Urodynamic indices and pelvic organ prolapse quantification 3?months after vaginal delivery in primiparous women

Introduction and hypothesis

This study aims to describe multichannel urodynamic indices and pelvic organ prolapse quantification (POP-Q) in primiparous women 3?months after vaginal delivery.

Methods

This was a secondary analysis of a group of women who had been randomized to either coached or non-coached pushing during the second stage of labor. Primiparous women were evaluated with POP-Q examination and multichannel urodynamic testing 3?months after vaginal delivery.

Results

Of 128 women evaluated, the cumulative stage of prolapse was distributed as 4.7% stage 0, 39% stage I, 56% stage II, and none with stage III prolapse or greater. For the anterior compartment, most had stage II prolapse. Stage I prolapse predominated for both the central and posterior compartments. Of the women, 14.1% had urodynamic stress incontinence, 12.5% had detrusor overactivity, and 6% had both.

Conclusions

In a predominantly Hispanic primiparous population, ICS POP-Q stage II prolapse of the vagina, urodynamic stress incontinence, and detrusor overactivity are common findings at a 3-month postpartum assessment.     

Clinical and urodynamic evaluation of women referred with diabetes mellitus

Introduction and hypothesis

We investigated the impact of diabetes mellitus (DM) on female lower urinary tract dysfunction.

Methods

We prospectively collected data of 1,640 consecutive diabetic women from the inpatient departments and outpatient clinics of urology, endocrinology, geriatrics, and nephrology in primary, secondary, and tertiary referral hospitals, rural healthcare stations, and nursing homes in Dujiangyan, China. Clinical histories were taken on an individualized basis depending on patient presentation. Urodynamics were performed in the enrolled female diabetic patients after excluding other causes of lower urinary tract dysfunction. Data on lower urinary tract symptoms and urodynamic parameters were analyzed.

Results

Ninety-three percent of diabetic women complained of lower urinary tract symptoms, and 88 % had positive urodynamic findings. Sixty-three percent presented with storage symptoms, 918 cases of which had detrusor overactivity, 787 impaired detrusor contractility, and 131 detrusor areflexia. Among the 918 patients with impaired detrusor contractility or detrusor areflexia, the mean first sensation of filling was 238.1 ml, with a mean maximum cystometric capacity of 624 ml, mean maximum flow rate of 9.6 ml/s, mean detrusor pressure at maximum flow rate of 32.4 cmH₂O, and mean postvoid residual of 323 ml. Thirty-eight of 131 patients with detrusor areflexia had impaired renal function on blood chemistry test, and massive bilateral ureterohydronephrosis and “Christmas-tree-shaped” bladder in videourodynamic studies. On the whole, 95 % diabetic women had diabetic cystopathy.

Conclusions

DM alters voiding patterns significantly, causing various lower urinary tract symptoms in a significant proportion of diabetic women. Diabetic cystopathy is a progressive condition with a spectrum of clinical symptoms and urodynamic findings. The prevalence of diabetic cystopathy is very high in Dujiangyan, China.     

Preoperative voiding detrusor pressures do not predict stress incontinence surgery outcomes

Introduction and hypothesis

The aim of this study was to determine whether preoperative voiding detrusor pressures were associated with postoperative outcomes after stress incontinence surgery.

Methods

Opening detrusor pressure, detrusor pressure at maximum flow (p _det Q_max), and closing detrusor pressure were assessed from 280 valid preoperative urodynamic studies in subjects without advanced prolapse from a multicenter randomized trial comparing Burch and autologous fascia sling procedures. These pressures were compared between subjects with and without overall success, stress-specific success, postoperative detrusor overactivity, and postoperative urge incontinence using independent sample t tests.

Results

There were no clinically or statistically significant differences in mean preoperative voiding detrusor pressures in any comparison of postoperative outcomes.

Conclusions

We found no evidence that preoperative voiding detrusor pressures predict outcomes in women with stress predominant urinary incontinence undergoing Burch or autologous fascial sling procedures.     

Which clinical risk factors determine a pathological urodynamic evaluation in patients with multiple sclerosis? an analysis of 100 prospective cases

Background

Urinary tract symptoms are an underestimated problem in multiple sclerosis (MS).

