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Neurourology and Urodynamics 21:261^274 (2002)

Good Urodynamic Practices: Uro£owmetry, FillingCystometry, and Pressure-Flow Studies

Werner Sch!fer,* Paul Abrams, Limin Liao, Anders Mattiasson, Francesco Pesce,Anders Spangberg, Arthur M. Sterling, Norman R. Zinner,

and Philip van KerrebroeckInternational Continence Society O⁄ce, Southme Hospital, Bristol, BSIO 5NB,

United Kingdom

This is the ¢rst report of the International Continence Society (ICS) on the development of com-prehensive guidelines for Good Urodynamic Practice for the measurement, quality control, anddocumentation of urodynamic investigations in both clinical and research environments. Thisreport focuses on the most common urodynamics examinations; uro£owmetry, pressure recordingduring ¢lling cystometry, and combined pressure^£ow studies. The basic aspects of good uro-dynamic practice are discussed and a strategy for urodynamic measurement, equipment set-up andcon¢guration, signal testing, plausibility controls, pattern recognition, and artifact correction areproposed. The problems of data analysis are mentioned only when they are relevant in the judgmentof data quality. In general, recommendations are made for one speci¢c technique. This does notimply that this technique is the only one possible. Rather, it means that this technique is well-estab-lished, and gives good results when used with the suggested standards of good urodynamic practice.Neurourol.Urodynam.21:261^274,2002. ! 2002Wiley-Liss, Inc.

Key words: urodynamics; standardisation; uro£owmetry; cystometry; pressure-£ow studies

INTRODUCTION

A Good Urodynamic Practice comprises three mainelements:

^ A clear indication for and appropriate selection of,relevant test measurements and procedures

^ Precise measurement with data quality control andcomplete documentation

^ Accurate analysis and critical reporting of results

The aim of clinical urodynamics is to reproduce symptomswhilst making precise measurements in order to identifythe underlying causes for the symptoms, and to quantify therelated pathophysiological processes. By doing so, it should bepossible to establish objectively the presence of a dysfunctionand understand its clinical implications. Thus, we may eithercon¢rm a diagnosis or give a new, speci¢cally urodynamic,diagnosis. The quantitative measurement may be supple-mented by imaging (videourodynamics).

Urodynamic measurements cannot yet be completely auto-mated, except for the most simple urodynamic procedure,uro£owmetry.This is not an inherent problem of the measure-ment itself, but is due to the current limitations of urodynamicequipment and the lack of a consensus on the precise methodof measurement, signal processing, quanti¢cation, documen-tation, and interpretation. With the publication of this ICSStandardisation document on good urodynamic practice, it

is expected that the necessary technological developments inautomation will follow.Urodynamics allows direct assessment of lower urinary

tract (LUT) function by the measurement of relevant physio-logical parameters. The ¢rst step is to formulate the ‘urody-namic question or questions’ from a careful history, physicalexamination, and standard urological investigations. Thepatient’s recordings of micturitions and symptoms on a fre-quency volume chart, and repeated free uro£owmetry withdetermination of post-void residual volume provide important

Urodynamic techniques were performed according to the ‘Good Urody-namic Practice’ recommended by the International Continence Society.

This report is from the Standardization Committee of the InternationalContinence Society.

*Correspondence to: Werner Sch!fer, International Continence SocietyO⁄ce, SouthmeHospital, Bristol, BSIO 5NB,United Kingdom.E-mail: Vicky@icso⁄ce.org.

DOI 10.1002/nau.10066

Published online inWiley InterScience (www.interscience.wiley.com).

! 2002Wiley-Liss, Inc.

INTRODUCTION

Cet article présente la traduction française de la terminologie adop-tée par l’International Continence Society (ICS) en 2002 [1]. Lesdéfinitions proposées sont en accord avec les termes utilisés dans laclassification internationale des maladies (ICD 10). Les anciennesdéfinitions ont été revues et corrigées le cas échéant. Ce documentest donc une mise à jour des rapports plus anciens [2-17].

Les termes originaux anglais ont été indiqués en italique à coté dechaque terme traduit en français. Des notes explicatives proposéespar les auteurs sont indiquées en Italique dans le texte entre cro-chets.

Cette validation linguistique est faite au nom de l’Association Fran-çaise d’Urologie (AFU) et de la Société Internationale Francopho-ne d’Urodynamique (SIFUD).

