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The Cystometrogram
Book chapter

The Cystometrogram

Ryan L Steinberg and Karl J Kreder
Practical Urodynamics for the Clinician, pp.43-60
Springer International Publishing
01/01/2016
DOI: 10.1007/978-3-319-20834-3_5

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Abstract

The cystometrogram is the most comprehensive means of assessing the bladder’s ability to store urine and activity during filling. Bladder and rectal pressures during testing should be performed with a transurethral catheter and a separate rectal balloon catheter with external pressure transducer, per International Continence Society guidelines. The detrusor pressure can then be calculated by subtracting the abdominal pressure from the intravesical pressure. Saline, water, or cystografin (when performing videourodynamics) should be used to fill the bladder at a rate of 0–100 mL/min. The cystometrogram is closely monitored in real time during filling to assess for decreased bladder compliance, which if left addressed, can lead to upper urinary tract deterioration over time. Provocative maneuvers, including a cough, Valsalva maneuver, and running water, may be employed to elicit detrusor overactivity. The administration of provocative medications during filling, such as bethanechol, is no long employed and are now only of historical interest. Leak point pressures can also be determined to evaluate for stress urinary incontinence and neurogenic bladders. Abnormally elevated pressures encountered during cystometry usually arise from the rectal catheter and may be related to catheter positioning.
 Leak point pressure Cystometrogram Bladder compliance Pressure-volume studies Cystometry

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