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Cystometry, also known as flow cystometry, is a clinical diagnostic procedure used to evaluate bladder function. Specifically, it measures contractile force of the bladder when voiding. The resulting chart generated from cystometric analysis is known as a cystometrogram (CMG), which plots volume of liquid emptied from bladder against intravesical pressure.

Use

Diagram of cystometry in a female patient.

Cystometric analysis is used to evaluate the bladder's capacity to contract and expel urine. It helps determine the source of urinary problems. A normal CMG effectively rules out primary vesical dysfunction. It is used as a component for diagnosis of various disorders including urinary tract infections, multiple sclerosis, stroke, spinal cord injury, urethral obstruction, and overactive bladder, among others.^[1]

Procedure

The procedure is relatively short, ranging from fifteen minutes^[2] to an hour in duration.^[3] It involves the insertion of one or two catheters into an emptied bladder through the urethra. In the two catheter method, one catheter transfers liquid while the other is a manometer (pressure sensor).^[4] In the single catheter method, a specialized catheter performs both functions. An additional rectal catheter may also be placed for additional data. The bladder will then be filled with saline and the patient's awareness of the event will be queried. The patient will often be asked to note when presence of liquid is felt, when the bladder feels full, and when the urgency to void is felt. The patient is then asked to void, and both flow and pressure are recorded.^[3] These are plotted against each other to create the cystometrogram.

Results

Cystometrogram showing high frequency oscillations characteristic of expulsion of liquid in the rat.

The primary results of cystometric analysis is the cystometrogram. The x-axis is the volume of liquid and the y-axis is the intraluminal pressure of the bladder. In normal patients, the plot is a series of spikes whose local minimums form a non-linear curve resembling an exponential growth curve. The spikes correspond to the bladder contractions associated with the micturation reflex. The curve formed by the bottom of the plot reflects the level of pressure necessary to void. In normal patients, the first couple hundred milliliters of urine flow with minimal applied pressure. Increasing pressure is necessary to void 200-300 millileters of urine. Beyond that, the pressure necessary to void additional urine rises sharply.^[5]

Risks & Contraindications

As with any catheterization, the primary risk is of urinary tract infection. As a result, the procedure is contraindicated in any patient with an active UTI because the results may be skewed and the infection may spread^{[citation needed]}.

There is also the potential for trauma to the bladder and urethtra, which may result in hematuria (blood in the urine).^[1]

References

^ ^a ^b "MedlinePlus - Cystometric study". http://www.nlm.nih.gov/medlineplus/ency/article/003904.htm. Retrieved 2008-08-04.
^ "University of Michigan Health System - Cystometrogram". http://www.med.umich.edu/1libr/urology/cystometrogram.htm. Retrieved 2008-08-04.
^ ^a ^b "Chicago Institute of Neurosurgery & Neuroresearch - Cystometrogram". http://www.cinn.org/diagnostic/cystometrogram.html. Retrieved 2008-08-04.
^ "National Kidney & Urologic Diseases Information Clearinghouse - Urodynamic Testing". http://kidney.niddk.nih.gov/kudiseases/pubs/urodynamic/index.htm. Retrieved 2008-08-04.
^ Guyton, Arthur C.; Hall, John E. (2006). Textbook of Medical Physiology. Philadelphia: Elsevier Saunders. pp. 312. ISBN 0-7216-0240-1.

UpToDate Contents

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English Journal

Patterns And Predictors Of Urodynamics Use In The U.S.

Reynolds WS, Dmochowski RR, Lai J, Saigal C, Penson DF; Urologic Diseases in America Project.SourceDepartment of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN. Electronic address: william.stuart.reynolds@vanderbilt.edu.
The Journal of urology.J Urol.2012 Nov 14. pii: S0022-5347(12)05556-5. doi: 10.1016/j.juro.2012.11.066. [Epub ahead of print]
PURPOSE: Due to the paucity of data on urodynamics (UDS) on a national level, we sought to assess UDS use in a large sample of U.S. individuals and identify predictors of increased complexity of UDS procedures.MATERIALS AND METHODS: Using administrative healthcare claims for adults enrolled in priva
PMID 23159270

Mechanisms and urodynamic effects of a potent and selective EP4 receptor antagonist, MF191, on cyclophosphamide and prostaglandin E(2) -induced bladder overactivity in rats.

Chuang YC, Tyagi P, Huang CC, Chancellor MB, Yoshimura N.SourceDepartments of Urology Pathology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan Department of Urology, William Beaumont Hospital, Royal Oak, MI Department of Urology, University of Pittsburgh School of Medicine ,Pittsburgh, PA, USA.
BJU international.BJU Int.2012 Nov;110(10):1558-64. doi: 10.1111/j.1464-410X.2012.11096.x. Epub 2012 Mar 27.
Study Type - Aetiology (case control) Level of Evidence 3b What's known on the subject and What does the study add Recent evidence has suggested that up-regulation of the prostaglandin E(2) (PGE(2) ) receptor subtype 4 (EP4) receptor in the bladder is involved in bladder overactivity. The prese
PMID 22452546

Japanese Journal

Effect of eviprostat on bladder overactivity in an experimental cystitis rat model

KOBAYASHI Mizuki,NOMURA Masayoshi,NISHII Hisae,MATSUMOTO Seiji,FUJIMOTO Naohiro,MATSUMOTO Tetsuro
International journal of urology 15(4), 356-360, 2008-04-01
NAID 10021277678

前立腺全摘除術後における排尿状態と国際前立腺症状スコア(I-PSS)との検討

五十嵐敦,斉藤克幸,七条武志,益山恒夫,檜垣昌夫,吉田英機
日本泌尿器科學會雜誌 95(4), 651-656, 2004-05-20
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NAID 110003060732