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PubMed1997

The role of urodynamic assessment in the diagnosis of lower urinary tract disorders.

The relationship between clinical symptomatology and urodynamic findings was studied prospectively in 1000 unselected women with symptoms of lower urinary tract dysfunction. Women in the study were subjected to both clinical and multichannel urodynamic assessment. The symptom of stress incontinence was confirmed by urodynamic assessment to be associated with genuine stress incontinence (95%). However, it was also associated with sensory urgency (96%) and detrusor instability (64%). Other lower urinary tract symptoms were associated with a range of abnormal urodynamic findings. It was concluded that urodynamic assessment provided useful information in women with lower urinary tract disorders, in developing principles of diagnosis and management.

Female↗
PubMed2006

Clinical relevance of urodynamic investigation tests prior to surgical correction of genital prolapse: a literature review.

Urodynamic investigations have been advocated to be incorporated in the standard diagnostic workup of patients undergoing surgical correction of genital prolapse. Stress incontinence is reported by 40% of patients with genital prolapse. Urodynamic stress incontinence (USI) is diagnosed in 70-75% of these patients. Occult urodynamic stress incontinence (OUSI) is diagnosed in about 50% of the patients with genital prolapse not reporting stress incontinence before surgery. Performing urodynamic investigation in patients undergoing prolapse surgery may be valuable if diagnosing USI or OUSI results in the selection of the optimal treatment strategy. This treatment strategy is either a combination of prolapse and stress incontinence surgery or prolapse surgery at the beginning and re-evaluation of possible stress incontinence afterwards. The combination of prolapse and stress incontinence surgery has the advantage of attempting to solve two problems at the same moment, but carries an increased risk on unwanted side-effects, of which, voiding dysfunction and detrusor overactivity are the most important. This review presents a literature overview of what has been proven about the diagnostic and therapeutic value of urodynamic investigations in patients undergoing prolapse surgery.

Female↗
PubMed2000

Effects of male sex hormones on urodynamics in childhood: intersex patients are a natural model.

The effects of sex hormones on bladder function have been evaluated in adult females, especially in regard to postmenopausal incontinence and bladder irritability syndromes. These have not been investigated in children in regard to urodynamic findings. An intersex patient whose bladder is under the influence of androgens is a natural model to investigate the effects of male sex hormones on bladder function in females. To evaluate the urodynamic findings and clinical symptoms in a group of intersex patients and to determine how androgens influence bladder function in female children, clinical and urodynamic records of 12 intersex patients with adrenogenital syndrome were investigated retrospectively. The mean age was 9 +/- 5.7 years (1.5-18) and the mean follow-up period was 5.1 +/- 4.4 years (1-12). Congenital adrenal hyperplasia (CAH) was present in all cases. Only 3 patients had urinary symptoms and incontinence, but these findings did not correlate with their urodynamic findings. None of the patients required medications for their urinary symptoms. Nine are still being treated medically by the pediatric endocrine team with hydrocortisone for CAH. The upper urinary tract was found to be normal with no hydronephrosis. The mean bladder capacity (269 +/- 122 ml) was lower (86.7%) than the estimated capacity for age. The mean compliance was 20 +/- 13.7 ml/cmH2O. No unstable detrusor contractions were encountered. The most remarkable finding was this reduced bladder capacity of androgenized female patients for age, which shows the antagonistic effect of androgens on bladder urodynamics in females.

Adolescent↗
PubMed1999

Urodynamic evaluation in boys treated for posterior urethral valves.

