A clinical study on subjective sensations during bladder filling

Subjective sensations during the tonic phase of a bladder filling during cystometry were determined in 649 patients with incontinence and/or micturition problems of neurogenic and non-neurogenic origin. In this study 354 patients perceived three distinct sensations: a ‘first sensation of filling’ at 40% of bladder capacity, a ‘first desire to void’ at 75% of bladder capacity and a ‘strong desire to void’ at maximum cystometric capacity; 184 patients had one or two different sensations. Volume seemed more important than intravesical pressure in eliciting the sensations. In the distinction by the patient between the three consecutive sensations, both changes in intensity of volume perception and the existence of a specific neurological pathway for each sensation might play a role. Sensations appeared earlier during filling when asymtomatic urinary tract infection was present. These data give additional information about the subjective proprioception of bladder filling.     

The effects of bethanechol and cisapride on urodynamic parameters in patients undergoing radical hysterectomy for cervical cancer. A randomized, double-blind, placebo-controlled study

To evaluate the effects of bethanechol and cisapride on urodynamic parameters in patients undergoing radical hysterectomy for cervical cancer. In this double-blind, placebo-controlled study, 79 patients with cervical cancer were randomized to receive bethanechol (30 mg/day), cisapride (30 mg/day), bethanechol combined with cisapride (same doses) and placebo. Urodynamic study was performed, including flowmetry, cystometry, pressure-flow study and urethral pressure profile before radical hysterectomy. Medication was administered postoperatively during 30 days. At the end of this period, urodynamic evaluation was repeated. There was an increase in both the maximum cystometric capacity and bladder capacity at first desire to void in the placebo group compared to the other groups. The rate of detrusor instability was higher in the group that used bethanechol combined with cisapride. Detrusor pressure at maximum flow was significantly higher when cisapride was used. There was a significant increase in postvoid residual volume in the placebo group. In patients undergoing radical hysterectomy, bethanechol and cisapride determined lower cystometric capacity and decreased bladder capacity at first desire to void, a higher maximum flow rate and higher detrusor pressure at maximum flow, with lower postvoid residual volumes. The early use of bethanechol and cisapride after radical hysterectomies positively modified urodynamic parameters, determining a more efficient detrusor function.     

Effect of thalamic deep brain stimulation on lower urinary tract function

OBJECTIVE: The precise mechanisms underlying cerebral regulation of lower urinary tract function are still poorly understood. In patients with disabling essential tremor (ET) refractory to pharmacotherapy, thalamic deep brain stimulation (DBS) is an effective treatment for tremor control. Here, we evaluated the effect of thalamic DBS on urodynamic parameters in patients with ET. PATIENTS AND METHODS: We investigated seven patients (two females, five males) with ET 15-85 mo after implantation of DBS leads into the ventral intermediate nucleus of the thalamus. We compared urodynamic parameters during thalamic DBS (ON state) and 30 min after turning the stimulator off (OFF state). RESULTS: In the ON compared with the OFF state, there was a significant decrease in bladder volume at first desire to void (median, 218 ml vs. 365 ml, p=0.031), at strong desire to void (median, 305 ml vs. 435 ml, p=0.031), and at maximum cystometric capacity (median, 345 ml vs. 460 ml, p=0.016). No significant differences between the ON and OFF state were detected for changes in detrusor pressure during filling cystometry, bladder compliance, maximum detrusor pressure, detrusor pressure at maximum flow rate, maximum flow rate, voided volume, and postvoid residual. CONCLUSIONS: Thalamic deep brain stimulation resulted in an earlier desire to void and decreased bladder capacity, suggesting a regulatory role of the thalamus in lower urinary tract function. Therefore, the thalamus may be a promising target for the development of new therapies for lower urinary tract dysfunction.     

