie Luna ambulatory recorder. Line placement, calibration and the urodynamic protocol are discussed along with descriptions of provocation tests that can be used during AUM. Examples of AUM traces are reviewed demonstrating common findings eg detrusor overactivity, urodynamic stress incontinence and voiding difficulties. Good urodynamic practice in relation to the interpretation of AUM is presented. Its application in clinical practice is often limited due to the cost of equipment (particularly the microtip transducers which range from £1200-£2500) and appropriate decontamination of the transducers (in this unit an anti-sporacidal 3 stage wipe system is employed (Tristel) however, many hospital infection control teams do not consider this sufficient so disposable water or air filled lines are used). Other limitations include the requirement for additional training and the time necessary to perform the test.

RESULTS

This video will educate and inform health care professionals regarding AUM so that they may consider its use in their armamentarium of investigations of lower urinary tract function and be able to counsel patients appropriately should they choose to refer them to an alternative provider for further investigation if they do not have direct access in their service.

CONCLUSION

AUM is a second line investigation of lower urinary tract dysfunction used in patients where conventional urodynamics have failed to make a diagnosis or replicate their symptoms. They allow for a more physiological assessment of bladder function. Protocols may vary from 1 h to 24 h but are dependent on re-creation of patient's symptoms.