This study describes the urodynamic findings in 22 patients with posterior urethral valves and discusses their association with urinary incontinence, age, mode of primary treatment, renal function, and changes in the upper tracts. The patients' ages ranged from 3 to 26 years and 27% were either adolescents or older. The urodynamic findings were categorized into 5 main patterns, although mixed patterns were also observed; (1) normal capacity and compliance with normal detrusor contractility (2/22 patients, 9.1%); (2) small-capacity, hypocompliant bladder (8/22 patients, 36.4%); (3) unstable bladder (2/22 patients, 9.1%); (4) large-capacity, hypotonic bladder with decreased detrusor contractility (2/22 patients, 9.1%); and (5) normal capacity and compliance but with decreased detrusor contractility (8/22 patients, 36.4%). More than one-half of the patients (57.1%) evacuated their bladders incompletely, and this seemed to be associated with post-treatment episodes of urinary-tract infection. The commonest symptom was daytime frequency, urgency, and leak with nocturnal enuresis, which urodynamically correlated with a small-capacity, hypocompliant or unstable bladder or to incomplete evacuation of the bladder, leading to significant post-void residue. Significant detrusor dysfunction was identified in 2 asymptomatic patients as well, emphasizing the need to perform a routine urodynamic work-up on all valve patients. Urodynamic properties seemed to be associated with age. Small, hypocompliant, and unstable bladders were almost always seen in prepubertal boys and in the first 5 years following undiversion, whereas large, hypotonic bladders with impaired contractility were seen in post-pubertal boys. While the current policy is to avoid high diversion, data in this study suggest that disorders of detrusor capacity, compliance, and contractility exist in children treated by primary valve ablation and vesicostomy and that abnormal detrusor dynamics seem to be a reflection of inherent developmental detrusor dysfunction consequent to congenital infravesical obstruction.

Adolescent↗
PubMed1990

Female urinary incontinence: comparative value of history and urodynamic investigations.

In order to identify the role of urodynamic investigation in relation to urinary symptoms, the authors assessed the diagnostic value of history and of urodynamic investigation in female urinary incontinence. 154 patients presenting with urinary incontinence were investigated prospectively, by standardised history and investigation of bladder stability and investigation of bladder stability and of cervico-urethral closure function. Clinical and urodynamic diagnostic conclusions were compared. Urodynamic results were highly discordant in the presence of clinical 'erethism', whilst agreement was more marked in the case of stress incontinence. Urodynamic investigation may be indicated after failure of medical treatment in the case of 'dysfunction'. By contrast, it is essential in stress incontinence in order to identify the mechanism or detect subclinical 'dysfunction'.

Female↗
PubMed2005

Comparison of darifenacin and oxybutynin in patients with overactive bladder: assessment of ambulatory urodynamics and impact on salivary flow.

OBJECTIVES: To evaluate the effects of darifenacin, an M3 selective receptor antagonist, compared with oxybutynin, on ambulatory urodynamics, salivary flow, heart rate and visual nearpoint in patients with overactive bladder (OAB). METHODS: A double-blind, randomized, crossover study (n=65) with three treatment cohorts: darifenacin immediate release (IR) 2.5 mg three times a day (t.i.d.) or oxybutynin 2.5 mg t.i.d.; darifenacin controlled release (CR) 15 mg once daily (q.d.) or oxybutynin 5 mg t.i.d.; darifenacin CR 30 mg q.d. or oxybutynin 5 mg t.i.d. Within cohorts, patients received 7 days' treatment with each agent separated by 14 days' washout. RESULTS: All active treatments improved urodynamic parameters. Both darifenacin CR doses had significantly less effect on salivary flow than oxybutynin. Effects on urodynamic parameters, heart rate and visual nearpoint were comparable. CONCLUSION: Ambulatory urodynamics appears to be an innovative and potentially useful investigative tool in the evaluation of the efficacy of new therapeutic agents. Darifenacin CR is an efficacious therapy for OAB with comparable effects on urodynamic parameters but producing significantly less dry mouth than oxybutynin.

Adolescent↗
PubMed2006

Urodynamic distinctions between idiopathic detrusor overactivity and detrusor overactivity secondary to multiple sclerosis.

OBJECTIVES: To evaluate the urodynamic characteristics of neurogenic detrusor overactivity (NDO) secondary to multiple sclerosis (MS) compared with idiopathic DO (IDO) to determine whether urodynamic distinctions could differentiate the different etiologies of DO. METHODS: The urodynamic characteristics of DO in women with MS (n = 54) were compared with the overactive contractions found in women with lower urinary tract symptoms and IDO (n = 42). Among other parameters, the amplitude of the first overactive contraction, maximal detrusor contraction, and threshold volume for the first overactive contraction were evaluated to assess the DO severity. A sensitivity analysis using cutoff values determined from those urodynamic parameters that differed between the patient groups is presented. RESULTS: The amplitude of the first overactive contraction was statistically greater in the patients with MS and NDO compared with patients with IDO (28.3 cm H2O versus 20.5 cm H2O, P = 0.003), as was the maximal detrusor contraction (46.4 cm H2O versus 30.8 cm H2O, P = 0.002). The threshold volume for DO was greater among patients with NDO (186.8 mL versus 150.5 mL, P = 0.037), likely secondary to the elevated postvoid residual urine volume noted among patients with MS (P = 0.049). Using a cutoff value of 30 cm H2O for amplitude of the first overactive contraction achieved a positive predictive value of 88% for identifying MS in our data set. CONCLUSIONS: The urodynamic characteristics of NDO differed significantly from those of IDO. Additional investigation is required to determine whether these differences are due to neurogenic influences directly on the detrusor muscle through aberrant innervation or by other mechanisms, such as enhanced outlet resistance during voiding.

