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Practice tips. Bedside cystometry. Simple diagnostic skill for family physicians.

Urinary incontinence is a common problem among elderly people with a prevalence of approximately 20% among seniors living in the community and up to 50% among residents of nursing homes. Despite this prevalence, many patients never seek or receive evaluation or treatment. After identifying patients with urinary incontinence and doing an initial assessment, family physicians often face long waits for urologic or gynecologic consultation and for urodynamic studies. Family physicians can, however, perform cystometry, a simple maneuver, in the office to aid diagnosis and guide treatment. Although urodynamics remains the gold standard for urologic function testing, cystometry has adequate sensitivity and specificity for assessing detrusor instability or overactivity and can identify stress incontinence and urinary retention. A United States clinical practice guideline on managing incontinence gave cystometry an ‘A’ recommendation (supported by scientific evidence from well designed trials) for assessing bladder compliance and contractility and measuring postvoid residual bladder volume and bladder capacity. Bedside cystometry can be done in the office by a physician or clinic nurse and is well tolerated by patients. The equipment for it is inexpensive and usually found in the office (Table 1). The procedure itself takes approximately 10 minutes, although preparation and catheterization of the patient, which does not require the physician’s attendance, takes additional time. At the South Eastern Regional Geriatric Program, we perform bedside cystometrics on all patients if the cause of urinar y incontinence is unclear after histor y, physical examination, and postvoid residual volume (PVR) measurement. The procedure can be used in the office instead of a PVR for convenience and to save time.