A Clear Picture

Doctors utilize video X-rays to pinpoint urinary tract troubles

WRITTEN BY Jessica Paulsen

A leaky bladder might feel like an embarrassing problem, but it’s actually a common complaint. One in every three to four Americans face urinary incontinence, reports the American Urological Association. And while no one really wants to talk about their bladder dysfunction, opening up to a doctor is the first step towards regaining control. “People are often embarrassed to talk about their situation or get frustrated thinking that nothing can be done,” says Dr. Lauren Rittenberg, a Roper St. Francis Healthcare affiliated urologist. “We work to make our patients feel as comfortable as possible and educate them on their condition and available treatment options. We really want to help improve patients’ quality of life.”

Dr. Lauren Rittenberg

Urodynamic testing, which measures how well the lower urinary tract is working, has been used since the 1950s to diagnose issues such as overactive bladder or urine leakage. Now, doctors are bolstering this tool with modern technology, utilizing fluoroscopy video X-rays for more accurate diagnoses. Here, Dr. Rittenberg engages in a frank conversation on this improved approach, which Roper St. Francis Healthcare first introduced to patients in September:

HOUSE CALLS (HC): What exactly is urodynamics?
Dr. Lauren Rittenberg (LR):
Urodynamics refers to a series of tests studying the function of the bladder, sphincter and urethra. Video urodynamics (VUDS) uses fluoroscopy, which are X-rays, to examine the movement of liquid flowing through the urinary system.

HC: What do the tests typically involve?
During a VUDS exam, we try to replicate a patient’s symptoms. The bladder is filled with contrast (liquid dye) through a catheter. As the bladder fills, the patient provides feedback about how they feel. They are then asked to urinate. The study is done in the office and takes about 30 to 60 minutes.

HC: How do video X-rays benefit urology patients?
The bladder tends to be a poor witness, as patients with different problems can have the same complaints. When we can visualize the bladder and urethra, we can diagnose issues like bladder and urethral diverticulum, fistulas, prolapse, strictures and reflux. The video provides a more thorough understanding of the scope of a patient’s problems and allows us to determine the best treatment.

HC: How were these problems diagnosed before the improved visuals?
Previously, if there was a suspicion of structural issues, a patient would have to undergo additional X-ray testing separate from the urodynamics test. VUDS simply allows us to conduct those tests simultaneously.

HC: Which patients might require a VUDS exam?
Not everyone needs urodynamic testing. We first complete an assessment of the patient’s symptoms, a urinalysis and a physical exam. The results determine if further evaluation through VUDS is necessary, such as when someone has difficulty urinating, an overactive bladder with leakage of urine or a history of neurogenic bladder (when the nervous system and bladder don’t communicate as they should). This approach is also beneficial when a patient has had unsuccessful treatments in the past or multiple urinary complaints without a clear treatment path.

Photography (Rittenberg) by Jared Shafto