Typical Value Ranges and Typical Signal Patterns in the Initial Cough in Patients With Neurogenic Bladder: Quality Control in Urodynamic Studies

Abstract

PurposeThe goal of this study was to establish typical value ranges (TVRs) and to analyze typical signal patterns (TSPs) of the initial cough (cough before bladder filling) for quality control in urodynamic studies.MethodsA total of 539 urodynamic traces from patients with neurogenic bladder obtained over the course of a year were retrospectively reviewed. The TVRs for cough amplitude in measurements of the intravesical pressure (Pves), abdominal pressure (Pabd), and detrusor pressure (Pdet) during the initial cough were established. We used the 95% range as a reference range for all parameters. Cough spikes in Pdet were described and classified, and the reasons for different patterns of cough spikes were established. The quality of all the cystometry traces was checked, and we also present remedial actions for inappropriate cough spikes.ResultsThe cough amplitudes in the measurements of Pves and Pabd were similar, with 95% of measurements falling within the following ranges: 4–62 cm H2O and 3–70 cm H2O, respectively, in supine position and 9–95 cm H2O and 8–98 cm H2O, respectively, in sitting position. For Pdet, the cough amplitude ranged from −38 to 25 cm H2O in supine position and from −44 to 41 cm H2O in sitting position. The cough spikes for Pdet were classified as follows: type I, Pdet pressure exhibited a minimal change (<5 cm H2O) during the cough; type II, a monophasic spike (>5 cm H2O) was observed for Pdet; and type III, biphasic spikes were observed for Pdet. Type I coughs were found to have more high-quality traces (P<0.01).ConclusionsTVRs for the initial cough test among neurogenic patients were established in order to provide guidelines for quantitative quality control. The TSPs for the initial cough signal were described, and the presence of a high-quality cough signal may be recommended as a component of quality control in urodynamic measurements.

Typical value ranges and signal patterns in patients with neurogenic bladder: Quality control in urodynamics using an air‐charged catheter system

“…In patients with NB in the initial resting state, the 95% range of the p ves and p abd in the supine and sitting positions were 3-27 and 16-46 cmH 2 O, respectively, which were higher than sitting position measurements (5-30 cmH 2 O) previously reported. 5 Similarly, the mean resting state p ves and p abd in the supine position were higher than non-neurogenic patients (11.6 vs 7.3 cmH 2 O and 11.6 vs. 7.0 cmH 2 O, respectively). 6 The above studies have reported the results measured using the WFC system, but the ACC system was used in the current study.…”

“…Therefore, as in our previous research, we defined a p det = 5 cmH 2 O as the threshold value for cough signal classification. 2,5 All cough waveforms with a p det change <5 cmH 2 O are classified as type I; thus, if the type I cough signal is obtained at the beginning of the examination, a high-quality pressure transmission is most likely. Therefore, we suggest that the type I cough signal obtained before bladder filling should be taken as a reasonable standard when using the ACC system for urodynamic measurement.…”

Performance of Urodynamics During the COVID-19 Pandemic: A Questionnaire Survey

“…Lu et al have concluded in his 539 urodynamic trace analysis that high-quality traces were observed with type I initial good quality coughs (P<0.01) and if this cough signal is obtained at the time of calibration, it will be likely observed later on during the test resulting in greater and more accurate results as a reasonable standard. 13 In 2003, Sullivan et al were the first to explore and propose a grading system for the quality of coughs. 12 Sulivan et al divided coughs into grade A, B or C depending on the signal amplitude change they create on the urodynamics trace (>100, 80-99 and 50-79 cmH20 for each grade respectively).…”

Can rectal catheters be avoided during paediatric urodynamic studies?

“…Normal saline solution (0.9%) at room temperature [10] was instilled in a retrograde manner, with physiological filling rate calculated as weight (in kg) divided by 4. At the beginning of the filling phase and at regular intervals, the child was instructed to cough to ensure that the abdominal and vesical pressure lines were balanced, when possible [11].…”

“…In all, 115 paediatric UDS were reviewed, which included 86 boys and 29 girls ( Table 1). The median (interquartile range) age of the children was 12 (8)(9)(10)(11)(12)(13)(14)(15) years. Neurogenic bladder was the commonest indication for UDS (56 children), followed by posterior urethral valves (PUVs; 41 children).…”