Adult↗
PubMed1998

Vesicourethral dysfunction and urodynamic findings in multiple sclerosis: a study of 149 cases.

OBJECTIVE: Vesicourethral dysfunction is common in people with multiple sclerosis and results in significant impairment. We studied the clinical and urodynamic findings in such patients to define risk factors for incontinence and upper urinary tract infections. DESIGN AND SETTING: A cohort study of 149 patients with multiple sclerosis and urinary symptoms seen in our urodynamic laboratory. INTERVENTION: A complete urodynamic study of each patient with urethrocystometry and continuous recording of the urethral sphincter electromyography and assessment of postvoid residual. RESULTS: Detrusor hyperreflexia and sphincter dyssynergia were the main dysfunctions. No significant relation between clinical features and urodynamic patterns was found. Women with low maximal urethral pressure were particularly prone to incontinence, which occurred in 69% of the patients. Pyelonephritis was associated with a postvoiding residual urine of > 30% of the functional detrusor capacity, and was found more often in the male population. CONCLUSION: Urodynamic assessment of bladder function is critical to direct therapy for urinary complaints in people with multiple sclerosis.

Adult↗
PubMed1996

Post-prostatectomy incontinence: urodynamic findings and treatment outcomes.

PURPOSE: We examined urodynamic findings and treatment outcomes in a large population of men with post-prostatectomy incontinence. MATERIALS AND METHODS: A total of 215 men was referred for evaluation and treatment of significant post-prostatectomy incontinence. Urodynamic evaluation consisted of provocation multichannel medium fill cystometry with vigorous attempts to demonstrate incontinence. Treatment was directed by the results of the urodynamic study. A pad scoring system was used to gauge the severity of incontinence before and after treatment. RESULTS: Based on the results of urodynamic studies 40% of the men had genuine stress incontinence alone and approximately 60% had a major component of bladder dysfunction contributing to incontinence. Treatment results of 135 men demonstrated a significant decrease in pad score (p<0.001) for those treated with anticholinergics, those undergoing artificial sphincter insertion and those treated pharmacologically before sphincter placement. CONCLUSIONS: In our large series most men with prostatectomy incontinence did not have genuine stress incontinence alone. Thus, urodynamic studies are critical, not only to define cause of incontinence but to direct effective therapy.

Aged↗
PubMed2002

Urodynamic patterns of normal male micturition: influence of water consumption on urine production and detrusor function.