Les articles soumis pour publication en langue française devrontfaire référence à cette nomenclature et devront indiquer dans le cha-pitre “Patients et méthodes” que “Toutes les définitions cliniques eturodynamiques sont conformes avec la validation fançaise de la ter-minologie de l’International Continence Society”

Symptômes du bas appareil urinaire (lower urinary tract symp-toms LUTS)

Les Symptômes sont des indicateurs subjectifs directement perçuspar le patient, faisant évoquer une maladie ou un état pathologiqueet le conduisant à rechercher une prise en charge médicale

Les symptômes peuvent être exprimés spontanément par le patientou bien être suggérés par l’interrogatoire réalisé par le médecin oule professionnel de santé. Leurs analyse est en général d’ordre qua-litatif. Le plus souvent l’analyse des symptômes seuls ne permetpas de porter un diagnostic de certitude.

Signes évocateurs d’une dysfonction du bas appareil urinaire(Signs suggestive of lower urinary tract dysfunction LUTD)

Les signes sont des observations faites par le médecin ou le profes-sionnel de santé qui peuvent permettre de confirmer un symptômeet éventuellement de le quantifier comme par exemple, l’observa-tion d’une fuite lors d’un effort de toux. Un signe a une traductionphysique objective alors que le symptôme est une description par lemalade. Les informations déduites de l’étude du calendrier mic-tionnel, des tests d’incontinence ou des questionnaires validés(symptômes ou qualité de vie) sont également une manière de véri-fier et quantifier des symptômes décrits par le patient.

Observations urodynamiques

Les observations urodynamiques sont les constatations faites aucours d’une examen urodynamique. Par exemple la survenue d’unecontraction involontaire du détrusor (hyperactivité détrusorienne)est une constatation urodynamique. En général, une même consta-tation urodynamique peut avoir plusieurs causes possibles et n’estpas pathognomonique d’une maladie ou d’un état pathologique spé-cifique.

Etat pathologique (Condition)

Un état pathologique est défini par l’association de symptômes, designes et d’observations urodynamiques, définissant alors une enti-té caractéristique.

SYMPTOMES DU BAS APPAREIL URINAIRE

Les symptômes du bas appareil urinaire sont définis à partir desexplications fournies par le patient soit spontanément soit sollici-tées à partir des questions qui lui sont posées par un professionnelde santé.

Les symptômes peuvent être classés en trois catégories : phase deremplissage, miction, post miction.

[Note des auteurs : le terme de “phase de remplissage vésical” aété choisi par commodité chronologique (par référence au cyclemictionnel, remplissage-miction). Mais ce terme ne sous entend pasforcément un mécanisme physiopathologique univoque. En effet, lescauses vésicales ne résument pas les étiologies de ces symptômes(urgences urinaires, pollakiurie, etc …) puisque des causes autres(urétrales, psychogènes, etc …) peuvent être retrouvées].

Les symptômes de la phase de remplissage (Storage symptoms)

Ce sont les symptômes ressentis pendant la phase de remplissage dela vessie sans distinction entre le jour et la nuit.

- Pollakiurie diurne (Increased daytime frequency) : augmentationde la fréquence mictionnelle pendant la journée

! RECOMMANDATIONS Progrès en Urologie (2004), 14, 1103-1111

Terminologie des troubles fonctionnels du bas appareil urinaire : adaptationfrançaise de la terminologie de l’International Continence Society

François HAAB (1), Gérard AMARENCO (2), Patrick COLOBY (3), Philippe GRISE (4), Bernard JACQUETIN (5),Jean-Jacques LABAT (6), Emmanuel CHARTIER-KASTLER (7), François RICHARD (7)

(1) Service d’Urologie, Hôpital Tenon, Paris, France, (2) Service de Rééducation neurologique et d’explorations périnéales, Hôpital Rotschild, Paris, France,

(3) Service d’Urologie, Centre Hospitalier René Dubos, Pontoise, France, (4) Service d’Urologie, Hôpital Charles Nicolle, Rouen, France,(5) Service de Gynécologie Obstétrique, Hôtel-Dieu, Clermont-Ferrand, France,

(6) Médecine Physique, Clinique Urologique, Hôtel-Dieu, Nantes, France, (7) Service d’Urologie, Hôpital de la Pitié, Paris, France

