Diagnostic procedures
Since many patients have a long history of symptoms, the following is helpful to reduce unnecessarily long waiting times. The first step is to ascertain the symptoms and their consequences (case history).
- To this end, the patient should have kept a voiding/incontinence diary before presenting at our department for the first time. This diary should contain the volume of liquid drunk, the urine volume, the number of pads used and the volume of urine loss as well as the situation in which this occurred (sudden urge to urinate).
- On presenting at our department for the first time, every patient should bring with them ALL previous files (x-ray images, discharge reports, reports by colleagues such as neurologists, gynaecologists, surgeons, internists and the general practitioner) that may be related to the incontinence in any way, a list of previous treatment efforts (i.e. medication taken) and a list of all medicines currently taken.
- The patient should have previously undergone a urine analysis and, if necessary, received antibiotic treatment from the referring colleague.
- The patient should present with a full bladder so that uroflowmetry and sonographic measurement of the residual urine can be performed by our nursing staff.
- After review of the documents and evaluation of the results of the uroflowmetry and the residual urine measurement, the patient describes the symptoms to the attending physician, with involuntary urination being a typical symptom.
Note:
- Consultation with the patient on the scheduled appointment date is only possible if all requested documents are available and all previous examinations and any required antibiotic treatment have been performed. If the patient fails to bring the requested documents with them, a new appointment will be scheduled to which the patient should bring with them all required documents.
- Reporting any previous surgeries, e.g. prostate surgeries in men or uterine surgeries or childbirths in women, is particularly important so that any questions related to the case history, such as the onset of the disease, can be clarified.
- Another particularly important question is when and under what circumstances the problems occur and how long they have persisted. By asking exploratory questions, the physician obtains important information to decide what examinations are best suitable to establish a diagnosis. After evaluating all results, the treatment is discussed with the patient and the treatment strategy is determined.
Functional diagnosis
- Voiding diary
Over 3 days, drinking habits (volume), urination (time, volume), incontinence, pain on urination, storage (urination intervals) - Urine analysis
- Pad test
Performed either over a certain period of time during specific exercises or measurement of urine loss on the basis of the weighed pads in the voiding diary) - Uroflowmetry/Pressure uroflowmetry
Measurement of urine flow (voiding into a special device that measures the urine flow, may be accompanied by measurement of pelvic floor muscle activity by means of adhesive electrodes, incl. sonographic measurement of residual urine (volume of urine remaining in the urinary bladder after urination) - Ultrasound examination
A non-invasive method allowing the examiner to assess organs and partly also their function (in urology, especially kidneys, bladder, prostate, urethra, penis, etc.) - Vaginal examination
Examination of the vagina - Urethrocystoscopy, if necessary, endoscopy or radiography of the upper urinary tract
May be required in the case of ureteropelvic junction obstruction (often congenital or resulting from inflammations or previous surgeries), ureteral stenosis, caused by a scar (stricture) or tumour - Excretory urography, CT, MRI
Special radiological examinations for more accurate assessment of the urinary organs, may take place at the Radiology Department - Voiding cystourethrography (VCUG)
Filling the urinary bladder with contrast medium (no risk of allergy to contrast medium) to assess the urinary bladder and micturition, diverticula (protrusions of bladder wall), innervation damage - Lateral cystography
Often performed together with the VCUG in lateral position to assess the position of the bladder within the body - Dynamic MRI
Special examination technique to assess the urinary bladder and rectum under stimulated voiding (pressing)
(Video-)urodynamic test
This examination is aimed at assessing the function of the urinary bladder and the urethra as well as the pertinent sphincters. This examination technique is used to better explain and treat specific symptoms, including forms of urinary incontinence (stress incontinence/urge incontinence and mixed forms, neurological conditions affecting the bladder function (detrusor sphincter dyssynergia, etc.), bladder voiding disorders (subvesical obstruction, e.g. prostatic hyperplasia, urethral stricture) entailing overflow incontinence, micturiction frequency, pain on filling and voiding the bladder, frequently recurring urinary tract infections.
This examination provides the physician with important information for selecting treatment options and assessing the therapeutic effect.
Depending on its scope and any accompanying tests, the urodynamic test takes up to one hour and can involve the following procedures:
Data from the bladder and the urethra is recorded via a thin catheter (tube). This serves to fill the bladder at an accelerated pace to simulate bladder filling and provoke changes so that they can be subsequently treated. Additionally, electrodes are attached to the skin to register the muscular activity and a thin tube is positioned in the rectum to measure the intra-abdominal pressure. All data is transmitted to a computer and stored for subsequent evaluation. If necessary, x-ray imaging is performed simultaneously to illustrate the measured data. In this case, the procedure is referred to as video-urodynamic test (bladder radiography on filling and on urination, also important to exclude reflux (backflow of urine into the ureter (connection between bladder and kidneys)). A urethral pressure profilometry is performed when additionally registering the data while the catheter is withdrawn from the urethra during periods of intermittent stress (e.g. coughing). This serves to examine the presence of stress incontinence. In the event of neurological conditions, the examination may be more extensive.