Video urodynamics (VUD) – in children

Introduction

Your child’s urology team has advised that your child undergoes an investigation called ‘video urodynamics’ (VUD) to help gain a better understanding about how your child’s bladder is working. This leaflet provides information on why this investigation is being recommended, what VUD involves and what to expect in order to supplement the advice you have already been given by the care team at Addenbrookes Hospital.

What is Video urodynamics (VUD)?

Video Urodynamics involves filling the bladder, through a small catheter (tube) that is passed into the bladder, and then recording pressures and video images of the bladder during its filling and emptying. VUD is therefore a test that helps assess bladder function; it investigates how the muscles in the bladder and urethra (the tube you pass urine through) work. By measuring the pressure inside the bladder we can be helped to understand what signals the bladder may or may not be receiving from the spinal nerves.

Some children already use a catheter to help the bladder to drain and they can have VUD performed as an outpatient. They would come directly to the fluoroscopy department and leave again once the investigation has been completed. Young children who do not already use a catheter to help their to bladder drain can often have the catheter passed as part of the outpatient investigation. Older children, however, will usually be admitted to one of our children’s wards, prior to VUD, so that the catheter can be inserted under general anaesthetic whilst the child is asleep.

Preparing your child for video urodynamics

When your child will have the catheters placed immediately before VUD in the fluoroscopy department:

• You will be contacted by our team’s medical secretarial team to arrange a date for VUD
• A urine test to check for infection should be completed one week before the VUD test. You will be provided with instructions for this at the time of the test being booked.
• Your child can eat and drink as normal before their test.
• If your child uses catheters at home to drain their bladder, please bring supplies for your child’s catheter with you and, if your child has a type of stoma called a colostomy or ileostomy (to drain stool from the bowel); please bring spare stoma bags to the appointment
• Any medication for bladder symptoms needs to be stopped for one week before the test
• Please note that anyone who is pregnant is not able to be present in the room in which VUD takes place due to x-ray radiation.
• You must inform the team if your child has any kind of pace maker, a neurosurgical shunt or any other implanted foreign body. You must also inform the care team if your child has a previous or current MRSA infection.

When the plan is for your child to have the catheter passed under general anaesthetic:

• You will be contacted by a member of our booking team to arrange a date for admission for the catheter to be inserted (usually one to three days prior to the test) and then also a date for the VUD.
• A urine test to check for infection should be completed one week before the VUD test. You will be provided with instructions for this at the time of the test being booked.
• Your child will need to stop eating and drinking before the procedure. Details of this will be given in your confirmation letter.
• Whilst your child is asleep receiving general anaesthetic, a minor operation is performed to insert a catheter with two channels inside it, into the bladder through the abdominal (tummy) wall. This type of catheter is called a suprapubic catheter. Sometimes a small camera (called a ‘cystoscope’) is passed through the urethra and into the bladder during the same anaesthetic in order to directly visualise the bladder and look for any abnormalities.
• After the catheter has been inserted under anaesthetic, you can be with your child in the recovery area and once your child is fully awake, your child will return to the ward to continue their recovery. Your child will then be able to drink and eat again.
• Depending on the timing between catheter insertion under anaesthetic and VUD, your child may stay overnight or go home and return for the VUD. Until the VUD takes place, the catheters will be coiled up next to your child’s skin and covered with a dressing. Your child should keep this dressing clean and dry until the scan has been completed. No baths or showers are permitted.
• Your child may feel uncomfortable after this procedure but can take pain killers (such as paracetamol or ibuprofen unless you have been told otherwise).
• Your child should be encouraged to drink plenty of fluid.
• If you are going home and returning on a different day for VUD, one of the nurse specialists will see you before you go home to provide guidance on care at home.
• Please note that anyone who is or may be pregnant is not able to be present in the room in which VUD takes place due to x-ray radiation.
• You must inform the team if your child has any kind of pace maker, a neurosurgical shunt or any other implanted foreign body. You must also inform the care team if your child has a previous or current MRSA infection.
• Siblings or other children should not attend the appointment.

What are the advantages of video urodynamics?

• VUD provides information that cannot be obtained from other types of investigation
• Understanding how your child’s bladder is working will help us to give advice on appropriate treatment.

What are the disadvantages/complications?

• Most procedures have a potential for side effects. You should be reassured that the majority of patients do not suffer any problems.
• Common (greater than one in 10)
  • Discomfort on passing urine
  • Blood-stained urine (called ‘haematuria’)
• Occasional (between one in 10 and one in 50)
  • Urine infection
  • Inability to pass urine (called ‘retention’)
  • Inability to pass the catheter into the bladder
• Rare (less than one in 50)
  • Allergy to the contrast which is used to fill the bladder
  • Failure to obtain the required information resulting in the need to repeat the test.
  • When a suprapubic catheter is used, there is a rare risk of the contrast used for the VUD leaking outside the bladder
  • When a suprapubic catheter is used there is a rare risk of bleeding at the site
  • When a suprapubic catheter is used there is a risk of the catheter falling out before the VUD is completed which would necessitate rebooking again on an alternative day.

