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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 milliliters 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". Retrieved 2008-08-04.
^ "University of Michigan Health System - Cystometrogram". Retrieved 2008-08-04.
^ ^a ^b "Chicago Institute of Neurosurgery & Neuroresearch - Cystometrogram". Retrieved 2008-08-04.
^ "National Kidney & Urologic Diseases Information Clearinghouse - Urodynamic Testing". Retrieved 2008-08-04.
^ Guyton, Arthur C.; Hall, John E. (2006). Textbook of Medical Physiology. Philadelphia: Elsevier Saunders. p. 312. ISBN 0-7216-0240-1.

UpToDate Contents

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1. 尿失禁女性の尿流動態検査 urodynamic evaluation of women with incontinence
2. 男性における下部尿路症状 lower urinary tract symptoms in men
3. 脊髄髄膜瘤（二分脊椎）の尿路合併症 urinary tract complications of myelomeningocele spina bifida
4. 女性の尿失禁の評価 evaluation of women with urinary incontinence
5. 膣後壁欠損の臨床症状、診断、および非外科的マネージメント clinical manifestations diagnosis and nonsurgical management of posterior vaginal defects

English Journal

(18F)FDG-PET brain imaging during the micturition cycle in rats detects regions involved in bladder afferent signalling.

Deruyver Y1,2,3, Rietjens R4,5,6, Franken J7,8,9, Pinto S10,11, Van Santvoort A12, Casteels C13, Voets T14,15, De Ridder D16,17.
EJNMMI research.EJNMMI Res.2015 Dec;5(1):55. doi: 10.1186/s13550-015-0132-0. Epub 2015 Oct 15.
BACKGROUND: This feasibility study established an experimental protocol to evaluate brain activation patterns using fluorodeoxyglucose positron emission tomography ((18F)FDG-PET) during volume-induced voiding and isovolumetric bladder contractions in rats.METHODS: Female Sprague-Dawley rats were ana
PMID 26467154

Urinary nerve growth factor in patients with detrusor overactivity.

Korzeniecka-Kozerska A1, Wasilewska A2.
Irish journal of medical science.Ir J Med Sci.2015 Dec;184(4):737-43. doi: 10.1007/s11845-014-1162-8. Epub 2014 Jun 21.
BACKGROUND: Detrusor overactivity (DO) is one of the most frequent bladder dysfunctions in children up to the age of 18. Nowadays, the only way to confirm DO is by urodynamic investigation, which is an invasive procedure. Among the many mediators influencing bladder function, nerve growth factor (NG
PMID 24951086

Telemetric monitoring of bladder function in female Göttingen minipigs.

Huppertz ND1, Kirschner-Hermanns R2, Tolba RH3, Grosse JO1.
BJU international.BJU Int.2015 Nov;116(5):823-32. doi: 10.1111/bju.13089. Epub 2015 May 24.
OBJECTIVES: To generate real-time radio-telemetric urodynamic reference data of maximum detrusor pressure (Pdet max ), maximum flow rate (Qmax) and estimated grade of infravesical obstruction, as well as duration of detrusor contraction (DOC), in female Göttingen minipigs and to describe translati
PMID 25682883

Japanese Journal

Bladder function of end-stage renal disease patients

TSUNOYAMA Kuniko,ISHIDA Hideki,OMOTO Kazuya,SHIMIZU Tomokazu,SHIRAKAWA Hiroki,TANABE Kazunari
International journal of urology 17(9), 791-795, 2010-09-01
NAID 10027259900

二種のラット頻尿(過活動膀胱および膀胱炎) モデルにおける排尿行動，排尿動態の比較

伊藤勝昭,岩見暁人,飯田真志,桂裕美,池田正浩,Ito Katsuaki,Iwami Akihito,Iida Masashi,Katsura Hiromi,Ikeda Masahiro
宮崎大学農学部研究報告 56, 153-161, 2010-02-28
… In cystometry experiments, where the bladder was infused with saline and the intravesical pressure was monitored under a conscious and restrained condition, either BOO or CYP-treated rats exhibited enhanced micturition reflex concomitant with occurrence of nonvoiding contractions. …
NAID 120002013645