1103

Manuscrit reçu : octobre 2004, accepté : octobre 2004

Adresse pour correspondance : Pr. F. Haab, Service d’Urologie, Hôpital Tenon, 4, rue dela Chine, 75020 Paris.

e-mail : francois.haab@tnn.ap-hop-paris.fr

Ref : HAAB F., AMARENCO G., COLOBY P., GRISE P., JACQUETIN B., LABAT J.J.,CHARTIER-KASTLER E., RICHARD F., Prog. Urol., 2004, 14, 1103-1111

Neurourology and Urodynamics 21:258^260 (2002)

Standardisation of Urethral Pressure Measurement: Reportfrom the Standardisation Sub-Committee of the

International Continence Society

Gunnar Lose,1 Derek Gri⁄ths,2 Gordon Hosker,3 Sigurd Kulseng-Hanssen,4Daniele Perucchini,5 Werner Sch!fer,6 Peter Thind,7 and EbooVersi8

1Department of Obstetrics and Gynecology, Glostrup County Hospital, University of Copenhagen, Denmark2Division of Geriatric Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania

3Department of Obstetrics and Gynecology, St. Mary’s Hospital, Manchester, United Kingdom4Department of Obstetrics and Gynecology, Baerum Hospital, Baerum, Norway

5Universit!ts Spital, Zˇrich, Switzerland6Urodynamic Lab, Urology Klinik der RWTH, Aachen, Germany

7Department of Urology, Rigshospi talet, University of Copenhagen, Denmark8Global Medical A¡airs, Pharmacia Upjohn, New Jersey

INTRODUCTION

Urethral pressure measurements are used to assess urethralclosure and voiding function. The lack of general agreementon an explicit de¢nition of urethral pressure and standardi-sation of the methodology for measurement has limited theutility of urethral pressure measurements. This report de¢nesurethral pressure and recommends standards for measure-ment methodology to facilitate communication betweeninvestigators and to improve the quality of clinical practiceand research. The document can be integrated with earlierreports of the International Continence Society (ICS) Com-mittee on Standardisation with special reference to the col-lated 2002 report [Abrams et al., 2002] and the ICSrecommendations on good urodynamic practice [manuscriptin preparation].

DEFINITION OF URETHRAL PRESSURE

Urethral pressure is de¢ned as the £uid pressure neededto just open a closed (collapsed) urethra [Gri⁄ths, 1985].This de¢nition suggests that the urethral pressure is similarto an ordinary £uid pressure, i.e., is a scalar (does not havea direction) quantity with a single value at each point alongthe length of the urethra.

The concept of urethral pressure is only useful if theurethra collapses easily at attainable pressures to zerocross-sectional area, as is normally the case.The use of a cathe-ter introduces a non-zero cross-sectional area (given by theprobe) and changes the natural shape of the lumen. The e¡ecton the measured urethral pressure is small for highly disten-sible/collapsible tubes [Gri⁄ths, 1985].

Microtip or ¢ber-optic catheters do not measure the ure-thral pressure directly; they measure the normal stress com-ponent on the surface of the transducer. This stress is due tothe interaction between the urethral tissue and the transducersurface. It depends in part on the sti¡ness of the catheter andthe form of the probe. It may cause directional variations inthe measured ‘‘urethral pressure’’ when the catheter is rotatedwithin the lumen. From the de¢nition it follows that direc-tional variations are artefacts.

MATERIALS AND METHODS

Urethral pressures can be measured at individual locationswithin the urethra (point pressures) or along the whole lengthof the urethra (urethral pressure pro¢le). Registration may beover a short period of time or over a protracted period (ambu-latory). Measurement can be carried out at di¡erent bladdervolumes and di¡erent subject positions (1) with the subjectat rest, or (2) during coughing or straining.‘‘Pressure measure-ments made in the urethra during the process of voiding yieldan ordinary £uid pressure, not the urethral pressure de¢nedabove.’’

*Correspondence to: International Continence Society O⁄ce, SouthmeadHospital, Bristol 5NB,United Kingdom.

DOI 10.1002/nau.10051

Published online inWiley InterScience (www.interscience.wiley.com).

! 2002Wiley-Liss, Inc.