Objective

Hundred urodynamics of MS patients have been evaluated prospectively.

Design, setting and participants

In an inpatient rehabilitation, all persons with MS who also suffered from urinary tract symptoms received a voiding diary, post-void sonography and an urodynamic examination according to International Continence-Society-Standard.

Results and limitations

Between 10/2009 and 3/2011, 100 patients (79 women; 21 men; mean EDSS, 4.52 ± 2.26) were examined who had primary progressive MS (9×), relapsing–remitting MS (41×), secondary progressive MS (43×) and CIS (1×). The mean duration of MS was 10.26 ± 10.09 years and mean duration of LUTS, 6.9 ± 7.75 years. Urodynamic testing showed normal findings in 22 patients, detrusor overactivity in 7, increased bladder sensation without detrusor overactivity in 21, detrusor–sphincter dyssynergia in 26, detrusor hypocontractility in 12, detrusor acontractility in 4 and unclear diagnosis in 8 patients. Statistically significant risk factors for pathological urodynamic findings were as follows: wheelchair dependency, use of more than one incontinence pad per day and a MS type other than relapsing–remitting.

Conclusions

The urodynamic investigation at hand showed urinary tract dysfunction in 78 of 100 MS patients with lower urinary tract symptoms (LUTS). The long latency between the occurrence of MS and/or the beginning of LUTS and the first neuro-urological evaluation indicates a deficit in treatment. Beyond national guidelines, all MS patients should at regular intervals be questioned about LUTS and receive urodynamic assessment especially according to the presented risk profile.     

Clinical findings associated with bladder trabeculations in women

Introduction and hypothesis

This study evaluated whether bladder trabeculations are associated with advanced prolapse, urinary urgency, or detrusor overactivity among women undergoing office cystoscopy. It is well established that bladder trabeculations are associated with bladder outlet obstruction (BOO) in men; however, the clinical significance of trabeculations in women is unclear. Whereas an analogous relationship has been proposed between prostatic obstruction in men and advanced pelvic organ prolapse (POP) in women, little data in the medical literature supports this theory.

Methods

A retrospective cohort study was conducted using Current Procedural Terminology (CPT) codes (52000, 52204) to identify all women who underwent office cystoscopy at our urogynecology center between January 2008 and May 2011. The 551 women identified were grouped by the presence or absence of bladder trabeculations. Multivariable logistic regression was used to estimate the association between trabeculations and the primary aim, increasing stage of prolapse, and the secondary aims: bladder outlet obstruction, detrusor overactivity, or urge urinary incontinence (UUI).

Results

Of the 551 women meeting inclusion criteria, 86 had trabeculations. Controlling for age, the odds of bladder trabeculations were eightfold greater for women with stage IV POP when compared with women with stage 0 prolapse [odds ratio (OR) 8.2, 95 % confidence interval (CI) 1.6–43.1]. The odds of bladder trabeculations were twofold greater for women with detrusor overactivity (OR 2.3, 95 % CI 1.3–4.0) found on urodynamic study and also as reflected subjectively by answers to Pelvic Floor Distress Inventory (PFDI) item number 16 (OR 4.2, 95 % CI 1.3–14.5).

Conclusion

In this study, bladder trabeculations were associated with stage IV prolapse in the anterior compartment as well as with detrusor overactivity and UUI.     

Maximum urethral closure pressure in women: normative data and evaluation as a diagnostic test

Introduction and hypothesis

Our goal was to identify correlates of maximum urethral closure pressure (MUCP) and MUCP as a diagnostic test for stress urinary incontinence (SUI).

Methods

This study was a retrospective review of women with non-neurological referrals for urinary incontinence between1995 and 2006.

Results

We studied the characteristics of 8,644 women who underwent urodynamics for non-neurological referrals. Mean MUCP was 48?cm?H₂O in urodynamic stress incontinence (USI), 50?cm?H₂O in mixed urinary incontinence (MUI), 65?cm?H₂O in detrusor overactivity incontinence (DOI) and 67?cm?H₂O for continent women . Age and MUCP were negatively correlated in all groups. Multiple regression analysis showed lower levels of MUCP in women with USI who also had previous hysterectomy or anti-incontinence surgery or who were in an older age group. Previous anti-incontinence surgery and older age were risk factors for lower MUCP in women with MUI and DOI. Receiver operator curves did not show MUCP to have utility as a diagnostic test despite age and parity stratification. MUCP?<?20?cm?H₂O showed a sensitivity of 5?% and specificity of 98?% in diagnosing USI.