PURPOSE: Urodynamic characterization of normal male micturition can be a useful standard in the analysis of data on patients complaining of voiding dysfunction. The validity of such a standard is based on the need to obtain baseline parameters of pressure flow values, an important consideration when evaluating prostatic obstruction and its treatment. While current numerical pressure flow values provide a useful summary of the voiding sequence, a more complete analysis of the pattern of normal voiding may reveal more functionally useful information concerning micturition. We establish basic experimental conditions that simulate normal voiding of physiologically produced urine by the kidneys measured at intervals representing real stages of bladder filling. We report the results of an investigation designed to study consecutive micturitions at bladder volumes determined by water consumption and endogenous circadian rhythm. Our particular focus is to examine critically the urodynamic pattern of pressure flow and obtain evidence to support the hypothesis that fluid consumption has an important role in detrusor function. MATERIALS AND METHODS: Urodynamic studies were conducted on 39 asymptomatic male volunteers with a mean age of 25.8 years (range 21 to 31) and mean weight of 75.5 kg. (range 63 to 95). Volunteers were divided into 2 groups according to water consumption regimen of 30 ml./kg. daily (17 patients, group 1) and 60 ml./kg. daily (12, group 2). Bladder pressure was monitored via a suprapubic catheter and abdominal pressure was measured via a rectal balloon using an ambulatory system. Average duration of each monitoring period was 20.5 hours. Detrusor pressure and flow rate records from each subject were identified, and consecutive filling and voiding phases were averaged during the entire monitoring period using the onset of micturition as a time marker. The average pattern of pressure, flow rate, cumulative volume and contractility curves for each subject, as well each for group, was computed and graphically presented. For each group the average parameters of urethral opening pressure, maximum detrusor pressure, detrusor pressure at maximum flow rate, bladder capacity and bladder contraction strength were calculated and compared statistically. Numerical values are mean +/- SE. RESULTS: Water consumption and urine production rate influenced the pattern and many of the urodynamic parameters of micturition. In both groups there was a detrusor pressure increase before voiding and numerically maximum detrusor pressure consistently occurred before micturition started. Micturition pattern showed an asymptotic relationship between pressure and flow. Doubling of water consumption increased urethral opening pressure from 51.2 +/- 3.2 to 61.5 +/- 5.1 (p <0.05), maximum detrusor pressure from 58.9 +/- 4.5 to 70.0 +/- 6.2 cm. H(2)O (p <0.01) and contractility from 15.4 +/- 1.4 to 17.7 +/- 1.4 w/m(2). There were no significant differences due to water consumption in maximum flow rate (24.4 +/- 1.4 to 25.2 +/- 1.8 ml. per second) or bladder capacity (286 +/- 20 to 329 +/- 15 ml.) but a significant increase in the number of micturitions from 5.8 +/- 0.5 to 9.8 +/- 0.5 per day (p <0.001) proportional to water consumption. CONCLUSIONS: The configuration of the observed pressure flow characteristics of the normal male is suggestive of the "Starlings law" relationship and the pattern of the urodynamic parameters were markedly different from those reported in the current standardization literature, suggesting the need to revise the current concept of normal male micturition. Voiding pressure and contractility increased in accordance with water consumption and urine production.

Adult↗
PubMed1993

The changing urodynamic pattern in infants with myelomeningocele.

A total of 43 infants with spina bifida was evaluated with a standard simplified urodynamic technique to determine whether bladder behavior altered with development and the optimal timing for urodynamic testing. Using urodynamic evaluation plus renal ultrasound and voiding cystourethrography the patients were divided into 2 groups: 1) those with a favorable prognosis and 2) those with an unfavorable prognosis. Only 55% of the initial urodynamic studies were predictive of future clinical course. The patients who worsened generally did so in the first 6 months of life. Of the patients initially believed to have an unfavorable prognosis 86% improved or stabilized with therapy. Urodynamic testing appears to be an important adjunct at 6-month intervals in infancy and early childhood as bladder behavior continues to evolve.

Follow-Up Studies↗
PubMed1993

Correlation of preoperative urodynamic findings to postoperative complications following pancreas transplantation.

Urological complications are common following pancreas transplantation with bladder drainage. Some investigators have excluded patients from pancreas transplantation because of abnormal preoperative urodynamics. To determine the risk of an abnormal bladder in bladder-drained pancreas transplantation, we prospectively evaluated 23 type I diabetic patients undergoing pancreas transplantation with preoperative urodynamics. For study purposes, criteria for an abnormal urodynamic evaluation were a bladder capacity of greater than 1,000 cc, absence of normal detrusor contractility and an abnormal voiding pattern. In addition, an abnormal study was defined by the presence of 2 or more of the following: 1) suppressed proprioception at 250 cc or at a volume of greater than 50% of bladder capacity, 2) peak flow of less than 10 cc per second, 3) interval to peak flow of greater than 30 seconds or 4) post-void residual of greater than 150 cc. Of the 23 patients 10 (43%) had abnormal preoperative urodynamic studies. All 23 patients underwent pancreas transplantation with bladder drainage, alone or in combination with a kidney transplant. The incidence of urological complications was 3.1 and 3.4 per patient, respectively, in the normal and abnormal groups (p = 0.126). Patient and graft survival rates were similar between the 2 groups (p > 0.5). We were unable to show that abnormal preoperative urodynamic studies preclude successful pancreas transplantation with bladder drainage or predict an increase in postoperative complications.

