0022-5347 /79/1225-0788$02.00/0 VoL 122, December Printed in U.S.A.
THE JOURNAL OF UROLOGY
Copyright© 1979 by The Williams & Willdns Co.
A SIMPLE INEXPENSIVE URODYNAMIC CATHETER JEFFREY R. WOODSIDE*
AND
EDWARD J. McGUIRE
From the Divisions of Urology, Departments of Surgery, University of New Mexico School of Medicine, Albuquerque, New Mexico, and Yale University School of Medicine, New Haven, Connecticut
ABSTRACT
Described herein is an easily constructed and inexpensive triple lumen urodynamic catheter. The catheter permits accurate and reproducible simultaneous measurements of urethral and bladder pressure. Measurement of urethral and bladder pressures is an integral part of a complete urodynamic investigation. Various recording techniques have been reported, including open catheter perfusion, 1 fluid-filled balloons, 2 microtransducers 3 and membrane catheters.' Open catheter perfusion was popularized by Brown and Wickham 5 and our technique is based on their original description. A urodynamic investigation in our laboratories includes urethral pressure profile determination, external sphincter electromyographic studies and simultaneous bladder and urethral pressures with fluoroscopic voiding cystourethrography. 6 For several years our perfused catheters were 2, SF infant feeding tubes: 1 for bladder filling and determination of bladder pressure and 1 for determination of urethral pressure. However, bladder filling was quite slow, both hands were required to manipulate the catheters and the catheters frequently became entangled during withdrawal of 1 catheter for urethral pressure profile determination. We herein describe an easily made and inexpensive triple lumen urodynamic catheter that eliminates these inconveniences.
- 100 cm. water per second pressure increase, with complete occlusion of the aperture. 7 The completed triple lumen catheter measures llF (fig. 2). A urodynamic study is performed by perfusing the urethral and bladder pressure channels at 4 ml. per minute with a constant infusion syringe pump. Pressures are measured by Statham pressure transducers and recorded on a Grass polygraph. The bladder is filled with a radiographic contrast agent contained in a plastic intravenous bag. A blood pump surround-
ifri
C
yy ''"---------------------~-----'
8cm
2cm
FIG. 1. Schematic of distal 15 cm. of catheter. a, unmodified bladder filling tube. b, bladder pressure tube with heat-sealed end (darkened area). c, urethral pressure tube. d, metal staple (radiographic marker). MATERIALS AND METHODS
Commercially available 5F infant feeding tubes are used.t The polyvinyl tubes are 15 inches long and have 2 distal drainage holes, each 1 mm. in diameter. One tube is unmodified and used for bladder filling (fig. 1, a). The other 2 tubes are used for perfused pressure determinations. The end of each of these tubes is cut off through the distal drainage hole and smoothly heat-sealed with a flame. A small amount of Eastman 910 adhesive is used to bond the tubes together.:j: We find it is most easily applied to the side of the bladder filling tube with a straightened paper clip. The first pressure tube is then bonded by placing its perfusion aperture 2 cm. proximal to the tip of the filling tube (fig. 1, b). Similarly, the second pressure tube is Accepted for publication March 2, 1979. * Requests for reprints: Division of Urology, University of New Mexico School of Medicine, 2211 Lomas, N. E., Albuquerque, New Mexico 87131. t Cutter Laboratories, Inc., Berkeley, California, 94710. t Eastman Chemical Products, Inc., Kingsport, Tennessee 37662.