Conclusions

MUCP failed to meet the criteria for a diagnostic test. Women with USI and MUI have lower MUCP than women with DOI and continent women in each decade of life. MUCP decreases with age.     

Mixed urinary symptoms: What are the urodynamic findings?

AIM: To define the urodynamic diagnoses of women with mixed urinary incontinence (MUI) symptoms. MATERIALS AND METHODS: Women with MUI symptoms were studied. They were divided into stress predominant MUI; urge predominant MUI; or equal severity of stress and urge MUI on the basis of the most severe symptom scored on the King's Health Questionnaire. The frequency of different urodynamic diagnoses for the all women with MUI and in each of the above groups was calculated. RESULTS: Overall 3,338 women were studied. Of these 49% (1,626/3,338) reported MUI symptoms and were included. In this group 29% (464/1,626) had stress predominant MUI, 15% (248/1,626) had urge predominant MUI and 56% (912/1,626) had equal severity of urge and stress MUI. On urodynamics 42% (665/1,626) had pure urodynamic stress incontinence, 25% (414/1,626) had pure detrusor overactivity, 18% (299/1,626) had both detrusor overactivity and urodynamic stress incontinence and 15% (248/1,626) had normal urodynamic studies. In those with stress predominant MUI, 82% had urodynamic stress incontinence; in those with urge predominant MUI, 64% had detrusor overactivity. The urodynamic diagnoses were significantly different for the different balance of symptoms (P < 0.05, Chi-Square test). In women with equal severity of urge and stress incontinence, 46% had detrusor overactivity while 54% had urodynamic stress incontinence. CONCLUSIONS: The relative severity of MUI symptoms from a symptom questionnaire significantly distinguishes between different urodynamic diagnoses. Women with urge predominant MUI are more likely to have detrusor overactivity while those with stress predominant MUI are more likely to have urodynamic stress incontinence.     

The open bladder neck: a significant finding?

Women with lower urinary tract symptoms were retrospectively studied. They were all investigated using a urinary symptoms questionnaire, a frequency-volume chart and videocystourethrography. An open bladder neck was recorded at maximum cystometric capacity with the patient standing in the left lateral position, if contrast medium entered the proximal urethra at rest in the absence of a detrusor contraction or an increase in intra-abdominal pressure. Women with neurological disorders were excluded. Of 4500 women, 2,593 (57.6%) had a single urodynamics diagnosis and were included in the study: 1207 (46.5%) had urodynamics diagnosis of urodynamic stress incontinence, 558 (21.5%) had detrusor overactivity, 118 (4.6%) had sensory urgency, and 710 (27.4%) had a normal urodynamic study. Out of the 2,593 women included, 776 women (29.9%) had an open bladder neck at rest while 1817 (70.1%) had a closed bladder neck at rest. Only 45% (542/1207) of women with urodynamic stress incontinence had an open bladder neck at rest. Seventy percent (542/776) of women with an open bladder neck had a diagnosis of urodynamic stress incontinence whilst 73% of women with detrusor overactivity and 93% of those with sensory urgency had a closed bladder neck. An open bladder neck at rest is not diagnostic of urethral sphincter incompetence but is associated with urodynamic stress incontinence. It is not associated with urgency as few women with sensory urgency and detrusor overactivity were found to have an open bladder neck. Imaging the bladder neck at rest has questionable value.Editorial Comment: The authors report on a very large series of women who had video urodynamic studies. They concluded that an open bladder neck was not conclusive of Intrinsic Sphincter Deficiency. They also noted that most women with detrusor overactivity or sensory urgency did not have an open bladder neck, which contradicts previous theories regarding bladder neck funnelling have a high association with detrusor overactivity.     

