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Functional imaging of the bladder

Department of Radiology, St Bartholomew's Hospital, London, UK

• Lower urinary tract symptoms can be due to structural or functional disorders of the bladder, or both.
  
• Simple flowmetry is the easiest measure of global bladder function, especially if combined with bladder ultrasound as the ultrasound cystodynamogram.
  
• The normal maximal flow rate is >15 ml s^–1; the average flow rate is >10 ml s^–1; and the post-void residue is <25 ml.
  
• Complex urodynamics are reserved for those with unusual clinical symptoms.
  

The two main functions of the bladder are to store urine and initiate micturition. These functions require a complex coordination between the bladder and the urethral sphincter. There are multiple disorders of the central nervous system, spinal cord and peripheral nervous system that affect and impair bladder and urethral function. Bladder dysfunction produces a variety of non-specific symptoms and signs requiring imaging investigations of the lower urinary tract. Urodynamic imaging studies should be interpreted in combination with clinical presentation and signs. Simple and routine urodynamics of the bladder include ultrasound assessment before and after micturition, intravenous urography and bladder flow rates. These simple techniques are frequently performed in all imaging departments and will suffice in the majority of patients when assessing bladder dysfunction. More complex techniques, including cystometry, videocystometry and videocystometrography, are only necessary for complex cases, in patients with failed surgery or in those where the clinical presentation and simple urodynamics are equivocal. Here, we review the normal lower urinary tract innervation, function and common disorders affecting the bladder and urethra. We discuss the role of imaging and findings in bladder outlet obstruction, urethral overactivity, detrusor failure, incontinence and detrusor instability.