1. Study day clinical cases 2012 2nd Seminar Clinical cases in urodynamics. One morning with Paul Abrams presented by: Dr. Jose Emilio Batista Centro Médico Teknon Barcelona, Spain

2. Study day clinical cases 2012 Detailed clinical hystory 21 year old male. Primary enuresis if he doesn’t wake up during the night. Daytime urinary frequency: 3 hours or less. Nocturia: 0. Feeling of incomplete emptying. Occasional urgency without leakage. Father was enuretic.

3. Study day clinical cases 2012 Urodynamic test: Uroflowmetry Tracing Qura Vol Voided volume. 296 ml Qmax. 29.7ml/s Post voided residual. 0 ml

4. Study day clinical cases 2012 Urodynamics: Cystometry Tracing Pves Pabd Pdet

5. Study day clinical cases 2012 Urodynamics: Cystometry Inf VolP vesP det First desire 140 ml41 cmH2O 5 cmH2O Mac Cys cap. 495 ml89 cmH2O 49 cmH2O Compliance: 10 ml/ cm H20

6. Study day clinical cases 2012 Urodynamics: Cystometry Comment : –Normal bladder capacity. –Low compliance. –No leakage with increased abdominal pressure. –Progressive increase of Pdet. Filling phase dysfunction.

7. Study day clinical cases 2012 Urodynamic test: Pressure/Flow Study Tracing Pves Pabd Pdet Qmax Vol

8. Study day clinical cases 2012 P/Q Plot

9. Study day clinical cases 2012 Urodynamic test: Pressure/Flow Study Voiding phase results –Qmax38.8ml/s –Pdet at Qmax41cmH2O –Voided volume495ml –Post voided residual0ml

10. Study day clinical cases 2012 Urodynamic test: Pressure/Flow Study Comment –Normal Qmax (38.8 ml/s). –Post voided residual: 0 ml. –Micturition by detrusor contraction.

11. Study day clinical cases 2012 Complementary Tests Radiography: –No rachischisis Abdominal ultrasound: –Normal Urinalysis: –Uric acid crystals

12. Study day clinical cases 2012 Therapeutic approach Filling phase: –Severe low compliance with normal capacity. Voiding phase: –No obstruction. –Contractile detrusor. Anticholinergic treatment is indicated.

13. Study day clinical cases 2012 Patient progress Progress: –10mg Solifenacine at night –At the beginning he had various leakage episodes. –Now, the last 15 days he was dry at night. –Next visit in 3 months.