Age and bladder outlet obstruction are independently associated with detrusor overactivity in patients with benign prostatic hyperplasia

Background

Detrusor overactivity is one known cause of lower urinary tract symptoms and has been linked to bladder storage symptoms (urgency, frequency, or urge incontinence).

Objective

To determine clinical and urodynamic parameters associated with detrusor overactivity in patients with suspected benign prostatic hyperplasia.

Design, Setting, and Participants

During 1993–2003, urodynamic investigations were performed in patients aged 40 yr or older and with lower urinary tract symptoms, benign prostatic enlargement, and/or suspicion of bladder outlet obstruction (maximum flow rate < 15 ml/s or postvoid residual urine > 50 ml).

Measurements

Detrusor overactivity was defined according to the new International Continence Society classification (2002) as involuntary detrusor contractions during cystometry, which may be spontaneous or provoked, regardless of amplitude. The Schäfer algorithm was used to determine bladder outlet obstruction.

Results

In total, 1418 men were investigated (median age: 63 yr) of whom 864 men (60.9%) had detrusor overactivity. In univariate analysis, men with detrusor overactivity were significantly older, more obstructed, had larger prostates, higher irritative International Prostate Symptoms Score subscores, a lower voiding volume at free uroflowmetry, and a lower bladder capacity at cystometry. The prevalence of detrusor overactivity rose continuously with increasing bladder outlet obstruction grade. Multivariate analysis showed that only age and bladder outlet obstruction grade were independently associated with detrusor overactivity. After age adjustment, the odds ratios of detrusor overactivity compared to Schäfer class 0 were 1.2 for class I, 1.4 for class II, 1.9 for class III, 2.5 for class IV, 3.4 for class V, and 4.7 for class VI.

Conclusions

In patients with clinical benign prostatic hyperplasia, detrusor overactivity is independently associated with age and bladder outlet obstruction. The probability of detrusor overactivity rises with increasing age and bladder outlet obstruction grade.     

Improving the clinical prediction of detrusor overactivity by utilizing additional symptoms and signs to overactive bladder symptoms alone

Introduction and hypothesis

We attempted to improve the accuracy of the clinical diagnosis of detrusor overactivity (DO) by using other significant clinical parameters in addition to overactive bladder (OAB) symptoms alone.

Methods

One thousand one hundred and forty women attending for their initial urogynecological assessment, including urodynamics, due to symptoms of pelvic floor dysfunction, underwent a comprehensive clinical and urodynamic assessment. Multivariate logistic regression analysis of a wide range of clinical parameters was used in order to determine a model of factors most accurately predicting the urodynamic diagnosis of DO. Data were separated according to women without DO; women with DO. The analysis involved the stepwise building of an optimal clinical model for predicting DO.

Results

In multivariate analysis, the OAB symptoms of urgency incontinence, urgency and nocturia (not frequency) were significantly associated with DO. Their prediction of DO was not particularly accurate (sensitivity 0.64; specificity 0.67). The addition of other significant clinical parameter, i.e. absent symptoms of stress incontinence; lower parity (0–1); no signs of prolapse, to the diagnostic model, resulted in marginally improved accuracy (area under the ROC curve increased from 0.70 to 0.74).

Conclusions

Overactive bladder symptoms alone are not accurate in predicting DO. Adding other significant clinical parameters to the model resulted in a small statistical advantage, which is not clinically useful. An accurate clinical diagnosis of DO in women would appear to remain elusive.     

Midurethral slings for women with urodynamic mixed incontinence: what to expect?

Introduction and hypothesis

We assessed the efficacy of midurethral slings (MUS) in women with urodynamically proven mixed incontinence (UMI).

Methods

A prospective study was carried out in women with UMI in whom conservative treatment failed and who underwent MUS. Pre- and postoperative assessment included: completion of the validated ICIQ-FLUTS questionnaire, POP-Q examination and urodynamics (UDS). The primary outcome was the assessment of symptoms at 12 months. Secondary outcomes included assessment of postoperative UDS findings and evaluation of differences in symptoms and UDS diagnosis between the TVT and TVT-O groups.