Frequency-volume charts: a tool to evaluate bladder sensation

AIMS: Bladder sensation is routinely evaluated by cystometric bladder filling and electrical stimulation. These methods require catheterization and stimulate the bladder artificially. In this study, we evaluated whether frequency-volume charts can be used as a non-invasive tool to study bladder sensation during normal daily life. Furthermore the agreement between sensory data obtained from frequency-volume charts and conventional cystometric bladder filling is studied. MATERIALS AND METHODS: Fifteen healthy female students filled out frequency-volume charts at home and scored the grade of perception of bladder fullness at each micturition. They also measured the volume of three voidings after postponing micturition as long as possible. Sensation of bladder filling was finally evaluated during cystometry. RESULTS: On frequency-volume charts, 65% of all voidings was made without desire to void, only 9.5% was with strong desire. Urgent desire to void was not reported except after voluntarily postponing micturition. Higher grades of perception of fullness were associated with significantly higher voided volumes. Mean volumes for the different sensations of fullness on the charts were not significantly different from volumes at different sensations reported during cystometry. CONCLUSIONS: In conclusion, bladder sensation during daily life can be evaluated by scoring the grade of perception of fullness on frequency-volume charts. During life voiding usually occurs without desire to void. The voided volumes at different sensations of fullness are comparable to the volumes at different sensations of filling during cystometry. Therefore, frequency-volume charts with evaluation of perception of fullness may provide an initial non-invasive tool to study bladder sensation.     

Can a faked cystometry deceive patients in their perception of filling sensations? A study on the reliability of spontaneously reported cystometric filling sensations in patients with non‐neurogenic lower urinary tract dysfunction

AIMS: To evaluate the reliability of spontaneously reported bladder sensations during real and faked cystometry in patients with non-neurogenic lower urinary tract dysfunction. METHODS: Fifty-nine patients with non-neurogenic lower urinary tract dysfunction were submitted to a real and faked filling cystometry and were asked to describe all bladder-related sensations they experienced during the investigations. All patients were told that the bladder had to be filled twice, but during the faked cystometry, no water was infused in the bladder. RESULTS: During the real cystometry, the normal pattern of filling sensation was reported by 88%. During the faked cystometry, none of the patients reported the normal pattern of filling sensations. Five patients reported first sensation of filling, one first desire to void (FDV). None of the patients reported a strong desire to void (SDV) during the faked cystometry. CONCLUSIONS: Asking patients with a non-neurogenic lower urinary tract dysfunction to report on the bladder filling sensations during cystometry is a valid method for sensory evaluation. A minority of patients may report some sensation of bladder filling even without actual bladder filling. Memory and habituation may play a role in the perception of bladder sensation and one should be aware of this. However, reporting some sensation during faked cystometry not necessarily means the evaluation of the perception of bladder filling is unreliable.     

Reference urodynamic values for stress incontinent women

OBJECTIVE: To determine reference urodynamic values for preoperative urodynamic studies in women undergoing surgery for pure or predominant stress urinary incontinence (SUI). MATERIALS AND METHODS: Six hundred fifty-five women with pure or predominant SUI were enrolled in a multicenter surgical trial and were randomized to undergo a Burch or autologous fascia sling procedure as part of the Urinary Incontinence Treatment Network (UITN) Stress Incontinence Surgical Treatment Efficacy Trial (SISTEr). Preoperative free uroflowmetry, filling cystometry, and pressure flow studies were performed in all women using a standardized research protocol and standardized urodynamic interpretation guidelines. We define the normal range of urodynamic values in this population as the values that encompass 95% of the results. RESULTS: In 655 women undergoing filling cystometry in the standing position, baseline vesical and abdominal pressures were between 12 and 60 cm H(2)O. The upper limit of detrusor pressure increase during bladder filling to maximum cystometric capacity was 16 cm H(2)O. Ten percent of women who qualified for stress incontinence surgery with a positive cough stress test on physical exam did not demonstrate urodynamic stress incontinence (USI) and less than 10% of subjects in this study demonstrated detrusor overactivity. CONCLUSIONS: Results from a large cohort of women with SUI are now available for quantitative plausibility assessments or as reference values when interpreting urodynamic studies.     

