Cystometry, Pressure Flow Study and Urethral Pressure Measurement

  • Jian Guo Wen
Part of the Urodynamics, Neurourology and Pelvic Floor Dysfunctions book series (UNPFD)


Cystometry, pressure flow study (PFS) and urethral pressure profile (UPP) are core contents of paediatric urodynamic studies (PUDS) which are becoming an increasingly popular tool to evaluate the lower urinary tract dysfunction (LUTD)/lower urinary tract symptoms (LUTS) in children with congenital or acquired malformations such as neurogenic bladder, vesicoureteric reflux, urinary tract infection, urge syndrome, nocturnal enuresis, urinary incontinence and anorectal malformations. The aims of these tests are to reproduce symptoms, to identify the underlying causes for symptoms and to quantify related pathophysiological processes. Cystometry is mainly used to evaluate bladder function of the filling phase and PFS for voiding phase. UPP is used to monitor urethral function (sphincter function), but its clinical application is limited. Instead, simultaneous bladder and urethral pressure measurement for evaluating urethral dynamic function is encouraging. However, it must be realized these studies are invasive and artefacts may occur and influence the correct interpretation of the results. Infants and children have a different spectrum of bladder dysfunctions from adults and are generally much less cooperative during a urodynamic study. The normal urodynamic parameters, such as bladder capacity, change with age. Therefore, cystometry, PFS and UPP operation need more gentle, and results interpretation need more carefully. This chapter will introduce how to perform the procedures, and emphasis will be placed on correctly setting up the equipment according to ICS and ICCS guidelines, correct terminology, indications for performing, as well as how to interpret results. Cystometry in combination with fluoroscopy which is referred to as a video-urodynamic study will not be covered in this report.


Cystometry Pressure Flow Voiding Urethral Bladder Detrusor Dysfunction Sphincter Children 


  1. 1.
    Wen JG, Lu YT, Cui LG, Bower WF, Rittig S, Djurhuus JC. Bladder function development and its urodynamic evaluation in neonates and infants less than 2 years old. Neurourol Urodyn. 2015;34(6):554–60.CrossRefPubMedGoogle Scholar
  2. 2.
    Austin PF, Bauer SB, Bower W, Chase J, Franco I, Hoebeke P, Rittig S, Walle JV, von Gontard A, Wright A, Yang SS, Nevéus T. The standardization of terminology of lower urinary tract function in children and adolescents: update report from the standardization committee of the international Children’s continence society. Neurourol Urodyn. 2016;35(4):471–81. [Epubahead of print] PubMed PMID: 25772695.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Austin PF, Bauer SB, Bower W, Chase J, Franco I, Hoebeke P, Rittig S, VandeWalle J, von Gontard A, Wright A, Yang SS, Nevéus T. The standardization of terminology of lower urinary tract function in children and adolescents: update report from the standardization Committee of the International Children’s continence society. J Urol. 2014;191:1863–5.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Lose G. Urethral pressure measurement. Acta Obstet Gynecol Scand Suppl. 1997;166:39–42.PubMedGoogle Scholar
  5. 5.
    Wen JG, Yeung CK, Djurhuus JC. Cystometry techniques in female infants and children. Int Urogynecol J Pelvic Floor Dysfunct. 2000;11:103–12.CrossRefPubMedGoogle Scholar
  6. 6.
    Bauer SB, Nijman RJ, Drzewiecki BA, Sillen U, Hoebeke P. International Children’s continence society standardization report on urodynamic studies of the lower urinary tract in children. Neurourol Urodyn. 2015;34:640–7.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Goldstein RE, Westropp JL. Urodynamic testing in the diagnosis of small animal micturition disorders. Clin Tech Small Anim Pract. 2005;20:65–72.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Groen J, Pannek J, Castro Diaz D, Del Popolo G, Gross T, Hamid R, Karsenty G, Kessler TM, Schneider M, ‘t Hoen L, Blok B. Summary of European Association of Urology (EAU) guidelines on Neuro-urology. Eur Urol. 2016;69(2):324–333. pii: S0302-2838(15)00740-X. Scholar
  9. 9.
    Maizels M, Weiss S, Conway JJ, Firlit CF. The cystometric nuclear cystogram. J Urol. 1979;121:203–5.CrossRefPubMedGoogle Scholar
  10. 10.
    Sfakianakis GN, Smuclovisky C, Strauss J, Hourani M, Lockhart G, Zilleruelo G, Freundlich M, Gorman H, Politano V, Serafini A. Improving the technique of nuclear cystography: the manometric approach. J Urol. 1984;131:1061–4.CrossRefPubMedGoogle Scholar
  11. 11.
    Andersson S, Bjerle P, Hentschel J, Kronström A, Niklasson U. Continuous and stepwise cystometry through suprapubic catheters--effect of infusion pattern and infusion rate on the cystometrogram of the normal human bladder. Clin Physiol. 1989;9:89–96.CrossRefPubMedGoogle Scholar
  12. 12.
    Sørensen SS, Nielsen JB, Nørgaard JP, Knudsen LM, Djurhuus JC. Changes in bladder volumes with repetition of water Cystometry. Urol Res. 1984;12:205–8.CrossRefPubMedGoogle Scholar
  13. 13.
    Chin-Peuckert L, Rennick JE, Jednak R, Capolicchio JP, Salle JL. Should warm infusion solution be used for urodynamic studies in children. J Urol. 2004;172:1657–61.CrossRefPubMedGoogle Scholar
  14. 14.
    Chapple CR, MacDiamid SA, Patel A. Urodynamics made easy. Third ed. London: Elsevier Churchill Livngstone. p. 83–102. ISBN:978-0-443-06886-7.Google Scholar
  15. 15.
    Wen JG, Tong EC. Cystometry in infants and children with no apparent voiding symptoms. Br J Urol. 1998;81:468–73.CrossRefPubMedGoogle Scholar
  16. 16.
    Wen JG, Yeung CK, Chu WC, Shit FK, Metreweli C. Video cystometry in young infants with renal dilation or a history of urinary tract infection. Urol Res. 2001;29:249–55.CrossRefPubMedGoogle Scholar
  17. 17.
    Harrison NW. The urethral pressure profile. Urol Res. 1976;10(4):95–100.Google Scholar
  18. 18.
    Park JM, Bloom DA, McGuire EJ. The guarding reflex revisited. Br J Urol. 1997;80:940–5.CrossRefPubMedGoogle Scholar
  19. 19.
    MacLachlan LS, Rovner ES. Good urodynamic practice: keys to performing a quality UDS study. Urol Clin North Am. 2014;41(3):363–73.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Jian Guo Wen
    • 1
    • 2
  1. 1.Pediatric Urodynamic CenterFirst Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
  2. 2.Pediatric Surgery and UrologyFirst Affiliated Hospital of Xinxiang Medical UniversityXinxiangChina

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