1. UDS ASSISTANT A Software for Urodynamic Semi-Automated Diagnosis

2. Why a Software ?

In recent years the role of urodynamics in the assessment of lower urinary tract dysfunctions has become contentious

Often the literature is contradictory and lacks adequate evidence, rendering meaningful conclusions difficult

In an attempt to overcome these shortcomings the International Continence Society (ICS) has published a number of standardization reports to guide clinical and research activity .

3. ECG Automated Diagnosis

Electrical spikes & segments

Pressure spikes & segments

4. Algorithms Sources-I

An international urogynecological association (IUGA)/international continence society (ICS) joint report on the terminology for female pelvic floor dysfunction

Bernard T. Haylen

Dirk de Ridder

Robert M. Freeman

Steven E. Swift

Bary Berghmans

Joseph Lee

Ash Monga

Eckhard Petri

Diaa E. Rizk

Peter K. Sand

Gabriel N. Schaer

Neurourol Urodyn 2010

5. Algorithms Sources -II 6. Display 7. Single vs multichannel UDS 8. Quality control procedure before Pressure/Flow study 9. Neurogenic patient 10. Final report ( neurogenic patient ) 11. Algorithms Rationale 12. Flowmetry Analysis Siroky - male < 50 yrs Bristol - male > 50 yrs Liverpool - female 13. Male Free Flow Predictive Value

Unobstructed Qmax >15ml/s

( Warning: 50% may be obstructed High Pressure / High Flow)

Equivocal Qmax10 to15 ml/s

( Warning:70% may be obstructed ; 30% may be unobstructed DU

Obstructed Qmax 200ml check upper tract for dilation

16. Filling Phase (Cystometry) Analysis

Normal tracing

Overactive Bladder

( clinically< 15 cm H20 significant contractions)

Hypersensitive Bladder

( early sensation < 100mlwhithout contractions )

Low Compliance Bladder

( > 10 cmH20 at cystometric capacity)

Yukio Homma ,2007

17. PRESSURE/ FLOW ANALYSIS-Male ICS Nomograms

BOO Index: pdetMax-2Qmax

>40obstructed

20-40equivocal

90 cm H20Hypermobility

between 60 and 90 cm H20Equivocal

50 yrs 63. LiverpoolNomogram Female 64. Male Free Flowmetry Predictive Value

• Question :

• Should all patients with LUTShave pressure-flow studies?

65. DisplaySample 66. Cistometry Display 67. Diagnosis 68. Urethral Function Analysis 69. MalePressure / FlowDisplay 70. FemalePressure / FlowDisplay 71. DisplaySample 72. Neurologic Patient Display 73. Clinical Examples 74.

• Case 1 :42 y.o. active tennis

• player.Two vaginal deliveries.

• She needs pads during matches.

75. Case 2 : 72 y.o. women.Mixed incontinence. Previous hysterectomy & ant. and post. repair. TVT failed 76. Case 4 :62 y.o. man with urgency,frequency,nocturia 77. Conclusions

• The purposeof the software is just to give some skill in interpreting the findings

• The software doesnt substitute in any way the clinical experience

• To get the best from a urodynamic investigation, it is necessary to understand the patients complaint and distinguish clinically significant findings from equipment malfunction.

• The software may ensure consistency between all who carry out urodynamics

• Once validated , it may be an instrument for the assessment of clinical reliabilty ofcurrent urodynamic tests

78. Future Software Developments

• Pediatric Urodynamics

• Options for Treatment

79. Urodynamics in Pediatric Age

• Adjustments for :

• Flowmetry( Liverpool Nomogram )

• Bladder Capacity ( Age x 30 + 30)

• 6 years old boy : 6x30+30 = 210 ml

80. Options for Treatment

• Sources

• EAU Guidelines

• AUA Guidelines

• ICIGuidelines

• Cochrane Reviews

• NICE Reviews

• High IF articles ,ecc..

81. 82. 83. 84. 85. 86.