Interactions between prostate volume, filling cystometric estimated parameters, and data from pressure-flow studies in 565 men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia

The aim of this study was to establish the characteristics and to investigate the interactions between prostate volume, degree of obstruction, bladder contractility, the prevalence of residual volume, bladder compliance, bladder capacities, and the prevalence of instability in a large, well-defined group of men with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH). The 565 consecutive men included in this study met the criteria of the International Consensus Committee on BPH and voided more than 150 mL during uroflowmetry. Their residual urine volume and prostate size were estimated, and filling cystometry and pressure-flow studies were performed. Fifty-three percent of the men appeared to have obstruction. We found a positive correlation between prostate volume and Sch?fer's obstruction grade, except that mean prostate volume decreased at Sch?fer's grades 5 and 6. Significant negative correlations existed between Sch?fer's grade and cystometric bladder capacity and effective capacity. Bladder outlet obstruction results in incomplete emptying. Of all men, 26% had a significant residual volume ( > 20% of cystometric capacity). Thirty-nine percent did not have residual volume. Of the 565 men, 46% had an unstable bladder. In particular, patients with an unstable bladder in the sitting and lying positions have a significantly higher Sch?fer's grade and contractility grade and a significantly lower cystometric and effective bladder capacity compared with patients without instability. Patients with a residual volume or instability were significantly older. We conclude that in men with LUTS suggestive of BPH, abnormalities of bladder and bladder outlet function vary greatly and have complex mutual interactions.     

Associations between subjective overactive bladder symptoms and objective parameters on bladder diary and filling cystometry

Introduction and hypothesis

A study was conducted to assess associations between different overactive bladder (OAB) symptoms and their outcomes on bladder diary and filling cystometry parameters.

Methods

We performed a retrospective cohort study in database of 6,876 Urinary Distress Inventories, 3,185 bladder diaries and 2,153 filling cystometries from women referred to our urogynecological center between 2003 and 2009. Women were dichotomized into two groups. Group I: those women without symptoms, and those with symptoms that were not bothersome. Group II: women with bothersome symptoms. Data obtained from bladder diaries were: daytime urinary frequency, nocturnal frequency, minimum voided volume, maximum voided volume, average voided volume, and incontinence episodes. From filling cystometries, volumes at first desire to void, normal desire to void, strong desire to void and maximum cystometric capacity, were extracted. Univariate and multiple linear regression analysis were performed to determine associations between OAB symptoms and bladder diary and filling cystometry measurements.

Results

After multivariate analysis the objective daytime frequency was most strongly associated with the frequency symptom (β 0.27, p?<?0.05), night time frequency with the nocturia symptom (β 0.40, p?<?0.05) and the number of incontinence episodes with the urge incontinence symptom (β 0.37, p?<?0.05). Both frequency and nocturia symptoms were significantly associated with bladder diary and cystometry filling volumes, and their effect size was the same. The urgency symptom proved to be poorly associated with objective parameters.

Conclusions

In contrast to the frequency and nocturia symptom, the urgency symptom is poorly associated with objective parameters on bladder diary and filling cystometry. Therefore, the current practice of using frequency and incontinence episodes in outcome research of OAB trials is justified.     

Bladder sensitivity testing using a visual analogue scale: comparative cystometric study on women

AIMS: To obtain improved assessment of bladder sensitivity during cystometry by using a 10 cm visual analogue scale (VAS), and comparing it with the standard method according to the International Continence Society (ICS). METHODS: Twenty-five patients with presumed normal bladder functioning underwent filling cystometries according to the VAS-based method and to the standard method. The order of the cystometries was set by randomization. The relationships between the bladder sensation using the VAS-based method and the volume of bladder perfusion were analyzed graphically. Various parameters were abstracted and compared to those obtained by the standard method. Correlations were searched for by principal component analysis. RESULTS: All the curves showed continuous progression of the desire to void. Eighteen of the 25 curves (72%) had a characteristic appearance, showing a latency phase with no perception of any bladder sensation, then a second phase with linear increase of the desire to void. The latency phase corresponded to the first sensation of bladder filling (226.3 ml +/- 169.1 vs. 200.0 ml +/- 143.1, r = 0.9). The progression in desire measured by the VAS method culminated in a sensation of maximum tolerable desire to void, which corresponded to the maximum cystometric capacity (MCC; 497.3 +/- 191.2 vs. 517.4 +/- 196.7, r = 0.9). The slope of the linear regression line for the desire to void constitutes an independent parameter. CONCLUSIONS: VAS reveals that the distinct sensations with the standard method are in fact a single sensation of a desire to void that increases continually during filling.     