Results

Eighty-five women were included; 44 (49.2%) underwent TVT and 41 (51.8%) underwent TVT-O. Concomitant prolapse surgery was performed in 65 out of 85 patients (76.5%). At 12 months’ follow-up there was a statistically significant reduction in stress urinary incontinence (p?<?0.001), urge urinary incontinence (p?<?0.001), urgency (p?=?0.021) and frequency (p?=?0.014). Depending on the symptom 10.6% to 24.7% of women reported deterioration of symptoms. UDS at 12 months revealed the absence of urodynamic stress incontinence (USI) in 82.4% of patients and no evidence of detrusor overactivity (DO) in 35.3%. No differences in symptoms were found between the TVT and TVT-O group, but the absence of DO was more common in the TVT group (48.5% vs 22.7%, p?=?0.014).

Conclusions

Placement of MUS alleviates incontinence and overactive bladder symptoms in patients with UMI. TVT causes similar subjective improvement to TVT-O, but resulted in higher resolution of DO. Our study provides data that could be helpful in informing patients preoperatively of the potential impact that the MUS may have on each individual symptom separately, including the likelihood of symptom deterioration.     

How often does detrusor overactivity cause urinary leakage during a stress test in women with mixed urinary incontinence?

Introduction and hypothesis

The study examined how often detrusor overactivity (DO) causes leakage during a stress test in women with mixed urinary incontinence (MUI) and whether there are differences between those who do and those who do not have DO during the stress test.

Methods

A retrospective study was performed in 100 women who had an ambulatory urodynamic recording done where bladder, urethral, and vaginal pressures, and leakage were recorded. The stress test consisted of 20 jumping jacks and three forceful coughs.

Results

All the women leaked during the stress test: five due to simultaneous stress test and DO, 87 due to the stress test only, and eight during the stress test as well as due to DO before or after the stress test.

Conclusions

During the stress test, 5 % of women with MUI leaked due to the coughs and jumps and simultaneous DO. Women in whom DO was detected had significantly higher Urgency Incontinence Index and leakage during the 24-h pad test.     

Clinical and urodynamic differences among women with overactive bladder according to the presence of detrusor overactivity

Introduction and hypothesis

We tried to determine whether clinical and urodynamic differences exist between women with and without detrusor overactivity (DO) using a large database of overactive bladder (OAB) patients.

Methods

We reviewed the medical records of 513 women who underwent urodynamic studies for OAB symptoms without neurogenic or anatomical conditions that affect micturition function. Clinical symptoms were evaluated using a 3-day frequency-volume chart (FVC) including the Urinary Sensation Scale and American Urological Association Symptom Index (AUA-SI). All clinical and urodynamic findings were compared between women with and without DO.

Results

The patients’ mean age was 58.9 years. DO was identified urodynamically in 167 (32.6 %) women. Those with DO were older (62.9 vs 57.0 years, p?<?0.001); however, no differences in AUA-SI, episodes of daytime voiding, and episodes of nocturia were observed between the groups. Functional bladder capacity was smaller in women with DO; however, this difference did not reach statistical significance. Women with DO had significantly more urgency incontinence symptoms than those without DO (55.1 vs 29.5 %, p?<?0.001). In urodynamic parameters, the volumes at first desire to void and strong desire to void and maximum cystometric capacity were significantly smaller, and detrusor pressure at the opening was significantly higher in women with DO compared to subjects without DO (26.2 vs 21.2 cmH₂O, p?=?0.004).

Conclusions

Our findings suggest a more severe disturbance of bladder function when DO exists, although no differences were observed in symptom scores and 3-day FVC parameters among women with OAB symptoms according to the presence of DO.     

Predictors of postoperative antimuscarinics in women with mixed urinary incontinence after transobturator surgery

Introduction and hypothesis

The study sought to identify the risk factors of postoperative use of antimuscarinics after transobturator surgery in women with mixed urinary incontinence (MUI) displaying both urodynamic stress urinary incontinence (SUI) and involuntary detrusor contraction (IDC) with leakage in urodynamic study.

Methods

The clinical data of 103 patients with MUI who underwent transobturator tape (TOT) sling surgery were retrospectively reviewed. The patients were followed at least a year. To determine risk factors for postoperative use of antimuscarinics, variables of only those with P values?<?0.05 on univariate analysis were included in the multivariate logistic regression analysis with forward stepwise building.