FIG. 2. Triple lumen urodynamic catheter 788
SIMPLE INEXPENSIVE URODYNAMIC CATHETER
FIG. 3. a, pelvic floor electromyograph, urethral and bladder pressure (cm. sphincter dyssynergia. b, radiograph shows radiographic marker (arrow) at area of
ing the bag enables bladder filling at 60 ml. per minute. Platinum-tipped electromyograph needle electrodes are placed in the external urethral sphincter. In the usual test the urethral pressure profile is determined and the urethral perfusion aperture is then placed at the external urethral sphincter. Simultaneous urethral and bladder pressures are recorded as the bladder fills and during micturition (fig. 3). The metal staple readily allows anatomical localization of the urethral perfusion aperture.
recording in 52-year-old male paraplegic shows detmsorurethral sphincter.
accurate and easily constructed urodynamic catheter, REFERENCES
J.: The urethral pressure profile: theoretical considerations and clinical application. Brit. J. Urol., 46: 325, 1974. Drouin, G. and McCurry, E. M.: Catheters for studies of urinary tract pressure. Invest. Urol., 8: 195, 1970. Yalla, S. V., Rossier, A. B., Fam, B. and Gabilondo, F. B.: Dual pressure transducer catheter for evaluating vesicourethral function. Experiences in patients with neurogenic bladder. Urology, §: 160, 1976. Tanagho, E. A and Jonas, U.: Membrane catheter. Effective for recording pressure in lower urinary tract. Urology, Hl: 173, 1977. Brown, M. and Wickham, J. E. A.: The urethral pressure profile. Brit. J. Urol., 41: 211, 1969. McGuire, E. J., Wagner, F. M. and Weiss, R. M.: Treatment of autonomic dysreflexia with phenoxybenzamine. J. Urol., 115: 53, 1976. Meunier, P. and Mollard, P.: Urethral pressure profile in children: a comparison between perfused catheters and micro-transducers, and a study of the usefulness of urethral pressure profile measurements in children. J. Urol., 120: 207, 1978.
1. Edwards, L. and Malvern,
2. 3.
COMMENT
We have obtained accurate and reproducible results in >50 urodynamic studies performed with this new catheter. Girls as young as 3 years old and 7-year--old boys have been studied successfully, The flexible tip of the bladder filling channel makes catheter insertion easy and atraumatic, The adhesive has maintained its bond through multiple immersions. A most attractive feature is that the total material cost is $0.96, a price far exceeded by the least expensive of any commercially available urodynamic catheter. Approximately 20 minutes are required for its assembly. We highly recommend this inexpensive,
789
4. 5. 6. 7.
THE JOURNAL OF UROLOGY
Copyright© 1979 by The Williams & Willdns Co.
A SIMPLE INEXPENSIVE URODYNAMIC CATHETER JEFFREY R. WOODSIDE*
AND
EDWARD J. McGUIRE
From the Divisions of Urology, Departments of Surgery, University of New Mexico School of Medicine, Albuquerque, New Mexico, and Yale University School of Medicine, New Haven, Connecticut
ABSTRACT
Described herein is an easily constructed and inexpensive triple lumen urodynamic catheter. The catheter permits accurate and reproducible simultaneous measurements of urethral and bladder pressure. Measurement of urethral and bladder pressures is an integral part of a complete urodynamic investigation. Various recording techniques have been reported, including open catheter perfusion, 1 fluid-filled balloons, 2 microtransducers 3 and membrane catheters.' Open catheter perfusion was popularized by Brown and Wickham 5 and our technique is based on their original description. A urodynamic investigation in our laboratories includes urethral pressure profile determination, external sphincter electromyographic studies and simultaneous bladder and urethral pressures with fluoroscopic voiding cystourethrography. 6 For several years our perfused catheters were 2, SF infant feeding tubes: 1 for bladder filling and determination of bladder pressure and 1 for determination of urethral pressure. However, bladder filling was quite slow, both hands were required to manipulate the catheters and the catheters frequently became entangled during withdrawal of 1 catheter for urethral pressure profile determination. We herein describe an easily made and inexpensive triple lumen urodynamic catheter that eliminates these inconveniences.