Early and late urodynamic assessment of ileal orthotopic bladder substitutes combined with an afferent tubular segment

PURPOSE: Limited information is available concerning changes in the urodynamic characteristics of orthotopic bladder substitutes with time. Therefore, we compared early and late urodynamic results in patients with an ileal orthotopic bladder substitute combined with an afferent tubular segment. MATERIALS AND METHODS: Of 139 patients surviving at least 5 years after cystoprostatectomy and ileal orthotopic bladder substitution with an afferent tubular segment 119 underwent urodynamic assessment, including 66 at a median of 9 months (early) and 77 at a median of 62 months (late). Of these patients 24 were assessed at each time point. Simultaneously all patients were asked to complete a bladder diary and questionnaire regarding continence for at least 3 days in the week preceding the urodynamic study. RESULTS: Urodynamic parameters were comparable in patients who were evaluated early and late postoperatively. In addition, median values at early and late urodynamic evaluation in the 24 patients with the 2 examinations showed no statistically significant differences for volume at first desire to void (300 vs 333 ml, p = 0.85), pressure at first desire to void (12 vs 13 cm H2O, p = 0.57), maximum cystometric capacity (450 vs 453 ml, p = 0.84), end filling pressure (19 vs 20 cm H2O, p = 0.17), reservoir compliance (25 vs 28 ml/cm H2O, p = 0.58) or post-void residual urine volume (5 vs 15 ml, p = 0.27). CONCLUSIONS: Urodynamic results after 5 years of living with an ileal orthotopic bladder substitute with an afferent tubular segment show grossly unchanged urodynamic characteristics. Patients maintain a reservoir capacity and micturition pattern consistent with a normal life-style. Reservoir pressure remained low, thereby protecting and preserving upper tract function. To achieve these results patients must be regularly followed, and the causes of bacteriuria, increased post-void residual urine and bladder outlet obstruction must be recognized and dealt with accordingly.     

Urodynamic effects of solifenacin in untreated female patients with symptomatic overactive bladder

Objectives: To investigate the urodynamic effects of solifenacin in untreated female patients with symptomatic overactive bladder (OAB). Methods: A total of 52 untreated female patients with OAB symptoms were given 5 mg solifenacin once daily for 12 weeks. Before and after treatment, the frequency volume chart, overactive bladder symptom score (OABSS), postvoid residual volume, filling cystometry and adverse events were evaluated. Results: After solifenacin treatment, OAB symptoms were improved, voided volume was increased and voiding number was decreased. Bladder capacities at the first sensation of bladder filling, first desire to void and strong desire to void were significantly increased. Intravesical pressure at the first sensation of bladder filling was significantly decreased. Detrusor overactivity (DO) disappeared in five patients. For 28 patients with persisting DO after treatment, bladder capacity at DO was significantly increased. Both groups with and without DO at baseline had significant improvements of OAB symptoms. Conclusions: Solifenacin urodynamically increases bladder capacity in female patients with symptomatic OAB.     

Comparison of self-reported voided volume with cystometric bladder capacity

We determined the validity of cystometric bladder capacity compared to self-reported voided urine volumes measured by the patient at home. The subjects included 200 ambulatory incontinent women 55 or more years old who were evaluated with a prospective protocol of home diaries, history, physical examination and urodynamic studies. The mean smallest and largest daily voided volumes, and the daily mean of all voided volumes were determined from the diary. Comparison of the cystometric bladder capacity with the daily voided volumes showed a significant positive correlation between cystometric bladder capacity and the largest voided volume (r equals 0.4938, p less than 0.01). Comparison of the mean daily and mean largest daily void, and the cystometric capacity with the different urodynamic diagnoses using analysis of variance revealed a statistical significance among the groups (p less than 0.01). We established the validity of cystometric bladder capacity in the measurement of functional bladder volume and that a home diary may be useful in clinical practice.     

