Pharmacologic treatment of detrusor incontinence with thiphenamil HCl.

A controlled double-blind crossover study is reported in which quantitative urodynamic data and qualitative information are combined to evaluate the treatment of detrusor incontinence using thiphenamil HCl in patients with detrusor instability. Patients placed on the treatment protocol were randomized to placebo or thiphenamil 400 mg q.i.d. Two weeks of thiphenamil HCl or placebo administration were followed by 1 week of washout followed by a cross-over to an additional 2 weeks of placebo or thiphenamil HCl administration. Of the 23 patients 7 dropped out at various stages of the study. The mean age of patients studied was 44 +/- 14 years old. Throughout the study, patients were asked to complete a formalized diary card of the amount and time of voiding and the incidence of incontinence. Three urodynamics studies were done in the following sequence: pretreatment, postwashout, and posttreatment. Parameters of bladder capacity, sensations, stability and pressure/flow were obtained. In addition, resting urethral closure pressures were recorded. The results show that the frequency of incontinence, which was based on the patients' responses, decreased significantly (0.01 less than p less than 0.025). There was an insignificant decrease in the number of voidings and increase in the amount voided each time. Patients on thiphenamil reported that their pads were significantly drier from baseline (p = 0.01). In response to questions comparing problems caused by urine loss during baseline and thiphenamil treatment, analysis shows a significant decrease of problems due to loss of urine (p = 0.01) when the patient was taking the drug compared to the placebo.(ABSTRACT TRUNCATED AT 250 WORDS)     

Impact of radical prostatectomy on the characteristics of bladder and urethra.

A prospective study was done to evaluate the long-term effects of radical prostatectomy on the function of the bladder in filling and voiding. Preoperative urodynamic studies were done on 29 patients with a mean age of 62.9 +/- 5.2 years. The preoperative results show that 16 of the 29 patients demonstrated detrusor instability with maximum contractile pressures of 59 +/- 28 cm. water. Followup urodynamic assessment was done in 13 of these patients 22.9 +/- 1.1 months after surgery. Postoperatively, the maximum detrusor instability pressure did not decrease significantly (49 +/- 17 cm. water). Comparison of the operative and postoperative urodynamic characteristics of bladder filling shows that radical prostatectomy produced no significant change in the filling characteristics of the bladder in terms of bladder capacity, or volume at which sensations of fullness or urgency are reported. Voiding pressure-flow studies show a significant increase in maximum flow rate (8 +/- 1 to 13 +/- 2 ml., per second, p = 0.007), and significant decreases in maximum detrusor pressure (61 +/- 5.4 to 39 +/- 4 cm. water, p = 0.002), urethral opening pressure (45 +/- 7 to 25 +/- 4 cm. water, p = 0.004) and residual volume (150 +/- 37 to 62 +/- 43 ml., p = 0.019). Urethral profile measurements show that there was no significant change in either the maximum urethral closure pressure (94 +/- 9 to 83 +/- 9 cm. water) or external sphincter length (3.6 +/- 0.8 to 3.2 +/- 0.8 cm.). Preoperatively, the bladder neck pressures were 25 +/- 4.4 cm. water and were abolished after prostatectomy, indicating that the decrease in obstructive characteristics is due to removal of the prostate.     

Objective measurement of bladder sensation: use of a new patient-activated device and response to neuromodulation

Detrusor overactivity is the primary objective focus of most investigations into the diagnosis and management of patients with urgency incontinence. Patients with an overactive bladder are characteristically troubled by subjective sensations of bladder fullness and urinary urgency, and frequently void at low bladder volumes attained before noticeable detrusor overactivity occurs. Bladder sensations are therefore crucial to understanding voiding patterns and symptoms, but little progress has been made in objectively describing the range of these sensations, and adequate information is lacking about their response to neuromodulation. Towards this end, a keypad 'urge score' device was designed to measure sensations during bladder filling. This patient-activated device gathers information about patient perceptions of bladder filling and the successive stages of increasing bladder sensation, without prompting or intervention by the investigator. The accuracy of the 'urge keypad' during filling cystometrography was validated in patients with urgency incontinence, and compared with data abstracted from patient voiding diaries. The device provides reliable and repeatable measures of different bladder sensations, with excellent, statistically significant consistency between bladder volumes and corresponding levels of sensation. Subsequently, it was shown that the sensation of urgency can be suppressed by neuromodulation in most patients tested; this suppression occurs with improvements in bladder capacity and voided volumes. It is therefore suggested that urodynamics with concurrent sensory evaluation may offer a more useful assessment tool for selecting those patients for therapies such as neuromodulation who present predominantly with the symptom of urgency.     