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$&&&&&&&&&&&&&&&&&&&&!$$&&&&&&&&&&&&&&&&&%$$&&&&&&&&&&&&&&&&&c$$&&&&&&&&&&&&&&&&&U$$&&&&&&&&&&&&&&&&&"$$&&&&&&&&&&&&&&&&&T$$&&&&&&,B&&

%$&,

B&

0*,-&!&,*.#;*8&

Cystometrie : pression de base

'G`&&&&?)12&&&&?8-3&

&&&?2>4&&&&?4-/&

&&&L)12&&N*.Y&

$&&&&&&&&&&&&&&&&&&&&!$$&&&&&&&&&&&&&&&&&%$$&&&&&&&&&&&&&&&&&c$$&&&&&&&&&&&&&&&&&U$$&&&&&&&&&&&&&&&&&"$$&&&&&&&&&&&&&&&&&T$$&&&&&&,B&&

%$&,

B&

0*,-&!&,*.#;*8&

P+-2v*.E&

M;&

Cystometrie : premier besoin

!"#$"#!%&

T&

'G`&&&&?)12&&&&?8-3&

&&&?2>4&&&&?4-/&

&&&L)12&&N*.Y&

$&&&&&&&&&&&&&&&&&&&&!$$&&&&&&&&&&&&&&&&&%$$&&&&&&&&&&&&&&&&&c$$&&&&&&&&&&&&&&&&&U$$&&&&&&&&&&&&&&&&&"$$&&&&&&&&&&&&&&&&&T$$&&&&&&,B&&

%$&,

B&

0*,-&!&,*.#;*8&

P+-2v*.E&

M;&

67)EA&

Cystometrie : toux

'G`&&&&?)12&&&&?8-3&

&&&?2>4&&&&?4-/&

&&&L)12&&N*.Y&

$&&&&&&&&&&&&&&&&&&&&!$$&&&&&&&&&&&&&&&&&%$$&&&&&&&&&&&&&&&&&c$$&&&&&&&&&&&&&&&&&U$$&&&&&&&&&&&&&&&&&"$$&&&&&&&&&&&&&&&&&T$$&&&&&&,B&&

%$&,

B&

0*,-&!&,*.#;*8&

P+-2v*.E&

M;&

67)EA&

m;&

Cystometrie : besoin pressant

'G`&&&&?)12&&&&?8-3&

&&&?2>4&&&&?4-/&

&&&L)12&&N*.Y&

$&&&&&&&&&&&&&&&&&&&&!$$&&&&&&&&&&&&&&&&&%$$&&&&&&&&&&&&&&&&&c$$&&&&&&&&&&&&&&&&&U$$&&&&&&&&&&&&&&&&&"$$&&&&&&&&&&&&&&&&&T$$&&&&&&,B&&

%$&,

B&

0*,-&!&,*.#;*8&

P+-2v*.E&

M;&

67)EA&

m;&

k&!"&5,Q%a&

I:;6&

Cystometrie : Contraction non inhibée du Detrusor

'G`&&&&?)12&&&&?8-3&

&&&?2>4&&&&?4-/&

&&&L)12&&N*.Y&

$&&&&&&&&&&&&&&&&&&&&!$$&&&&&&&&&&&&&&&&&%$$&&&&&&&&&&&&&&&&&c$$&&&&&&&&&&&&&&&&&U$$&&&&&&&&&&&&&&&&&"$$&&&&&&&&&&&&&&&&&T$$&&&&&&,B&&

%$&,

B&

0*,-&!&,*.#;*8&

P+-2v*.E&

M;&

67)EA&

m;&

I:;6&

bQ&

67)EA&

PB7K&R28-3&

@,+B*/)4-&k&!$&5,Q%a&

Cystometrie : Hyperactivité Rectale

'G`&&&&?)12&&&&?8-3&

&&&?2>4&&&&?4-/&

&&&L)12&&N*.Y&

$&&&&&&&&&&&&&&&&&&&&!$$&&&&&&&&&&&&&&&&&%$$&&&&&&&&&&&&&&&&&c$$&&&&&&&&&&&&&&&&&U$$&&&&&&&&&&&&&&&&&"$$&&&&&&&&&&&&&&&&&T$$&&&&&&,B&&

