Cystomanometry

What is Cystomanometry?

Cystomanometry is an indispensable part of Urodynamic Testing. Urodynamic Testing is a specialized screening test providing the most objective evaluation of LUT function. In other words, it provides information about the condition and functionality of bladder and urethra while storing and emptying urine. It is a minimally invasive procedure measuring pressures within the bladder, to identify the origin of the patient’s symptoms.

When is Cystomanometry performed?

Cystomanometry is not a first-line test and is ordered when there are specific indications. For example, it will be asked in patients with neurological problems, mainly paraplegia or quadriplegia and MS (multiple sclerosis), as well as in some patients with urinary symptoms before surgery or when the initial conservative therapy has failed. In addition, Cystomanometry is performed in women with urinary incontinence, when surgery is to follow.

What preparation is need for Cystomanometry?

It is quite a demanding test that takes about 1 hour. First, the physician has to make sure that there is no urinary tract infection. The physician usually asks for a urine test before or performs a quick urine test on the spot with the use of a special tape.   There is no need for the patient to have an empty stomach or make any other special preparation such as interrupting anticoagulants.

How is Cystomanometry performed?

First, the physician will clinically examine the patient. For the clinical examination, two special very thin catheters are used (their thickness is equal to 1/3 of the usual catheter diameter) to measure urodynamic pressures that are shown on the computer screen. The physician will empty the bladder and place the first catheter into the bladder and the second one into the rectum (end of the bowel), to measure the pressure in the abdomen. Then, the flexible soft catheter tubes are connected to the computer of the special urodynamics device. With the use of a special pump at a pace determined by the physician, sterile water starts entering the bladder and the patient is asked to describe when s/he feels the first urge to urinate and the following ones. In this way, the physician evaluates the sensitivity and behavior of the bladder during its filling and thus tries to interpret the patient's symptoms.

How are the results of Cystomanometry interpreted?

Cystomanometry is the only way to identify the exact origin of urinary incontinence. The typical finding in women with urinary urgency (sudden urge to urinate, followed by involuntary loss of urine) is that, during bladder filling, the bladder at some point starts contracting and this leads to the intense urge to urinate. In such a case, lifestyle changes are recommended; for example, restriction of coffee and fluid consumption. There are also appropriate medications called anticholinergics. Also, detrusor hyperactivity is very common in patients with spinal fractures and Multiple Sclerosis. In neurological patients, mainly with spinal fractures and spinal cord injuries, bladder contractions are usually more intense and may cause severe renal impairment (urinary reflux).  Thus, Cystomanometry helps the physician check the bladder condition and function to find out whether there is risk for kidneys.

In women with Stress/Effort Incontinence (the most common type of urinary incontinence), it seems that although the bladder feels and behaves normally with no contractions, there is involuntary urine loss when the woman increases intra-abdominal pressure (e.g. by coughing) due to  relaxation of the pelvic floor. In most cases, pelvic floor exercises are recommended, In case pelvic floor exercises fail, then surgical treatment follows.