Background:

The bladder is a stretchy, muscular pouch that acts as the storage container

for urine. Urine is made by the kidney and then passes down a connecting

tube (ureter) to the bladder. The urinary sphincter acts like a valve to help hold the urine in the bladder and stop it leaking out. When it is time to void (wee), bladder contract, the sphincter relaxes (valve opens) and the urine passes out from the bladder through the urethra. While the bladder is filling with urine, it is relaxing to keep the pressure inside the bladder very low. As the bladder becomes full, its wall becomes stretched. This gives the feeling of needing to go to the toilet. Bladder pressure increases during voiding

to expel all the contained urine.

Who need video-urodynamic study?

Children may need a video-­‐urodynamic study if the information required cannot be gained in any other way. This is often the case in the investigation of a bladder that is high pressure (neurogenic) or ‘leaky (incontinent).

What are the benefits of my child having urodynamic?

The test will help improve the doctor or nurse’s understanding of your child’s incontinence or urinary problem. This can be helpful in deciding the best treatment for your child.

Are there any other alternatives?

It is the only test that can give information about bladder compliance (stretchiness), bladder muscle activity (stability) and actual bladder pressures during filling and emptying.

Suprapubic catheter:

Your child needs to have a supra-pubic catheter inserted before having urodynamic studies.

A suprapubic catheter is a tube that goes into the bladder through the abdominal wall.

A double lumen (channel) cystometry supra-pubic catheter is inserted in theatre under general anaesthetic. The catheter is held in situ by a stitch and a dressing. In some cases the catheter may be held in place by a dressing only. This procedure will be done couple of days before the urodynamic.

Before insertion of a Supra-Pubic Catheter:

The week before the Urodynamic study date, your child need to have urine sample sent to check for urine infection. A catheter would not be inserted if your child has urine infection. The appointment will need to be rescheduled.

After care and catheter management:

• The catheter is held in place with a dressing. THIS MUST NOT BE REMOVED.
• Urine can leak from the insertion site, this is normal. You can reinforce the original dressing with gauze and tape if required.
• Keep the dressing dry. Avoid the bath/shower.
• Avoid sports/activity/rough play until the catheter is removed as it may become dislodged.
• If you notice that the catheter has pulled or is dislodged, please contact our urology CNS.

Potential complications:

• Haematuria (blood in the urine): This is normal after surgical insertion of a catheter and will settle. Also, friction from the catheter rubbing the inside of the bladder can cause pink/rose colour urine. Encourage plenty of water based fluids. If bleeding is excessive or fresh, please contact our urology CNS
• Bladder spasms: due to the catheter tip irritating the trigone, which is the sensitive area at the base of the bladder. Spasm often presents as a sharp gripping pain, which your child may feel in their bottom or penis. Encourage fluids. Contact our urology CNS as your child may require medication to help relax the bladder.
• Bypassing (urine leaking around catheter): A small amount of leak can be normal soon after insertion. Reinforce the original dressing with gauze but if it persists inform our urology CNS.
• Urinary Tract Infection – signs and symptoms may include temperature / tummy or back pain / cloudy or foul smelling urine / generally unwell/vomiting. Your child may require an antibiotic.

Removal of SPC catheter:

• The catheter will be removed immediately after the test by the Urology CNS.
• This is a simple and quick procedure.
• A dressing will be placed over the site and left in place for 24 hours to absorb any urine that may leak.
• You can remove it at home the following day.
• Encourage your child to drink fluids following catheter removal. This helps to promote bladder emptying and help prevent bladder irritation.

How do I prepare my child for the test?

The test will take about two hours. Your child should have one, soft, easy to pass bowel movement daily. If your child is on a special bowel program, please have them complete this the night before the test. Constipation may affect how accurate the test is. Your child should take all medicines as prescribed.

We understand this test may be difficult for your child. A play specialist may be involved to help distract and help your child cope during the test and keep your child comfortable.