%$&,

B&

0*,-&!&,*.#;*8&

P+-2v*.E&

M;&

67)EA&

m;&

I:;6&

bQ&

67)EA&

k&c$&5,Q%a&

II&

Cystometrie : Urethre instable Cystometrie : besoin urgent

'G`&&&&?)12&&&&?8-3&

&&&?2>4&&&&?4-/&

&&&L)12&&N*.Y&

$&&&&&&&&&&&&&&&&&&&&!$$&&&&&&&&&&&&&&&&&%$$&&&&&&&&&&&&&&&&&c$$&&&&&&&&&&&&&&&&&U$$&&&&&&&&&&&&&&&&&"$$&&&&&&&&&&&&&&&&&T$$&&&&&&,B&&

%$&,

B&

0*,-&!&,*.#;*8&

P+-2v*.E&

M;&

67)EA&

m;&

I:;6&

bQ&

67)EA&

II&

P;&

N7B)./21=&67./12597.&

@)/7.7,*5&67./17B&

!"#$"#!%&

f&

'G`&&&&?)12&&&&?8-3&

&&&?2>4&&&&?4-/&

&&&L)12&&N*.Y&

$&&&&&&&&&&&&&&&&&&&&!$$&&&&&&&&&&&&&&&&&%$$&&&&&&&&&&&&&&&&&c$$&&&&&&&&&&&&&&&&&U$$&&&&&&&&&&&&&&&&&"$$&&&&&&&&&&&&&&&&&T$$&&&&&&,B&&

%$&,

B&

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P+-2v*.E&

M;&

67)EA&

m;&

I:;6&

bQ&

67)EA&

II&

P;&

67)EA&

V-2v&

Cystometrie : Leak Point Pressure

'G`&&&&?)12&&&&?8-3&

&&&?2>4&&&&?4-/&

&&&L)12&&N*.Y&

$&&&&&&&&&&&&&&&&&&&&!$$&&&&&&&&&&&&&&&&&%$$&&&&&&&&&&&&&&&&&c$$&&&&&&&&&&&&&&&&&U$$&&&&&&&&&&&&&&&&&"$$&&&&&&&&&&&&&&&&&T$$&&&&&&,B&&

%$&,

B&

0*,-&!&,*.#;*8&

P+-2v*.E&

M;&

67)EA&

m;&

I:;6&

bQ&

67)EA&

II&

P;&

67)EA&

V-2v&

Ib&

G6&

Cystometrie : Capacitée Maximum

'G`&&&&?)12&&&&?8-3&

&&&?2>4&&&&?4-/&

&&&L)12&&N*.Y&

$&&&&&&&&&&&&&&&&&&&&!$$&&&&&&&&&&&&&&&&&%$$&&&&&&&&&&&&&&&&&c$$&&&&&&&&&&&&&&&&&U$$&&&&&&&&&&&&&&&&&"$$&&&&&&&&&&&&&&&&&T$$&&&&&&,B&&

%$&,

B&

0*,-&!&,*.#;*8&

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M;&

67)EA&

m;&

I:;6&

bQ&

67)EA&

II&

P;&

67)EA&

V-2v&

Ib&

G6&

P1

P2

Compliance = V2 - V1

P2 - P1

V1 V2

Cystometrie : Compliance du Detrusor

Resultats Cystométrie'$

P/712E-&+A23-&

'8-.-,-./3&&&&&&&&&&&&&&&&&&& & &?4-/& &&&&&&&&&&&&N7B),-&&& &&&&&&&&&&&67,+B*2.5-&

& &&&&&&&&&&&&& & &5,Q%a & &&,B& &&&&&&&&&&&&&&&,B#5,Q%a&&

?1-33*7.&>23- &&&&&&&& &Z? &c & &%$&

!-1&>-37*.&&&&&&&&&&&&&&&&&& &M; &f& & &!T$ & &&&&&&&&&LR&

ZX&?1-332./&&&&&&&&&&& &m; &!% & &%f$ & &&&&&&&&&HH&

ZX&*,+p1*-)o&&&&&&&&&&&&&P; &%! & &UU$ & &&&&&&&&&G`&

I1E-.5= & &Ib &c$ & &"f" & &&&&&&&&&GR&

62+25*/p&G2o&6=3/7X& &66 &c% & &T!$ & &%$&&&&GS!