Adult↗
PubMed1992

Effect of time interval and overdistension on repeated urodynamic studies.

Repeated urodynamic testing of the lower urinary tract is often needed both clinically and experimentally. The objective of this study is to find out the time interval needed if repeated urodynamic tests are required even if overdistension occurs initially. Three hundred forty urodynamic studies were performed using five female rhesus monkeys (Macaca mulatta). Two groups of experiments (with or without bladder overdistension) were performed at the following time intervals: immediate, 15, 30 and 45 minutes after the initial urodynamic study. All urodynamic parameters (pressure, capacity, compliance and detrusor strength) were reproducible after a 30-minute waiting period. In case of overdistension, a 45-minute period is required.

Animals↗
PubMed1991

Extramural ambulatory urodynamic monitoring during natural filling and normal daily activities: evaluation of 100 patients.

Conventional urodynamic tests are short and performed under nonphysiological circumstances. The introduction of ambulatory urodynamic tests is a promising improvement of our diagnostic abilities with respect to these disadvantages. To test the value of our ambulatory urodynamic method we evaluated 100 patients with urinary incontinence and/or voiding problems by both diagnostic methods. Pre-classification according to medical history was compared with the urodynamic diagnosis obtained from the conventional and extramural ambulatory monitoring methods, and the combination of both techniques in patients with urinary incontinence. The conventional method showed no abnormalities in 32% of the patients, compared to only 3% with the ambulatory method. The conventional method confirmed pre-classified stress incontinence in 36% of the patients, compared to only 14% by extramural ambulatory monitoring. Combining both methods, pre-classified stress incontinence was confirmed in 43% of the patients. Pre-classified urge incontinence was confirmed in 47%, 59% and 84%, and pre-classified mixed incontinence was confirmed in 23%, 29% and 55% of the patients using the conventional, extramural ambulatory monitoring and combination methods, respectively. An over-all correlation with the pre-classification in the incontinence group was found in 34% with the conventional method and 43% with extramural ambulatory monitoring. Combining both diagnostic tools showed a correlation with the pre-classification in 67% of the patients. These results show the promising impact of ambulatory urodynamic testing in the near future.

Adolescent↗
PubMed1987

Clinical versus urodynamic diagnosis in an incontinent geriatric female population.

The clinical presentation of incontinence was compared to diagnoses based on urological and urodynamic evaluation in 135 elderly women assessed consecutively in an outpatient clinic. Most patients (64 per cent) presented with mixed symptoms: 16 per cent presented with pure stress and 16 per cent with pure urge incontinence. After evaluation 46 per cent of the patients had stress incontinence with a stable bladder, 27 per cent had detrusor instability or hyperreflexia without sphincter weakness and 19 per cent had mixed urodynamic abnormalities. Presenting symptoms were predictive of urodynamic diagnosis in 64 per cent of the patients with pure stress incontinence and 55 per cent with pure urge incontinence. In general, symptoms in our patient population were less predictive of urodynamic findings than in previously reported series of younger incontinent women but they were more predictive than in other series of elderly women. Predictive values for some urodynamic findings were enhanced by combining a symptom with certain physical findings. Implications of these data for the evaluation and treatment of incontinence in the geriatric population are discussed.

Aged↗
PubMed1979

Urodynamic testing: alternatives to electronics.

Electronic urodynamic testing, including bladder pressure, urethral pressure profile, voiding rate and velocity, and electromyography, is expensive in terms of equipment, operator and time. Clinical urodynamic testing, including voiding habits and timing, bladder capacity, residual urine volume, voiding cystography, cystometrography and neurologic evaluation, is readily done in the office. Analysis of common syndromes requiring urodynamic assay shows that clinical urodynamic testing may be more useful than electronic urodynamic testing for appropriate treatment.

Child↗
PubMed1996

An observational urodynamic evaluation of men with lower urinary tract symptoms treated with doxazosin.