Are there any alternatives?

There are other tests which can provide important and useful information about parts of your child’s urinary system including ultrasound, x rays, and nuclear medicine tests (called DMSA and MAG 3 scans) and non-invasive urodynamics, but no alternative test can provide information on the pressure of the bladder.

Arriving for the video urodynamics

VUD takes place in the fluoroscopy department, in radiology out-patients on level 3 at Addenbrookes hospital. On arrival you should inform the receptionist.

The following is a photograph of the room in the fluoroscopy department set up for VUD:

The team that are present to complete the VUD include a consultant and a nurse specialist who specialise in urology, a radiographer and, where needed, a play specialist. The team will talk to you and your child about the equipment and help your child settle into the environment of the room. Any child aged over 12 years may be asked if there is any possibility they may be pregnant.

Your child will be asked when they last passed urine (had a wee) and may then be asked to empty their bladder before the test. Your child will then need to lie on the x ray bed (shown in the image above), undressed from the waist down. We will ensure they are as comfortable as possible. To maintain dignity your child may wear a gown and will be covered with a sheet. It is important that your child lies still during the test. It may be helpful for them to watch their favourite programme on a phone or iPad, or read a book, whilst the test is taking place.

During video urodynamics

• Two parents or carers can attend with their child, although usually only one parent is allowed to be present during the test. Other children cannot attend.
• During VUD the accompanying parent/carer will wear a lead apron to protect them when the X-ray pictures are taken.
• If your child has had a suprapubic catheter placed already, this will be connected to the VUD apparatus. Otherwise a small tube (catheter) is passed into the urethra and connected to the VUD apparatus (measuring equipment).

If your child catheterises themselves at home they can pass the urodynamic catheter themselves. Children will also need to have a separate, small catheter inserted into their anus (back passage) by the nurse or doctor. For children who have a colostomy or ileostomy stoma the catheter is passed into their stoma rather than their anus. This rectal catheter measures the pressure inside the abdomen. Passing the catheters is not painful but may be a little uncomfortable for a few minutes so older children may use Entonox (giggle gas). This can be discussed with the clinical nurse specialist team prior to the date of VUD.

• Once the catheters have been inserted and connected to the VUD equipment and your child is comfortable, the test can begin.
• First the bladder is filled with a liquid called ‘contrast’ which shows up on X ray. The bladder filling can be seen on the x ray screen.
• If your child can talk they will be asked questions about whether they can feel their bladder filling and when they feel like they need to pass urine (wee). The child may also be asked to cough at intervals. If leakage has been a symptom for your child, we will try to reproduce this so we can see what the bladder is doing when the leakage occurs. Sometimes we move, or tilt, the x ray bed slightly to get better images; if this is done, you will be informed before the move happens.
• X rays are usually taken during the study as the bladder fills.
• As the bladder is filling the pressure in the abdomen and in the bladder is measured by the video urodynamic equipment.
• At the end of the test all the catheters (tubes) are removed and your child can empty their bladder and get dressed. If a suprapubic catheter has been in place, a small dressing will be placed over the site.

Video urodynamic results

At the end of the test the doctors will talk to you about the results and how to care for your child at home (for example encouraging drinking or how to care for a dressing where a suprapubic catheter has been used). They will also talk to you about what action may be needed to improve your child’s symptoms.

How long does video urodynamics take?

VUD usually takes approximately one hour.

What should I expect after discharge?

• If your child needs antibiotics after the test you will be given instructions before leaving the department about where to collect these and instructions on giving them.
• The doctor will write a report, and this will be shared with you and appropriate professionals.
• Your child should be encouraged to drink sufficiently so that their urine is clear rather than yellow.
• There may be some discomfort on passing urine after the test but this should resolve over a few days. Pain killers such as paracetamol can be given unless you have been told otherwise.
• If pain on passing urine does not settle or pain relief does not help you should contact your GP or nurse specialist (contact details below).
• If your child develops signs of a urine infection (pain on passing urine, high temperature, feeling unwell without obvious cause) your child should be seen by their GP
• If your child had a suprapubic catheter for their video urodynamic test and the site looks red, inflamed or has oozing from the wound your child should be seen by their GP.
• A small amount of blood may be seen in the urine for a few days but if this does not settle or if there appears to be a lot of blood your child should see their GP or attend an emergency department.
• If your child has difficulty passing urine they should attend an emergency department.

Are there any other important points?

• If your child is unwell on the day of the test please contact the clinical nurse specialist team on 01223 586973 without delay as it is likely the test will need to be rescheduled.

Useful contact numbers

Paediatric surgery clinical nurse specialist team office: 01223 586973 (Mon to Fri 08:00 to 18:00 except bank holidays)