Results

Eight-four (81.6 %) of 103 patients were included in this study. The cure rate of urge urinary incontinence (UUI) was 69.0 % (58/84). Antimuscarinics were prescribed postoperatively in 22 (26.2 %) of 84 patients. Variables affecting postoperative use of antimuscarinics were age, parity, episode of any UUI, preoperative use of antimuscarinics, predominant urgency incontinence type, detrusor pressure at maximum flow, and Urogenital Distress Inventory 6. Increasing age and preoperative use of antimuscarinics increased the odds of postoperative use of antimuscarinics following TOT surgery.

Conclusion

Patients who were older and had taken antimuscarinics preoperatively were significantly associated with postoperative use of antimuscarinics.     

Intravaginal Stimulation Randomized Trial

Purpose

The effectiveness of intravaginal electrical stimulation was compared to standard therapy in the treatment of genuine stress urinary incontinence and detrusor instability.

Materials and Methods

A total of 57 women with urinary incontinence was evaluated with video urodynamics and voiding diaries before and after treatment. Of the women 18 with stress urinary incontinence were randomized to electrical stimulation or Kegel exercise and 38 with detrusor instability were randomized to anticholinergic therapy or electrical stimulation.

Results

Of patients using electrical stimulation in the stress urinary incontinence group 66 percent improved and 72 percent of the patients with detrusor instability treated with electrical stimulation improved. These rates were not statistically significant when compared to traditional therapy.

Conclusions

Electrical stimulation is safe and at least as effective as properly performed Kegel and anticholinergic therapy in the treatment of stress urinary incontinence and detrusor instability.     

The prevalence of detrusor overactivity amongst patients with symptoms of overactive bladder: a retrospective cohort study

Introduction and hypothesis

Overactive bladder (OAB) is a symptom-based condition consisting of urgency, with or without incontinence, usually with frequency and nocturia. There are many potential causes of OAB, yet many patients are prescribed anticholinergic medications empirically. This study aimed to determine what proportion of patients presenting for urogynecologic assessment with symptoms of OAB had urodynamic detrusor overactivity (DO).

Methods

Retrospective chart review was performed for 220 consecutive patient referrals. Demographic data, physical exam information, and urodynamic results were collected. The t test and Fisher’s exact test were used for statistical analyses.

Results

The prevalence of DO was 11.8?% in this population. Urogenital atrophy and incomplete emptying were more common. Patients with DO were older and more often menopausal than those without DO. Significant prolapse was a common finding amongst patients with OAB symptoms.

Conclusions

Patients with symptoms of OAB should undergo pelvic examination and assessment of post-void residuals before being initiated on anticholinergic medication.     

Review on ultrasound measurement of bladder or detrusor wall thickness in women: techniques, diagnostic utility, and use in clinical trials

Purpose

To provide a narrative review of literature evaluating ultrasound techniques for the measurement of bladder wall hypertrophy in women as an alternative to invasive urodynamic assessment for the diagnosis of lower urinary tract symptoms (LUTS).

Methods

A literature review was performed using PubMed and all paper journals of congress abstracts searching for articles on ultrasound measurement of bladder wall thickness (BWT) or detrusor wall thickness (DWT) published between January 1990 and May 2012. Each study was classified with a level of evidence using the Oxford Centre for Evidence-based Medicine classification (2009).

Results

Ultrasound measurement of bladder wall hypertrophy is not standardised, and techniques vary widely according to anatomical approach, ultrasound frequency and other factors. This review compared transvaginal, translabial/transperineal and suprapubic approaches for ultrasound BWT/DWT measurement. BWT/DWT measurements correlated well with urodynamic diagnoses of detrusor overactivity (DO) using all three ultrasound techniques. BWT values were consistently higher in women with DO than in women with stress incontinence, although threshold values for the differential diagnosis of DO varied between clinical studies (5.0–6.5 mm using transvaginal ultrasound). Few data were available on the use of translabial or suprapubic ultrasound in women. Inter- and intraobserver variability was higher with transperineal and suprapubic ultrasound, and these techniques appear less reliable than transvaginal ultrasound. Studies suggest that BWT is reduced in response to antimuscarinic therapy in women with overactive bladder or DO.