- 100 cm. water per second pressure increase, with complete occlusion of the aperture. 7 The completed triple lumen catheter measures llF (fig. 2). A urodynamic study is performed by perfusing the urethral and bladder pressure channels at 4 ml. per minute with a constant infusion syringe pump. Pressures are measured by Statham pressure transducers and recorded on a Grass polygraph. The bladder is filled with a radiographic contrast agent contained in a plastic intravenous bag. A blood pump surround-
ifri
C
yy ''"---------------------~-----'
8cm
2cm
FIG. 1. Schematic of distal 15 cm. of catheter. a, unmodified bladder filling tube. b, bladder pressure tube with heat-sealed end (darkened area). c, urethral pressure tube. d, metal staple (radiographic marker). MATERIALS AND METHODS
Commercially available 5F infant feeding tubes are used.t The polyvinyl tubes are 15 inches long and have 2 distal drainage holes, each 1 mm. in diameter. One tube is unmodified and used for bladder filling (fig. 1, a). The other 2 tubes are used for perfused pressure determinations. The end of each of these tubes is cut off through the distal drainage hole and smoothly heat-sealed with a flame. A small amount of Eastman 910 adhesive is used to bond the tubes together.:j: We find it is most easily applied to the side of the bladder filling tube with a straightened paper clip. The first pressure tube is then bonded by placing its perfusion aperture 2 cm. proximal to the tip of the filling tube (fig. 1, b). Similarly, the second pressure tube is Accepted for publication March 2, 1979. * Requests for reprints: Division of Urology, University of New Mexico School of Medicine, 2211 Lomas, N. E., Albuquerque, New Mexico 87131. t Cutter Laboratories, Inc., Berkeley, California, 94710. t Eastman Chemical Products, Inc., Kingsport, Tennessee 37662.
FIG. 2. Triple lumen urodynamic catheter 788
SIMPLE INEXPENSIVE URODYNAMIC CATHETER
FIG. 3. a, pelvic floor electromyograph, urethral and bladder pressure (cm. sphincter dyssynergia. b, radiograph shows radiographic marker (arrow) at area of
ing the bag enables bladder filling at 60 ml. per minute. Platinum-tipped electromyograph needle electrodes are placed in the external urethral sphincter. In the usual test the urethral pressure profile is determined and the urethral perfusion aperture is then placed at the external urethral sphincter. Simultaneous urethral and bladder pressures are recorded as the bladder fills and during micturition (fig. 3). The metal staple readily allows anatomical localization of the urethral perfusion aperture.
recording in 52-year-old male paraplegic shows detmsorurethral sphincter.
accurate and easily constructed urodynamic catheter, REFERENCES
J.: The urethral pressure profile: theoretical considerations and clinical application. Brit. J. Urol., 46: 325, 1974. Drouin, G. and McCurry, E. M.: Catheters for studies of urinary tract pressure. Invest. Urol., 8: 195, 1970. Yalla, S. V., Rossier, A. B., Fam, B. and Gabilondo, F. B.: Dual pressure transducer catheter for evaluating vesicourethral function. Experiences in patients with neurogenic bladder. Urology, §: 160, 1976. Tanagho, E. A and Jonas, U.: Membrane catheter. Effective for recording pressure in lower urinary tract. Urology, Hl: 173, 1977. Brown, M. and Wickham, J. E. A.: The urethral pressure profile. Brit. J. Urol., 41: 211, 1969. McGuire, E. J., Wagner, F. M. and Weiss, R. M.: Treatment of autonomic dysreflexia with phenoxybenzamine. J. Urol., 115: 53, 1976. Meunier, P. and Mollard, P.: Urethral pressure profile in children: a comparison between perfused catheters and micro-transducers, and a study of the usefulness of urethral pressure profile measurements in children. J. Urol., 120: 207, 1978.
1. Edwards, L. and Malvern,
2. 3.
COMMENT
We have obtained accurate and reproducible results in >50 urodynamic studies performed with this new catheter. Girls as young as 3 years old and 7-year--old boys have been studied successfully, The flexible tip of the bladder filling channel makes catheter insertion easy and atraumatic, The adhesive has maintained its bond through multiple immersions. A most attractive feature is that the total material cost is $0.96, a price far exceeded by the least expensive of any commercially available urodynamic catheter. Approximately 20 minutes are required for its assembly. We highly recommend this inexpensive,
789
4. 5. 6. 7.