OBJECTIVES: To assess the urodynamic changes in men with lower urinary tract symptoms (LUTS) suggestive of bladder outlet obstruction treated with doxazosin and to correlate these changes with voiding symptoms. METHODS: Fifty patients with LUTS were treated with doxazosin at a dose of 4 mg/day for 3 months. All men were initially evaluated by International Prostate Symptom Score (I-PSS) questionnaires, measurements of urinary flow rate, and complex urodynamic study. Those patients completing the 3-month study underwent repeat testing. RESULTS: Forty-four (88%) men underwent initial and follow-up urodynamic evaluation. The mean I-PSS improved from 20.6 to 10.5 (P < 0.001), mean peak urinary flow rate increased for 11.7 to 13.2 cc/s (P = 0.20), mean detrusor pressure at peak flow decreased from 9 3.6 to 83.0 cm H20 (P = 0.15), and mean cystometric bladder capacity increased from 266 to 304 cc (P = 0.07). Using the Abrams-Griffiths nomogram and number, more than 58% of patients remained obstructed after treatment with doxazosin for 3 months. Men with and without objective evidence of bladder outlet obstruction at the outset of the study had similar improvement in voiding symptoms. Most patients elected to continue treatment with doxazosin at the completion of the study (41/44, 93%). CONCLUSIONS: The majority of patients had objective evidence of persistent bladder outlet obstruction after treatment with doxazosin for 3 months despite significant benefit. The results of complex urodynamic evaluation did not predict treatment response in men with LUTS suggestive of bladder outlet obstruction. Urodynamic study does not appear to be helpful in the evaluation of patients with uncomplicated LUTS prior to treatment with doxazosin.

Adrenergic alpha-Antagonists↗
PubMed1997

Associations among cystoscopic and urodynamic findings for women enrolled in the Interstitial Cystitis Data Base (ICDB) Study.

OBJECTIVES: Interstitial cystitis is a symptom complex characterized by pelvic pain, urinary urgency, urinary frequency, and nocturia. Patients with these symptoms, at the 5 clinical centers participating in the National Interstitial Cystitis Data Base (ICDB) Study, have been evaluated with history and physical exams, questionnaires, and urodynamic studies. METHODS: Of the 388 female subjects entered in the study as of December 31, 1995, 150 women have undergone cystoscopy with hydrodistension. The data from the endoscopic procedures and the urodynamic studies were analyzed. The associations among cystoscopic and urodynamic findings were reviewed. RESULTS: Patient demographics of this subgroup show a predominance of Caucasians 139/150 (92.7%), with the average age being 43 (+/-13.2) years. Of the total, 17 patients (11.3%) had a Hunner's patch (HP). The prevalence by center varied from a low of 2/38 (5.3%) to a high of 3/9 (33.3%). Bloody effluent following hydrodistension was present in 113/150 (75.3%). Glomerulations appeared in varying degrees (mild, moderate, severe) in 91.3% of the 150 patients. There was a strong inverse relationship (P < 0.001) between bladder capacity under anesthesia and the presence of a HP (mean of 845 cc with HP absent versus a mean of 531 cc when present). The incidence of HP varied from 67.6% among women with a bladder capacity at hydrodistension of < 400 cc to 3.8% for those with a bladder capacity of at least 800 cc. The presence and increasing severity of glomerulations was positively associated (P < 0.003) with the presence of HP, ranging from 0/13 (0%) when glomerulations were not present to 6/31 (19.4%) when glomerulations were graded as severe. Of the patients with HP, 17/17 (100%) had glomerulations after hydrodistension. HP is more closely associated with the moderate to severe range of glomerulations (P < 0.01). Nearly half of the patients with HP or 8/17 (47.1%) had "moderate" glomerulations, while 6/17 (35.3%) had "severe" glomerulations. The volume at first sensation to void on urodynamics (mean 87 cc without HP versus 34.7 cc with HP) was highly inversely associated (P = 0.002) with the presence of HP, but not with any of the other cystoscopic findings. Of patients with HP, 94% had a volume at first sensation to void of < or = 50 cc where only 36% of patients without HP had a volume at first sensation to void of < or = 50 cc. The volume at maximum capacity on urodynamics was positively associated with the volume at hydrodistension (P < 0.001). CONCLUSIONS: Overall, patients with HP had lower bladder capacities, lower volumes at first sensation to void, and more severe glomerulations. Thus, the presence of HP would imply a more severe case of interstitial cystitis. Logically, a higher bladder capacity on cystometrogram is associated with a higher volume at the time of hydrodistension, and bloody effluent is associated with more severe glomerulations.

Adult↗