Data from frequency-volume charts versus filling cystometric estimated capacities and prevalence of instability in men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia

The aim was to examine associations of filling cystometric estimated compliance, capacities, and prevalence of bladder instability with data from frequency-volume charts in a well-defined group of men with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH). Men with LUTS suggestive of BPH were included if they met the criteria of the International Consensus Committee on BPH, i.e., they voided more than 150 mL during uroflowmetry, their residual volume and prostate size were estimated, and they completed frequency-volume charts correctly. From the frequency-volume charts, voiding habits, and fluid intake in the daytime and at night were evaluated. Filling cystometric studies were performed in these men as well. Decreased compliance was an exceptional finding. Cystometric capacity and especially effective capacity (cystometric capacity minus residual volume) corresponded significantly with the maximum voided volume on the frequency-volume charts. Effective capacity was almost twice as high as the average voided volume. Minimum voided volume on frequency-volume charts was not related to filling cystometric data. The presence of instability in the supine or sitting position or in both positions was not significantly associated with smaller voided volumes, higher nocturia, or diuria. Filling cystometric capacities were strongly associated with maximal and mean voided volumes derived from frequency-volume charts. The presence of detrusor instability during filling cystometry did not significantly affect voided volumes, diuria, or nocturia     

Urodynamic effect of acute transcutaneous posterior tibial nerve stimulation in overactive bladder

PURPOSE: Of the various treatments proposed for urge incontinence, frequency and urgency electrostimulation has been widely tested. Different techniques have been used with the necessity of surgical implantation (S3 neuromodulation or sacral root stimulation) or without requiring surgery (perineal transcutaneous electrostimulation). Recently peripheral electrical stimulation of the posterior tibial nerve was proposed for irritative symptoms in first intention or for intractable incontinence. Clinical studies have demonstrated good results and urodynamic parameters were improved after chronic treatment. However, to our knowledge no data concerning acute stimulation and immediate cystometry modifications have been reported. We verified urodynamic changes during acute posterior tibial nerve stimulation. MATERIALS AND METHODS: A total of 44 consecutive patients with urge incontinence, frequency and urgency secondary to overactive bladder were studied. There were 29 women and 15 men with a mean age +/-SD of 53.3 +/- 18.2 years. Of the patients 37 had detrusor hyperreflexia due to multiple sclerosis (13), spinal cord injury (15) or Parkinson's disease (9), and 7 had idiopathic detrusor instability. Routine cystometry at 50 ml. per minute was done to select the patients with involuntary detrusor contractions appearing before 400 ml. maximum filling volume. Repeat cystometry was performed immediately after the first study during left posterior tibial nerve stimulation using a surface self-adhesive electrode on the ankle skin behind the internal malleolus with shocks in continuous mode at 10 Hz. frequency and 200 milliseconds wide. Volume comparison was done at the first involuntary detrusor contraction and at maximum cystometric capacity. The test was considered positive if volume at the first involuntary detrusor contraction and/or at maximum cystometric capacity increased 100 ml. or 50% during stimulation in compared with standard cystometry volumes. RESULTS: Mean first involuntary detrusor contraction volume on standard cystometry was 162.9 +/- 96.4 ml. and it was 232.1 +/- 115.3 ml. during posterior tibial nerve stimulation. Mean maximum cystometric capacity on standard cystometry was 221 +/- 129.5 ml. and it was 277.4 +/- 117.9 ml. during stimulation. Posterior tibial nerve stimulation was associated with significant improvement in first involuntary detrusor contraction volume (p <0.0001) and significant improvement in maximum cystometric capacity (p <0.0001). The test was considered positive in 22 of the 44 patients. CONCLUSIONS: These results suggest an objective acute effect of posterior tibial nerve stimulation on urodynamic parameters. Improved bladder overactivity is an encouraging argument to propose posterior tibial nerve stimulation as a noninvasive treatment modality in clinical practice.     

Comparison of cystometric methods in female rats

AIMS: Rat cystometry is a common model used to investigate urinary storage and voiding function. The effect of cystometric instrumentation in rat studies might be a source of deviation from normal physiologic responses. We hypothesized that transurethral catheterization would produce obstruction-related changes, and that suprapubic catheterization would limit volume-related functions as well as disrupt normal urothelial sensory function. We investigated the influence of transurethral and suprapubic catheterization on storage and voiding in the rat model. METHODS: Three groups of female SD rats 250-300 g under urethane anesthesia were studied. Cystometric and pseudoaffective responses to physiologic voiding with and without suprapubic catheter placement, and cystometry via suprapubic and transurethral catheterization were studied. RESULTS: In free-voiding animals, per-void volume was 1.8 +/- 0.2 ml with an average flow rate of 0.18 ml/sec, and intercontraction interval (ICI) 60 min. Suprapubic catheterization decreased the ICI and per-void volume consistent with capacity reduction. Suprapubic cystometry did not significantly alter parameters compared to voiding except for a shortened ICI. Bladder pressures and somatic responses were increased, and urine flow impaired by transurethral cystometry. Terazosin did not significantly improve voiding parameters. CONCLUSIONS: Other than volume-related parameter changes probably related to surgical compromise of bladder capacity, suprapubic catheterization does not alter the cystometric and physiologic responses to voiding when compared to normal, uninstrumented voiding. Transurethral cystometry appears to be obstructive and may activate nociceptive reflexes. For this reason, whenever possible, urodynamic testing using the rat model should employ suprapubic catheterization.     