:6P& & &a(+EE21!b!W12<#1+(!.3-*?'-!b!=$%:3-*?'-!

;'0bIPab &m71,2B&]P/2>B-^ & &m71,2B&

& &a8-12598-&]I.3/2>B- &̂I.4-12598-&

& &&&&[$92112c2d&+ & &@57./1259B-&

& & & & &&&&712c2d&+!

& & & & &&&&&&&&=2*2-<1+(&%2E&

P/712E-&?A23-&&&&&&&&&&&&&&&&&&N7*4*.E&?A23-&&&&&&&&&&

Ib'0Qb@&m71,2B&]P/2>B-^ & &m71,2B&

& &:.57,+-/-./ & &a>3/1)598-&

& &&&&W1&-+1$!&-*'-?-2-*2 &&&&52*#+-&*+(!^+-+<'8$_&

& &P+A*.5/-1&21-J-o*2 & &&&&>B21+*?B2!^:3-*?'-_!

& & & & &&&&&&&&a(+EE21!-2*@!

! ! ! ! !!!!!!!!=$%*''1E&-+?'-!

! ! ! ! !!!!!!!!=$%%$-21)&+!

! ! ! ! !!!!!!!![$99212c2d&+&ZV@;;'b&m71,2B&

P-.3297.&:.51-23-4&]Q=+-13-.3*98-^&& &b-4)5-4&]Q=+73-.3*98-^&

& &@>3-./&

V-3&57)1>-3&

!"#$"#!%&

w&

EMG

uV

0

200

400

600

Pves

cmH2O

0

20

40

60

Pabd

cmH2O

0

20

40

60

Vinfus

ml

0

200

400

600

Cysto PR 50ml EMG#1

50 s 00:00 01:40 03:20 05:00 06:40 08:20 10:00

PB B1

Toux

T

Toux

T

Toux

T

Toux

TCM

ODM

Miction

M

.Vo = 101 ml

.Vo

.Vo = 201 ml

.Vo

ST

EMG

uV

0

100

200

Pves

cmH2O

0

20

40

60

80

Vinfus

ml

0

200

400

600

800

Cysto 50ml EMG#1

30 s 00:00 01:00 02:00 03:00 04:00 05:00 06:00

PB B1

Toux

T

Toux

T

Toux

T

Toux

T

Parle

Par

Rires

Rit

Rires

Rit

Vol = 101 ml

Vol

Vol = 201 ml

Vol

Vol = 301 ml

Vol

Vol = 401 ml

Vol

ST

détrusor hyperactif à faible capacité.

détrusor stable à capacité

normale.

Hyperactivité vésicale : urodynamique

Q'9$1&)#<!e!52E<1'-&*!.1+-*2!=1!78+12-*'!HIIG!

Q'9$1&)#<!e!52E<1'-&*!.1+-*2!=1!78+12-*'!HIIG! Q'9$1&)#<!e!52E<1'-&*!.1+-*2!=1!78+12-*'!HIIG!

Cas : vessie hyperactive neurogène

'G`&

&

&

&

?)12&

&

&

&

?8-3&

&

&

&

?2>4&

&

&

&

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&

&

&

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N*.Y&$&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&f$&&&&,B&&

%$&,

B&

0*,-&!&,*.#;*8&

67)EA&

•! vitesse remplissage : 20 ml/min.

•! faible Volume Vesical

•! Contraction du Detrusor Immediate

•! Compliance normale

•! Pura et EMG augmentent pdt la

miction N7*4*.E&?A23-&

Cas : Instabilité idiopathique Detrusor

'G`&

&

&

&

?)12&

&

&

&

?8-3&

&

&

&

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&

&

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&

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0*,-&!&,*.#;*8&

%$&,

B&

67)EA&

N7*4*.E&?A23-&

•! vitesse remplissage 20 ml/min.

•! Contraction du Detrusor après stimulation

•!Compliance basse

!"#$"#!%&

x&

Cas : défaut de compliance Post Radiotherapie

'G`&

&

&

&

?)12&

&

&

&

?8-3&

&

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&

?2>4&

&

&

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N*.Y&$&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&%$$&&&&,B&&

0*,-&!&,*.#;*8&

%$&,

B&

N7*4*.E&?A23-&

•! Vitesse remplissage 20 ml/min.