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.     

Voiding cystourethrography with synchronous measurements of pressures and flow in the diagnosis of subvesical obstruction in men: a radiological view

Cystourethrography with synchronous urodynamic monitoring was done in 90 men who were diagnosed radiologically as having normal function or bladder outlet obstruction. The separation was based on the caliber of the bladder outlet measured on spot roentgenograms at peak voiding: less than 4 mm. for obstructed and more than 6 mm for normal voiding. The radiological observations are discussed together with the measurements of bladder capacity, residual urine, intravesical pressures and voiding flow rate. The separation between normal men and those with obstruction according to radiologically determined calibers had a strong impact on the distribution of the maximum flow rates. Observations on the onset of micturition suggest that in normal voiding the contracting detrusor meets a simultaneously relaxing bladder neck without interposition of an isometric phase. The patients with subvesical obstruction presented with 2 forms of isometric overload, either as uninhibited contractions or as a variable isometric time lag between the onset of detrusor contraction and opening of the bladder neck. The pre-voiding isometric pressure increase is believed to be an abnormal finding that distinguishes the normal state from obstruction and other disorders. A characteristic decrease in subtracted intravesical pressure at the opening of the bladder neck in patients with uninhibited contractions conceivably indicates that bladder instability is caused by an abnormal reflex originating in the tightened bladder neck. Voiding cystourethrography was an accurate means of diagnosis of subvesical obstruction, especially owing to its ability to quantitate the caliber of a narrowed zone.     

Urinary bladder bilharziasis as a cause of impaired bladder muscle contractility

In an attempt to evaluate the effect of bilharziasis on bladder contractility as a factor in the genesis of voiding disorders, 44 cases of bilharzial bladder neck obstruction diagnosed using traditional methods (symptomatological, radiographic, and endoscopic) were subjected to complete urodynamic evaluation (flowmetry, cystometry, pressure/flow study, and stop-flow test). Their parameters were compared with those of 28 patients with urodynamically obstructed benign prostatic hyperplasia and 8 nonsymptomatic controls. Contractility parameters (isometric detrusor pressure, maximum estimated flow rate, detrusor power at maximum flow) were calculated for the studied cases and their distribution according to the Schafer pressure/flow diagram was evaluated. Bladder biopsy including the detrusor was evaluated in all 72 patients. Poor bladder contractility associated with an extensive bilharzial effect on the detrusor muscle was found to be the major abnormality in 20 of 44 patients with presumed bilharzial bladder neck obstruction with no evidence of urodynamic outflow obstruction. We believe such a workup is essential in cases of suspected obstruction associated with bilharziasis to throw light on the pathophysiology of the voiding disorders, avoid unnecessary surgery, and provide a better prognosis. Neurourol. Urodynam. 17:483–492, 1998. © 1998 Wiley-Liss, Inc.     

Measurement of voiding pressures on ambulatory monitoring: comparison with conventional cystometry

A series of 20 patients underwent conventional medium fill cystometry (CMG) and ambulatory monitoring during natural bladder filling (AM). The measurement of voiding pressures by the 2 techniques was compared. The maximum subtracted detrusor contraction pressure recorded during CMG (50 +/- 30 cm H2O) was significantly less than that recorded during AM (86 +/- 35 cm H2O). Voiding pressures during natural filling are greater than those observed during conventional urodynamic studies: this finding may have important implications in the definition of bladder outflow obstruction.     

尿动力学测定对前列腺增生患者逼尿肌不稳定的应用价值

为探讨膀胱出口梗阻患者逼尿肌不稳定的情况，对８３例存在膀胱出口梗阻的前列腺增生患者进行尿动力学测定。结果表明：４０例（４８．２％）患者出现逼尿肌不稳定，压力－流率测定发现该组病例排尿期逼尿肌各压力值均增高，尤以膀胱颈部开口压增高为显著，不稳定组为１３．２±３．４ｋｐａ，稳定组为８．２±２．４ｋＰａ，不稳定组开口压增高速率（０．９±０．１ｋＰａ／ｓ）明显大于逼尿肌稳定组（０．３±０．１ｋＰａ／ｓ）；随开口压增高，逼尿肌不稳定的发生率相应增高。长期高压力、高输出状态可能为逼尿肌无抑制性收缩的形成条件     

Relationship between detrusor function and residual urine in men undergoing prostatectomy