Infrequent voiders syndrome (nurses bladder). Prevalence among nurses and assistant nurses in a surgical ward

We evaluated the prevalence of infrequent voiders syndrome (defined as women with a mean voided volume above 400 ml) and predisposing factors among the female nursing staff in a busy 100 beds department of surgery. One hundred and five nurses and assistant nurses were invited to fill in a questionnaire and a frequency/volume chart for a 24-hour period. The infrequent voiders were further studied using uroflowmetry and medium-fill CO2 cystometry. Seventy-two women completed the study. Six (95% c.l. 3%-17%) were infrequent voiders, although fifty women (57%-80%) suppressed the desire to void during working hours. Main reasons for suppression of desire to void were busy work, poor toilet facilities and indolence. The frequency of micturition was higher during evening and night shifts than in the day shift. In the infrequent voiders the functional bladder capacity ranged from 550-1,100 ml, but none had residual urine exceeding 120 ml.     

Voiding dysfunction and Parkinson's disease: urodynamic abnormalities and urinary symptoms

PURPOSE: We evaluated bladder dysfunction and Parkinson's disease in regard to disease severity and determined whether subjective patient urinary symptoms correlated with urodynamic abnormalities. MATERIALS AND METHODS: We assessed bladder dysfunction in 70 patients with Parkinson's disease and urinary symptoms using the International Prostate Symptom Score and urodynamic tests. RESULTS: Urodynamic evaluation revealed detrusor hyperreflexia in 47 patients (67%), hyporeflexia or areflexia in 11 (16%), hyperreflexia with impaired contractile function in 6 (9%), hyperreflexia with detrusor-sphincter dyssynergia in 2 (3%) and normal function in 4 (6%). The incidence of urodynamic abnormalities appeared to increase with disease severity. However, the only urodynamic parameter that correlated with disease severity was post-void residual urine volume. On the other hand, symptom index scores increased with disease severity. The irritative symptom score correlated with maximum cystometric capacity and volume at initial desire to void, whereas the obstructive symptom score correlated with post-void residual urine volume. Also, irritative and obstructive scores were good predictors of overactivity during the storage and underactivity at the voiding phases. CONCLUSIONS: Bladder function may deteriorate progressively with advancing disease. Symptom scores are fairly accurate for predicting likely urodynamic abnormalities. Our results imply that quantifying subjective urinary symptoms is useful for estimating the severity and type of bladder dysfunction.     

Handwashing in the cystometric evaluation of detrusor instability

Ambulatory community living women were evaluated for complaints of urinary incontinence. Diagnostic testing included a detailed history and physical examination, urinalysis, full bladder stress testing, and urodynamic studies consisting of uroflometry, urethropro-filometry, and provocative water cystometry. Provocative maneuvers included coughing, heel bouncing, and handwashing. Uninhibited contractions were detected during cystometry in 34 of the 112 patients who completed diagnostic testing. The majority (74%) of the 34 patients with detrusor instability demonstrated evidence of uninhibited contractions during the filling phase of cystometry; coughing elicited contractions in 20%, heel bounces in 9%, and handwashing in 68% of patients, respectively. Of the nine patients with detrusor instability who did not have contractions during filling, all nine demonstrated bladder contractions after handwashing, whereas coughing and heel bouncing each elicited contractions in one patient apiece. In 66 patients who had evidence of stress-related urine loss during the cystometric study, all but one lost urine with coughing but only 14% after handwashing. These findings suggest handwashing may be a sensitive and specific stimulus for detection of detrusor instability during cystometric testing.     

