Reinvestigation of cough provocation in Urodynamic Testing

초록

Introduction: The cough provocation during the urodynamic study is an essential procedure used to frequently check the patency of the narrow and long channels of multiple urodynamic catheters during the study. The aim of our study is to investigate the underlying mechanisms that during the cough provocation, the detrusor pressure is not zero, using AcqKnowledge data acquisition and analysis soft ware which is an interactive, intuitive waveform analysis program. Methods: From Jan 2009 to June 2014,urodynamic tests performed on about 163 patients were included.After saving the time and pressure data 292 cough provocations performed during this test as a text file in the machine, it was transferred to the acq programs of another computer and detailed analysis was performed again. Results: cough lasted for 0.82± 0.32(0.30-1.74)sec. When there was no change in Pdet during cough.zero was defined as 3cmH2O(-3∼3). Pdet was zero in only 31(9.51%) of the 326 patients during the cough(Fig 1A). P det demonstrated a change of 3cm H2O or greater in 90.49% of cases during the cough. To determine why Pdet is not zero, the starting point of change during cough was identified and difference observed in the curves oh Pves and Pabd. The maximum and minimum Pdet were determined during coughing, and the values of Pves and Pabd were compared at the same time. The difference in cough onset time between Pves and Pabd was less than 0.1 sec in 58.9% of 192 patients, and more than 0.1sec in 41.1% (Fig. 1B). Between the maximum and minimum values of Pdet, there was a significant difference in the pressure values of Pves and Pabd (Fig.2). Conclusions:Even if Pdet is non-zero during cough induction, this is not due to channel blockage, however, the abovementioned