Conclusions

Data from clinical trials suggest that transvaginal ultrasound measurement of BWT is a reliable method of diagnosing DO in women with LUTS, and BWT decreases during antimuscarinic therapy.     

The “bother” of urinary incontinence

Introduction and hypothesis

Patient reported measures are important for the evaluation of symptom-specific bother and the distinction between different types of urinary incontinence. The aim of the study was to assess the validity of physician administered visual analogue scales (VAS) for the bother from stress urinary incontinence (SUI) and urge urinary incontinence (UUI).

Methods

In this prospective cohort study based at a tertiary urogynecological unit, women attending for investigation of lower urinary tract symptoms (n?=?504) were asked to indicate their subjective bother from SUI and UUI on a 10-cm VAS. Clinical assessment, including multichannel urodynamic testing and 4D translabial ultrasound was performed for clinical diagnosis. Linear regression was used to model the average increase in VAS bother score of SUI and UUI for each explanatory variable.

Results

74 % (n?=?375) reported symptoms of SUI, with mean bother of 5.7 out of 10 (SD 2.8), and 73 % (n?=?370) symptoms of UUI, with a mean bother of 6.5 out of 10 (SD 2.6). Bother from UUI was positively associated with the symptoms of nocturia (p?<?0.0001) and frequency (p?=?0.002), and the urodynamic findings of detrusor overactivity (p?<?0.0001). Bother from SUI was positively related to the urodynamic diagnosis of USI (p?<?0.0001) and a low abdominal leak point pressure (ALPP) (p?=?0.002), as well as to the ultrasound findings of cystourethrocele (p?<?0.0001) and funnelling (p?=?0.04). All univariate associations remained highly significant on multivariate analysis, controlling for age, BMI, parity, previous incontinence/prolapse surgery and previous hysterectomy.

Conclusions

Physician-administered VAS are a valid, reliable and practicable tool to measure bother related to SUI and UUI.     

A multicenter prospective trial evaluating fetal bovine dermal graft (Xenform® Matrix) for pelvic reconstructive surgery

Background

Most bladder tumors are derived from the urothelium. Benign mesenchymal tumors are rare. Leiomyoma of the bladder is the most common benign neoplasm. We present a case of leiomyoma of the bladder presenting with acute urinary retention in a female patient and report on the post-operative change in urodynamic findings. To our knowledge, few cases of this kind have been reported.

Case Presentation

A 56-year-old woman presented with acute urinary retention. Evaluations including ultrasound, magnetic resonance imaging, cystoscopy, and urodynamics contributed to a diagnosis of leiomyoma of the bladder. Various medications were ineffective for solving her lower urinary tract symptoms; therefore, a transurethral resection was performed. The final pathological report was leiomyoma. After the operation, her symptoms resolved; this improvement was confirmed by an urodynamic analysis. The postoperative urodynamics demonstrated a lower frequency of detrusor overactivity during filling cystometry and an increase in the uroflow rate, with reduced detrusor pressure in a pressure flow study.

Conclusions

Leiomyoma of the bladder can cause female outlet obstruction. A review of the literature and disease management is discussed.     

Botulinum toxin for conditions of the female pelvis

Introduction and hypothesis

Botulinum toxin has recently been approved by the Food and Drug Administration (FDA) for the treatment of urinary incontinence associated with neurogenic detrusor overactivity. However, it has also been used off-label for a multitude of other conditions in the female pelvis, including urological, gynecological, and colorectal. This article reviews the most recent data regarding its efficacy and safety, and administration techniques for those conditions.

Methods

A literature review of the most relevant reports published between 1985 and 2012.

Results

Urinary incontinence related to neurogenic detrusor overactivity is currently the only approved indication in the female pelvis. Other supported off-label uses include: idiopathic detrusor overactivity, interstitial cystitis/bladder pain syndrome, detrusor sphincter dyssynergia, high-tone pelvic floor dysfunction, anal fissure, anismus, and functional anal pain.

Conclusions

Botulinum toxin may effectively and safely be used in many conditions of the female pelvis. More high quality research is needed to better clarify its role in the therapeutic algorithm for those indications.