A comparison of maximum cystometric bladder capacity with maximum environmental voided volumes

The aim of the study was, to determine whether maximum cystometric capacity accurately reflects the maximum functional bladder volume in women with urinary incontinence. We performed a retrospective chart review involving 85 women between the ages of 22 and 89 with primary complaints of urinary incontinence. The maximum cystometric capacity as determined by cystometry was compared with the maximum environmental voided volumes as recorded in a 24-hour voiding diary, using Pearson's correlation coefficients and pairedt-tests. Patients diagnosed as having a small bladder capacity (<300 ml maximum volume) based on cystometry were also examined with contingency table analysis to determine whether the bladder volumes in the voiding diaries supported the diagnosis of a small bladder. In 85 subjects the average maximum cystometric capacity was 14.7% less than the maximum volume recorded in the voiding diary. The correlation between the maximum cystometric capacity and maximum functional bladder volume wasr=0.473 (P<0.001). However, there was a statistically significant difference between the two volumes by pairedt-test analysis (P=0.006). Using cystometry to diagnose small bladder capacity showed a sensitivity of 62.9% and a specificity of 71.2% when using voiding diary volumes as the criterion standard. The positive predictive value was 51.4% and the negative predictive value was 84.0%. These results suggest that whereas the maximum bladder capacity measured by cystometry correlates with maximum environmental bladder capacity as determined by 24-hour voiding diaries, there is a statistically significant difference. The diagnosis of a small bladder should not be based on office cystometry alone.Editorial Comment: Although voiding diaries provide a wealth of information regarding daily intake and voiding habits, including episodes of incontinence, they can be difficult to obtain from all patients. The authors question whether a cystometrogram can provide adequate information regarding bladder capacity, and in particular identify low-capacity bladders which would require further evaluation. The answer in their population seems to be no. That this would be the case is not completely surprising, given the artificial environment of the urodynamic laboratory from many standpoints, as enumerated by the authors. The voiding diary should be used to establish functional bladder capacity and cystometry to evaluate bladder sensation, compliance and uncontrolled detrusor activity.     

Is sensory urgency part of the same spectrum of bladder dysfunction as detrusor overactivity?

It has been suggested that the urogynecological diagnosis of sensory urgency is an early form of detrusor overactivity and may be just earlier in the spectrum of disease. The former term is generally defined as increased perceived bladder sensation during filling, a low first desire to void and low bladder capacity in the absence of recorded urinary tract infection (UTI) or detrusor overactivity. The aims of this study are to determine the prevalence and associations of sensory urgency in comparison with detrusor overactivity, and whether sensory urgency is shown to be in the same spectrum of bladder dysfunction as detrusor overactivity. Five hundred and ninety-two women attending for an initial urogynecological/urodynamic assessment took part in this prospective study. In addition to a full clinical assessment, all women underwent free uroflowmetry, residual urine volume measurement (by vaginal ultrasound) and multichannel filling and voiding cystometry. Data were separated into those having (1) sensory urgency or (2) detrusor overactivity. Apart from prevalence figures, comparative associations were sought for (3) age; (4) parity; (5) presenting symptoms; (6) presence of at least one (medically) documented UTI in the previous 12 months; (7) two or more (recurrent) documented UTIs in the previous 12 months; (8) prior hysterectomy; (9) prior continence surgery; (10) menopause; (11) menopause and HRT use; (12) sign of clinical stress leakage; (13) retroverted uterus; (14) anterior vaginal wall prolapse; (15) uterine prolapse; (16) posterior vaginal wall prolapse; (17) apical vaginal prolapse; (18, 19) maximum, average urine flow rate (MUFR, AUFR) centiles, Liverpool Nomograms; (20) median residual urine volume (RUV) in milliliters; (21, 22) voiding difficulty: VD1,VD2 (MUFR, AUFR under 10th centile Liverpool Nomogram and/or RUV >30 ml); (23) diagnosis of urodynamic stress incontinence and (24) diagnosis of uterine and/or vaginal prolapse (grade >0). The prevalence of sensory urgency was 13%. The only differences in the clinical and urodynamic profiles of it and detrusor overactivity were (1) significantly increased prevalence of the symptom of urge incontinence and (2) (by definition) abnormal detrusor contractions during filling cystometry in women with detrusor overactivity. Overall, sensory urgency and detrusor overactivity appear to be part of the same spectrum of bladder dysfunction.