Patient Instructions for Urodynamic Testing 1. Please arrive for your tests with a comfortably full bladder. Make sure you DO NOT use the bathroom to ...
Patient Instructions for Urodynamic Testing 1. Please arrive for your tests with a comfortably full bladder. Make sure you DO NOT use the bathroom to empty your bladder. You will do that first thing for the uroflow test in the testing room. 2. Please complete the Bladder Questionnaire enclosed in this packet and bring it with you to your appointment. 3. For a 48 hour period of your choosing, please complete the “Bladder Diary” and bring that with you to give to your urodynamics nurse practitioner at your appointment. 4. Do not take laxatives the day of or the day before the test. 5. Usually we require that you stop any medication given to you for bladder control or emptying problems 48 hours before the test. Common medications include: Detrol La, Ditropan XL, Enablex, Gelnique, Oxybutinin, Oxytrol, Sanctura XR or Vesicare. Check with the physician ordering the test to verify if this is desired. 6. Make sure you know the charges and the co-payments for which you are responsible in advance of the test appointment. Our office staff and insurance department can help you obtain this information. 7. The test is elaborate and takes about one hour to complete. It employs a specially trained nurse practitioner and a physician. We use sophisticated computer systems and equipment in specialized urodynamic laboratories. Time slots for these procedures are in great demand and there is often a waiting time until your study can be scheduled. Should you need to cancel your studies, please attempt to notify us at least 48 hours in advance so that other patients can be scheduled in that appointment period. Please call the office where your study is scheduled and let them know if you need to make a change. 8. We request that patients arrive 15 minutes before your scheduled urodynamic test. Be aware that repeated testing is occasionally required to demonstrate and better understand the disease process affecting your bladder function. This can prolong the time of the examination. 9. Please call to reschedule if you are having your menstrual period, diarrhea, or other bowel issues (call us for questions). 10. You may eat and drink the day of your test, as stated above in number 1, just arrive for your testing with a comfortably full bladder.
BLADDER HEALTH QUESTIONNAIRE Please bring this form with you on the day of your appointment
How often do you urinate during the day/evening? _________________________________ How often do you get up at night to urinate? ____________________________________ When did your bladder problems begin? _______________________________________ Do you experience urgency where you feel like you might not make it to the bath room in time? YES NO Do you have pain when your bladder is full? YES NO Can you postpone emptying your bladder easily? YES NO Do you lose urine when: You are lying down asleep? YES NO You sneeze, cough, jump, run or laugh? YES NO You get up from a sitting position? YES NO You hear, see or feel running water? YES NO You can’t get to the bathroom on time? YES NO You don’t even know it? YES NO Do you wear pads for urinary leakage? YES NO If yes, how many pads do you use per day? _______________________________ Do you have difficulty starting your urine stream? YES NO How do you start your urine stream? Easy________ Push/Strain_______ Wait less than 1 min ___ Wait more than 1 min ____ Do you have pain when emptying your bladder? YES NO When urinating, can you stop your stream? YES NO Do you feel you completely empty your bladder? YES NO Do you notice dribbling of urine after emptying your bladder? YES NO Have you ever had a catheter placed in your bladder because you were unable to empty your bladder? YES NO Have you ever had your urethra dilated or stretched? YES NO Have you ever passed blood in your urine? YES NO
Have you ever had a kidney or bladder stone? Have you been treated for 3 or more urinary tract infections? Have you had a UTI infection within the last 6 months?
YES NO YES NO YES NO
Do you leak gas or stool? YES NO Are you constipated? YES NO How many pregnancies have you had? ________________________________________ Vaginal deliveries___________________ C-Sections _______________________ Miscarriages ___________________ Abortions _______________________ What treatments for your bladder have you tried in the past? Kegel exercises __________________ Pessary Insertion ___________________ Fluid restriction __________________ Collagen Injections _________________ Medications – list them: ______________________________________________ Surgery- (list below) __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ List all medications you have been taking over the last 6 months including all over the counter medications and vitamins. ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ List all of the surgeries you have had and the dates of each. ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Do you have any of the following? Please circle all that apply: Heart problems High blood pressure Arthritis
Multiple sclerosis Asthma Back injury
Diabetes Stroke Other
BLADDER DIARY Please bring this form with you on the day of your appointment
This diary is a chart for you to report the amount you drink and when you urinate (empty your bladder). List all fluid intake and every time you urinate. It is important to also list any time you feel you are leaking urine. Please complete this form for any 48 hour period prior to your appointment.
Name:____________________________________________________________ Dates:_______________________________ Time
Fluid Intake (Please list type of fluid and approx how much, Ex. 1 glass, 2 glasses)
Bladder emptied (Place a checkmark in column)
Did you experience leaking prior to Urination? D= Drops M=Medium S= Soaked
Activity immediately prior to leaking?
Time
Fluid Intake (Please list type of fluid and approx how much, Ex. 1 glass, 2 glasses)
Bladder emptied (Place a checkmark in column)
Did you experience leaking prior to Urination? D= Drops M=Medium S= Soaked
