How to test your urine flow

Written by: Mr Nikesh Thiruchelvam
Published: | Updated: 02/04/2019
Edited by: Laura Burgess

When you see a urologist with urinary problems, such as difficulty in passing urine, they normally recommend certain tests to determine the cause of your symptoms and to try and help manage them. Leading Cambridge urologist Mr Nikesh Thiruchelvam explains what tests are used to make a diagnosis.

What are the possible urological problems?

Problems with storing your urine can give you symptoms of urinary frequency and urinary urgency, whereby you have a sudden and often intense urge to pass urine and have to rush to the toilet. Sometimes you can leak before getting to the toilet (urge urinary incontinence).

At other times, when you are more active such as walking or running, or with coughing or sneezing, you can leak urine (stress urinary incontinence). It can also be difficult to store urine at night causing you to get up a number of times when you are asleep (called nocturia).

Problems with emptying your bladder can lead to symptoms of urinary retention, a poor flow, hesitancy or straining to void or dribbling after your void.

What are the different tests used to detect these urological symptoms?

Simple tests that can be performed in the clinic include:

  • Urinary dipstick test
  • Urine flow test (Uroflowmetry)
  • Post-void bladder scan - to measure any residual urine that is left in the bladder.

A frequency-volume chart, also known as a bladder diary or input-output chart is a form completed by the patient which documents the time, volume and type of fluids drank and time and volume of urine passed, associated with urinary leakage. This should ideally be performed for three days and nights.

Further outpatient visit tests involve looking inside the bladder and water pipe with a flexible telescope under a local anaesthetic (flexible cystoscopy) and urodynamics, to assess bladder function.

What’s the difference between Urodynamics and Uroflowmetry?

Uroflowmetry involves passing urine into a measuring device, which measures the volume of urine passed, the maximum flow rate of urine passed and the pattern of flow. The pattern can help diagnose a urethral stricture or obstruction to the bladder.

Urodynamics involves placing a fine catheter into the bladder and one into the back passage. The bladder is then artificially filled and you then void the fluid placed into the bladder. Pressures are measured during this filling phase and also during the voiding part. The filling part of the test is useful to diagnose an overactive bladder, types of urinary incontinence (urge or stress) and a bladder that does not stretch adequately (poor compliance).

The voiding part can diagnose a bladder that is blocked (usually by the prostate in men) or if the bladder has lost its contractile ability (bladder underactivity). Sometimes during the pressure test, I use a dye to fill the bladder and take X-ray pictures (video-urodynamics). It is also possible to measure the pressures in the bladder over a longer period with the normal physiological filling of the bladder with urine (ambulatory urodynamics).

What are the limitations of these tests?

For an adequate flow test, patients need to pass at least 150mls. This is not easy as many patients have urinary symptoms and may find it difficult to hold their urine long enough to pass enough to make the test meaningful.

Urodynamics involves artificial filling of the bladder and asking the patient to void with catheters in place, in a strange environment. Although the test aims to reproduce the patient’s urinary symptoms, clearly this can be difficult given the unusual circumstances of the test!

Are there any risks involved?

There are no risks with the flow test. Urodynamics can cause blood in the urine and burning on passing urine. These symptoms usually resolve within 48 hours. The test can also cause a urinary tract infection but as the risk of this is so low, it is not normal practice to give a preventative antibiotic before the test.

By Mr Nikesh Thiruchelvam

Mr Nikesh Thiruchelvam is a highly-experienced consultant urologist based in Cambridge. He has a specialist interest in all aspects of urinary dysfunction and treatment, in addition to benign prostate enlargement, vasectomy, and reverse vasectomy. Mr Thiruchelvam is celebrated for performing the first Urolift procedure in Cambridge, and runs a specialist vasectomy reversal clinic using microsurgical techniques. He enjoys excellent reviews from patients praising his clear explanations and high level of care and attention.

Originally qualifying from St Bartholomew’s Hospital Medical College in London, Mr Thiruchelvam pursued specialist training at leading centres of urological excellence including St. Bartholomew’s, the Royal London Hospital, Ipswich Hospital and Great Ormond Street Hospital. Over the course of his career Mr Thiruchelvam has secured multiple fellowships to travel to the USA and Australia, studying cutting edge techniques in treating prostate enlargement and urinary incontinence. He completed an MD in London, and was appointed Consultant Urologist at Cambridge University Hospitals in 2009.

Widely published in textbooks, patient guides, and peer-reviewed journals, Mr Thiruchelvam is highly-regarded for his extensive knowledge in the basic science of urology as well as surgical best practice. He is a significant contributor to NICE consultations, NHS Horizon Scanning documents, NICE Eyes on Evidence and NIHR Design for Dignity. Internationally, Mr Thiruchelvam is a co-author to the European Association of Urology Guidelines for Urinary Incontinence, invited faculty of European School of Urology and is regularly invited to lecture at urology conferences abroad and undertake Visiting Professorships.

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