•! basse Compliance

•! pression Detrusorienne élevée ~ 150 cmH2O

;p>)/&

,*597.&

M*.&

,*597.&Z!&

-,E&

?X&

8-3&

8)>>:)$*)B",A,F:GB)$H$I7J)"(+KE:DL$9M,":F:*)$9LD"B>,":)**)$

;p>)/&

,*597.&

M*.&

,*597.&Z!&

-,E&

?X&

8-3&

8)>>:)$*,*$*)B",A,F:GB)$H$I7J)"(+KE:DL$J("$9LN(BD$JL":*L,4>JI:*+DL":)*$J",4:*I:C:D)B"$

-332*&4n*.A*>*97.&

87B7./2*1-&

EMG

uV

0

200

400

600

Pves

cmH2O

0

20

40

60

Pabd

cmH2O

0

20

40

60

Vinfus

ml

0

200

400

600

Cysto PR 50ml EMG#1

50 s 00:00 01:40 03:20 05:00 06:40 08:20 10:00

PB B1

T

o

u

x

T

T

o

u

x

T

T

o

u

x

T

T

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x

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t

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M

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1

0

1

m

l

.Vo

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2

0

1

m

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ST

A=+-12598*/p&8p3*52B-&-/&ZI;i&17)E-&g&.7*1&y&

@z-1&57./12597.& ;->*/&?&b-5/2B-&

!"#$"#!%&

!$&

!"#$"#!%&

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M-,,-&-/&A7,,-&{&

!"#$"#!%&

!%&

EMG

uV

0

200

Pves

cmH2O

0

20

40

60

Pabd

cmH2O

0

20

40

60

Vinfus

ml

0

200

400

600

Cysto PR 50ml EMG#1

45 s 00:00 01:30 03:00 04:30 06:00 07:30 09:00

PB B1

Toux

T

Toux

T

Toux

T

Toux

T

Toux

T

Toux

T

Toux

T

Toux

T

Parle

P

CM

ODM

Perc

ussio

ns

P

Perc

ussio

ns

P

Pesante

ur

P

.Vo =

101 m

l

.Vo

.Vo =

201 m

l

.Vo

.Vo =

301 m

l

.Vo

.Vo =

401 m

l

.VoST

EMG

uV

0

200

400

Pves

cmH2O

0

20

40

60

Pabd

cmH2O

0

20

40

60

Vinfus

ml

0

200

400

600

Cysto PR 50ml EMG#1

55 s 00:00 01:50 03:40 05:30 07:20 09:10 11:00

PB B1

Toux

T

Toux

T

Toux

T

Toux

T

Toux

T

Toux

T

Parle

P

CM

ODM

Perc

ussio

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P

Art

efa

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A

. = 1

01 m

l

.

. = 2

01 m

l

.

. = 3

01 m

l

.

