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Urodynamic investigations are used to investigate bladder function and dysfunction in women with urinary symptoms, the most common being urinary incontinence. Guidance from the National Institute for Health and Clinical Excellence covers much of when investigations should be performed. Women are often anxious and embarrassed when they attend the tests. Recognition of the artificial test conditions and the feelings of the woman are crucial to optimising the chances of reproducing symptoms. Before cystometry, written information explaining the test should be provided with the appointment letter or when the woman attends the clinic. The information should include instructions on providing a urine sample in a sterile container, bladder chart and questionnaires and advice to come with a comfortably full bladder. Women who are using drugs to treat lower urinary tract dysfunction should normally stop using the medication for an appropriate period of time before the investigation.
The bladder diary is an important tool in the investigation of patients with lower urinary tract symptoms and voiding dysfunction. There are different methods for recording information on voiding patterns. A frequency-volume chart is the simplest method and collects information on volumes voided and micturition times. A voiding or bladder diary provides a more detailed record. The paper diary is the most common as it is easy to produce and store, inexpensive and convenient to post or hand directly to the patient. The electronic bladder diary such as the UroDiary uses an intelligent character recognition programme and calculates a centile ranking for results, correcting for age and 24-hour voided volume. Bladder diaries are more accurate than recall when recording urinary symptoms. The bladder diaries guide many aspects of conservative treatment, especially timing and types of fluids.
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