What are the contraindications for bladder pressure assessment?

Updated: Jan 16, 2020
  • Author: Pamela I Ellsworth, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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There are several contraindications to the use of bladder pressure to assess intra-abdominal pressure (IAP). [13] Bladder pressures should not be used in patients with intraperitoneal adhesions, pelvic fractures, abdominal packs, pelvic hematomas, or neurogenic bladder (including patients with spinal shock and Parkinson disease). These conditions may alter pressure readings in the bladder owing to a loss of bladder compliance or the inability of the bladder wall to move freely, leading to inaccuracies in measurement. In addition, the morbid obesity, pregnancy, or ascites can lead to chronic elevations in IAP, further complicating the diagnosis of IAH. [16]

The AbViser is contraindicated in patients with a history of bladder rupture or bladder wall repair within the prior 3 months. [17] In addition, the AbViser must be replaced at the time of urinary catheter and/or tubing change.

The Holtech Foley manometer should not be used for more than 7 days and should be changed when the Foley catheter or urine collection device is changed. [14]

Of note, there does not appear to be an increased risk of nosocomial urinary tract infection with systems using a closed transducer.

Urodynamics should not be performed if the patient has or is actively being treated for a urinary tract infection. In patients on clean intermittent catheterization, bacteria are often present in the urine (colonized) in the absence of an acute infection. A urine dipstick test is helpful; the presence of significant pyuria would suggest a urinary tract infection, and the procedure should be canceled and urine cultured.

In addition, a significant amount of stool in the rectal vault interferes with the abdominal pressure monitoring and therefore requires management prior to proceeding with the study.

Lastly, if the patient has cardiovascular issues and/or orthopedic hardware in place, the patient or the physician providing the cardiovascular and/or orthopedic care should be consulted regarding the need for prophylactic antibiotics.

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