Your child will need to be relaxed for the test. We suggest you to talk to your child about this test in ways they can understand. Talk to them about the test, what to expect, why it is needed, what your consultant is trying to learn from this test and how it might help improve your child’s quality of life. This may help them better understand and make testing easier for your child. It is common for some children to leak urine during the test. It is helpful to reassure them before the test that this is nothing to worry about. Reassure your child that you will be with them during the entire test. The more relaxed the parent is, the more relaxed your child will be. By working together, we hope to complete the test with the least amount of stress for you and your child. If you or your child are worried about urodynamic it may be helpful for you to talk to our paediatric urology nurse before the test.

What to bring for the test?

Please bring items you feel will comfort your child. Feel free to bring their favourite comfort item, toy, pacifier or tablet to distract and help your child relax during the test.

Will urodynamic hurt my child?

Your child may experience a little discomfort/ stinging when we inserting the bladder catheters line due to the gel we use which acts as an anaesthetic but this will pass off in seconds. Your child may also experience some discomfort when we are filling the bladder.

How can I prepare for a urodynamic test?

If your child taking any medicines for their bladder they must stop taking them five days before the test. (However, some patients may need to stay on these tablets, your consultant will advise you accordingly).

Examples of such medicines are:

• Oxybutynin tablets or patches (e.g. Ditropan® or Kentera®),

Important information:

You child will be prescribed antibiotic treatment. This treatment is necessary to reduce the risk of your child developing a urinary tract infection.

The treatment is given for three days and is usually Trimethoprim – unless your child has an allergy to this.

The antibiotic treatment must be started 24 hours before the test and completed 5-days course.

During the Test:

Your child will lie on an exam table for the test. The suprapubic catheter already in place will be used. This catheter measures your child’s bladder pressure.

A second type of soft catheter will be placed just inside your child’s rectum. This catheter measures your child’s abdominal pressure and is not painful, but may be uncomfortable. Your child may feel like they need to have a bowel movement.

All tubes will be secured with tape to make sure they stay in place during the test. Once the catheters are inserted they are connected to a special machine and the test begins.

Your child’s bladder will be slowly filled with sterile water or dye. The bladder is filled at a similar rate to how the bladder fills on its own. This dye shows up on X-Ray pictures, which means that the doctor can clearly see your child’s kidneys, bladder and urethra (wee tube). X-Ray pictures will be taken during the test. You and your child will be told when any X-Ray pictures are to be taken.

If your child can talk they may be asked questions about whether they can feel their bladder filling and when they feel like they need to pass urine (wee). To confirm that the test is working properly your child will be asked to cough at regular intervals, if they are able to do so to check that the pressure transducers are working.

After we get the information we need, the nurse will help your child urinate in a bedpan or urinal with all catheters in place. We will need to gather information as your child’s bladder empties. If your child is not able to urinate on their own, the bladder will be emptied by the nurse through the catheter. The catheter may need to be adjusted from time to time during the test to make sure the bladder is completely empty. Sometimes the bladder needs to be refilled more than once to get all the information needed.

The result of the study will be sent to your consultant who will be seeing in our outpatients to discuss in details along with the recommendations.

After the Test:

When the test is complete, all of the tubes and sticky pads will be removed. This does not hurt. Your child may have some burning when they urinate after the test. This is normal and should improve the more often your child urinates and should go away within 24 hours. Make sure your child drinks plenty of fluids of fluids to flush the bladder. If your child is having any pain, you may give Paracetamol as directed for their age and weight. A warm bath or shower may also help if they are having discomfort when they urinate.

There may be some blood in the urine after the test (pink or red in colour). This should clear within 2 hours, and will also be helped by drinking plenty of fluids. If your child develops a high temperature, or has persisting blood stained urine, the wound site looks red, inflamed and feels hotter than the surrounding skin, there is any oozing from the wound, either contact our urology CNS or the consultant PA or attend our urgent care centre.

For further information please contact

We hope that you find this information helpful. If you have any questions or problems either before or after the urodynamic test, please do not hesitate to contact, Clinical Nurse Specialist, Paediatric Urology on 020 7580 4400, 10838 (09:00 – 17:00 Monday to Friday) or email at: [email protected]

For Out of hours: Contact our Paediatric Site Practitioner via the switchboard on: 02075804400 ex 10843

Disclaimer Whilst this leaflet aims to provide you with useful information, it must be noted that it should only act as a guideline. Should you have any further concerns about this procedure, it is advisable that you discuss them with your Consultant.