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

2. Study day clinical cases 2012 Detailed clinical hystory 45 years old man. Multiple Sclerosis diagnosed 8 years p Urgency incontinence. Daytime urinary frequency : 2-3 hours Nocturia: 1.

3. Study day clinical cases 2012 Detailed clinical hystory Unsatisfactory urination, constant feeling to urinate. Treatment: interferon. No previous urologic complaints. Treated with Solifenacine 5 mg without improvement

4. Study day clinical cases 2012 Urodynamic test: Uroflowmetry Tracing Qura Vol Voided volume. 195 ml Qmax. 13.7ml/s Post void residual. 71 ml

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

6. Study day clinical cases 2012 Urodynamics: Cystometry Infused VolP vesP det Cysto cap. 140 ml33 cmH2O 40 cmH2O

7. Study day clinical cases 2012 Urodynamic test: Cystometry Comment : –Bladder with diminished capacity. –Low compliance. –Un-inhibited detrusor contractions –High detrusor leak poing pressure > 40 cm H2O. Filling phase dysfunction.

8. Study day clinical cases 2012 Urodynamics: Pressure/Flow Study Tracing Pves Pabd Pdet Qura Vol

9. Study day clinical cases 2012 P/Q Plot

10. Study day clinical cases 2012 Urodynamic test: Pressure/Flow Study Voiding phase results –Qmax10.7ml/s –Pdet at Qmax51cmH2O –Voided volume56ml –Post voided residual80ml

11. Study day clinical cases 2012 Urodynamic test: Pressure/Flow Study Comment –Low Qmax (10.7 ml/s). –Post voided residual: 80 ml. –Micturition by detrusor contraction. –Interrupted flow, probably dyssynergia.

12. Study day clinical cases 2012 Therapeutic approach Filling phase: –Neurogenic overactive detrusor with a high point pressure leakage. Voiding phase: –No obstruction. –Contractile detrusor; post voided residual probably because of dyssynergia.

13. Study day clinical cases 2012 Recommendations Anticholinergic treatment (10mg /d solifenacine vs 40mg Trospium chloride 12h). If post voided residual is confirmed, we indicate intermittent self-catheterism after urination. We recommend annual urodynamics and ultrasound tests.