. = 4

01 m

l

.ST

EMG

uV

0

1000

2000

3000

Pves

cmH2O

0

20

40

60

Pabd

cmH2O

0

20

40

60

Vinfus

ml

0

200

400

600

Cysto PR 50ml EMG#1

50 s 00:00 01:40 03:20 05:00 06:40 08:20 10:00 11:40

PB

Toux

T

Toux

T

Toux

T

Toux

T

Toux

T

Parle

P

Parle

P

CM

ODM

Perc

ussio

ns

P

.Vo =

101 m

l

.Vo

.Vo =

201 m

l

.Vo

.Vo =

301 m

l

.Vo

.Vo =

401 m

l

.VoST

!"#$"#!%&

!c&

EMG

uV

0

1000

2000

3000

Pves

cmH2O

0

20

40

60

Pabd

cmH2O

0

20

40

60

Vinfus

ml

0

200

400

600

Cysto PR 50ml EMG#1

35 s 00:00 01:10 02:20 03:30 04:40 05:50 07:00

PB B1

Parle

Par

CM

ODM

Doule

ur

vésic

ale

D

V =

101 m

l

V

V =

201 m

l

V

V =

301 m

l

VST

Stim

Right Latence Sacrée BC

10ms

0.2mVStimPer - BulbCav 53mA

StimPer - BulbCav 53mA

StimPer - BulbCav 53mA

StimPer - BulbCav 53mA

StimPer - BulbCav 53mA

0.1mV

100ms

Débit

ml/s

0

5

10

15

Vol. Uriné

ml

0

100

200

300

400

Débimétrie#1

5 s 00:45 00:55 01:05

DM

QM

= 1

2,3

ml/s

QM FM

Débit

ml/s

0

5

10

15

20

Vol. Uriné

ml

0

100

200

300

400

Débimétrie#2

7 s 00:14 00:28 00:42 00:56 01:10 01:24 01:38

DM

QM

= 1

7,7

ml/s

QM FM

Gt,-&+29-./&{&

Pura

cmH2O

0

20

40

60

80

100

120

140

160

PPU mono-voie + tracteur#1

10 s 00:10 00:30 00:50 01:10 01:30 01:50 02:10

DP PM FP

Prectum

cmH2O

0

20

40

60

80

100

120

140

VLPP#1

7 s 00:00 00:14 00:28 00:42 00:56 01:10 01:24

ST

Pdet

cmH2O

0

20

40

Pves

cmH2O

0

20

40

Pabd

cmH2O

0

20

40

Qura

ml/s

0

5

10

Vinfus

ml

0

100

200

Etude Pression Débit#2

15 s 02:15 02:45

M DM Pdet

FM

Non obstrué

Equivoque

Obstrué

Qura [ml/s]

Pdet [cmH2O]

2 4 6 8 10 12 14 16 18 20 22 24 26

20

40

60

80

100

120

140

160

180

P à Début Miction cmH2O-1

P à Débit Max. cmH2O5

Q à Débit Max. ml/s21,5

P à Débit min. cmH2O24

P à Débit min. cmH2O23

Pente descendante cmH2O/ml/sN.A.

Retard à la Miction s0,7

A/G Non obstrué

A/G# -38,3

!"#$"#!%&

!U&

20uV

100ms

ms/D V/D #Avg R1/R2

(Fz-Cz)

P40

10 2u 81/100

1 D

Display

Run1 Run2 Superimposed

Run2Run1

Stimulation

Run1 : 3Hz, 0.2ms, 16.6mA, Perinee

Run2 : 3Hz, 0.2ms, 17.8mA, Perinee

Pura

cmH2O

0

20

40

60

80

PPU mono-voie#1

15 s 00:00 00:30 01:00 01:30 02:00 02:30 03:00

DP PM FPST

Débit

ml/s

0

20

40

60

Vol. Uriné

ml

0

100

200

300

400

Débimétrie#2

5 s 00:00 00:10 00:20 00:30 00:40

DM

QM

= 5

5,5

ml/s

QM FMST Débit

ml/s

0

10

20

30

Vol. Uriné

ml

0

100

200

300

400

Débimétrie#1

5 s 00:25 00:35 00:45 00:55 01:05 01:15 01:25

DM

QM

= 3

0,8

ml/s

QM FM

Pura

cmH2O

0

20

40

PPU mono-voie + tracteur#1

9 s 00:00 00:18 00:36 00:54 01:12 01:30

DP PM FP

Toux

T

ST

EMG

uV

0

500

1000

Pves

cmH2O

0

20

40

60

Pabd

cmH2O

0

20

40

60

Vinfus

ml

0

200

400

600

Cysto PR 50ml EMG#1

25 s 00:00 00:50 01:40 02:30 03:20 04:10 05:00

PB B1

Toux

T

Toux

T

Toux

T

Parle

P

Parle

P CM

Mic

tion

M

fin

de M

iction

M

.Vo =

101 m

l

.Vo

.Vo =

201 m

l

.Vo

ST

EMG

uV

0

500

1000

Pves

cmH2O

0

20

40

60

Pabd

cmH2O

0

20

40

60

Vinfus

ml

0

200

400

600

Cysto PR 50ml EMG#1

80 s 00:00 02:40 05:20 08:00 10:40 13:20 16:00

PB B1

Toux

T

Toux

T

Toux

T

Toux

T

Toux

T

Toux

T

Parle

P CM

ODM

Mic

tion

M

Mic

tion

M

Perc

ussio

ns

P

Perc

ussio

ns

P

Perc

ussio

ns

P

Art

efa

ct

A

Art

efa

ct

A

Art

efa

ct

A

. = 1

01 m

l

.

. = 2

01 m

l

.

. = 3

01 m

l

.

. = 4

01 m

l

.ST