Urodynamics Testing

Conditions for Urodynamics

• Conditions for Which Urodynamics May Be Used

  • Spina bifida
  • Colorectal and pelvic floor abnormalities
  • Bladder exstrophy or epispadias
  • Cloacal exstrophy
  • Posterior urethral valves
  • Other conditions affecting the brain or spinal cord causing urinary symptoms
  • Recurring febrile urinary tract infections
  • Unexplained urinary incontinence
  • Difficulty toilet training

Types of Tests

• Types of Urodynamics Tests

  Your child's healthcare provider will evaluate his or her situation and determine which urodynamics tests may be appropriate. Tests include:

  • Uroflowmetry (Uroflow) – How fast your child pees
  • Electromyelogram (EMG) – How well the pelvic floor muscles (muscles that help hold in urine) work
  • Cystometrogram (CMG) – Tests if your bladder stores urine at normal pressures and how well your child senses a full bladder
  • Voiding pressure study – How fast your child pees and with what pressure
  • Postvoid residual (PVR) – If your child empties their bladder after peeing
  • Video fluoroscopy – A real-time X-ray study is performed while putting contrast fluid into the bladder. It shows the shape of the bladder, bladder neck and urethra during filling and emptying. It can also diagnose backflow of urine to the kidneys called “vesicoureteral reflux” which is one cause of urinary tract infections.

Urodynamics at Children's National

• Who Performs the Test?

  Urodynamics testing is always performed by at least two experienced advanced practice providers (a nurse practitioner or a physician assistant) who are specially trained in performing urodynamics, as well as using positive distraction techniques to help your child remain comfortable during the study. Should your child need additional support during the study, a child life specialist is available upon request.
  
  Your doctor is typically not present during the actual study, but he or she will help read and interpret the results and formulate a plan tailored to your child’s needs.

  See who is on our Urodynamics team.

• What Should You Bring and How Do You Prepare for the Test?

  Your child may eat or drink before the test. We recommend that you bring the following to help your child on the day of the study:

  • Drinks or snacks
  • Soothing aids such as a pacifier and stuffed animal
  • Distraction items
  • Cell phone, iPad or tablet to listen to music or watch videos
  • Books your child likes to read

  It is important to give your child all prescribed medications on the day of the test. If your child is taking Ditropan (Oxybutynin Chloride) or any other medicines for their bladder, please give these medicines as prescribed. Do not skip these medicines the morning of the test, as this will alter the results.
  
  If your child catheterizes, continue with current clean intermittent catheterization (CIC) regimen on the day of the test. Please take note of your catheter type and size. For two days prior to the study, measure and record the amount of urine that drains with each routine catheterization and bring the day of the study.
  
  If your child has a fever (greater than 100.4F) or symptoms of a urinary tract infection, call the Urology office at 202-476-5042 as soon as possible to discuss with the nurse/nurse practitioner. The study may need to be rescheduled for when your child is well to obtain the most accurate results.
  
  Siblings will not be allowed in the testing area during video urodynamics, so please plan childcare accordingly.

• How Can You Talk to Your Child About the Test?

  You can reassure your child that he or she will receive excellent care throughout the urodynamics study with us. Be sure to let your child know that:

  • You will be with your child the entire time (or the caregiver who is present).
  • No needles are used for the study.
  • A small tube will be placed in the bladder to get pee out.
  • Another small, thin tube will be placed in the bottom.
  • Catheter insertion may be uncomfortable in some situations, and your child may feel the need to go to the bathroom; but staying relaxed during insertion helps it go quickly and smoothly.
  • It may feel weird to pee during the study, but try your best to relax and let it happen.

  Check out our Patient Preparation Guides for the urodynamics and video urodynamics tests, which uses pictures and child-friendly language to walk through what to expect the day of the study. 

• Where Do You Go and When Should You Arrive?

  The Urology Clinic is located on the 4th Floor of the main hospital building at Children’s National Hospital, 111 Michigan Ave NW, Washington DC 20010.

  • Please arrive 30 minutes early to register and prepare.
  • Testing takes 90 minutes to complete.
  • If you arrive late by 15 minutes or more, we may ask you to reschedule.
  • If you cannot come, please call 202-476-2162 to let us know.

• What Happens During the Test?

  The Set Up

  • A thin tube (catheter) is inserted into your child’s bladder to fill the bladder and measure pressure in the bladder.
  • A thin tube (transducer) is inserted into your child’s rectum to measure abdominal pressure. This is important because abdominal pressure can influence the bladder pressures.
  • Monitor stickers are placed on your child’s hip and on either side of the bottom to measure muscle activity.
  • The tubes and wires are connected to a computer which organizes and stores the information from the study.

  *No needles are used during the study.
  
  During the Study

  • The genitalia area is cleansed.
  • The catheter, thin rectal tube and stickers are placed.
  • The bladder is emptied of urine.
  • The bladder is slowly filled with a fluid called normal saline (for non-video) or a type of fluid X-ray dye called Cysto-Conray solution (for video) until your child leaks urine or feels the urge to urinate.
  • For video urodynamic testing: X-rays are taken of the bladder during parts of the filling of fluids and urinating.
  • When your child finishes urinating, the catheters are removed, and the test is over.

• How Do You Receive Your Child's Test Results?

  The results will not be discussed with you on the day of the study, as the study will need to be carefully read and interpreted by a urologist. The results and any recommendations will be discussed in a follow up visit in-person or via telehealth (video visit).