Two hundred and fifty-three men undergoing prostatectomy were studied by means of urodynamic investigation to determine the relationship between the volume of residual urine and detrusor function. Increased volumes of residual urine were associated significantly with increasing age, low peak flow rate and high urethral resistance. However, weak voiding pressures were uncommon and did not correlate with increased residual volumes. Increased residual volumes also correlated significantly with a high resting detrusor pressure and a high detrusor pressure rise during the filling phase, but there was a wide scatter of the results for pressure rise and patients could not be classified into groups on the basis of this parameter. Whilst detrusor decompensation was not manifest by weak voiding pressures in patients with increased residual volumes, impairment of the ability of the detrusor to empty the infused cystometric capacity during the subsequent voiding study correlated with increased residual volumes. These data are consistent with theories relating bladder outflow obstruction to the development of increased volumes of residual urine in men undergoing prostatectomy.     

Clinical evaluation of isometric detrusor pressure in patients with benign prostatic hyperplasia]

The subjects chosen for this investigation were 88 patients with benign prostatic hyperplasia who proved not to have neurogenic bladder and 6 male volunteers without lower urinary tract disorders. In addition to the conventional preoperative urodynamic studies, isometric detrusor pressure was measured by the technique with balloon occlusion at the bladder neck. Although all 88 patients had undergone either transurethral resection of the prostate or subcapsular prostatectomy and routine postoperative examinations revealed sufficient canal formation in the prostatic urethra, in 23 patients (26.1%) a significant amount of residual urine was still observed and/or maximum urinary flow rate was considerably low. A retrospective analysis of the data from this study suggested that maximum isometric detrusor pressure is a useful parameter for the prediction whether or not micturition is improved after the removal of organic lower urinary tract obstruction, especially in cases with low detrusor pressure during urination. Furthermore, measurement of the maximum isometric detrusor pressure might be helpful in making the diagnosis of the clinical stage of benign prostatic hyperplasia, since several different stages could be defined by the value of maximum detrusor pressure during urination and maximum isometric detrusor pressure.     

女性盆底器官脱垂伴尿失禁患者的尿动力学特征

目的 探讨女性盆底器官脱垂伴尿失禁患者膀胱储尿期和排尿期的尿动力学参数变化. 方法对182例女性尿失禁和盆底器官脱垂患者进行尿动力学检查,其中尿失禁140例,尿失禁伴盆底器官脱垂42例.在统一标准下行尿动力学检查测定膀胱灌注量、排尿量、膀胱顺应性、最大尿流率、最大尿流率逼尿肌压、最小尿流率逼尿肌压、尿道阻力因子(URA)、膀胱梗阻指数(OBI)以及归-化逼尿肌收缩力,评价女性尿失禁患者盆底器官脱垂对膀胱储尿功能和排尿功能的影响. 结果 尿失禁组与尿失禁伴盆底器官脱垂组患者尿失禁病程[(58.1±75.4)与(41.9±55.4)个月]、膀胱灌注量[(295.3±95.8)与(276.5±80.8)ml]、膀胱顺应性[(77.7±122.1)与(51.5±61.9)ml/cm H2O]、最大尿流率[(15.8±12.5)与(14.7±13.9)ml/s]、最小尿流率逼尿肌压[(3.2±5.8)与(2.8±5.5)ml/cm H2O]、归-化逼尿肌收缩力[(7.5±12.8)与(8.2±13.8)cm H2O]相比差异均无统计学意义(P>0.05);而年龄[(58.7±12.2)与(67.1±8.3)岁]、排尿量[(269.2±145.2)与(248.9±135.1)ml]、最大尿流率逼尿肌压[(20.4±16.2)与(25.7±21.3)cm H2O]、URA[(11.3±9.5与(14.8±12.6)cm H2O]、OBI[(15.6±14.5)与(21.7±20.1)cm H2O]2组相比差异有统计学意义(P<0.05).结论高龄女性尿失禁患者更可能伴有盆底器官脱垂,而盆底器官脱垂对膀胱储尿功能无影响,但可影响排尿期相关参数,增加膀胱出口阻力和膀胱残余尿量.     

URODYNAMIC CHARACTERIZATION OF NONOBSTRUCTIVE VOIDING DYSFUNCTION IN SYMPTOMATIC ELDERLY MEN

PURPOSE: The pathogenesis of lower urinary tract symptoms in men without bladder outlet obstruction has not been well characterized. Therefore, we defined the urodynamic abnormalities associated with symptomatic nonobstructive voiding dysfunction, and determined the relationship between age and type of dysfunction. MATERIALS AND METHODS: Video urodynamic studies of symptomatic men without outlet obstruction were examined. The criterion for a normal bladder outlet was a pressure gradient across the prostatic urethra of 5 cm. water or less in the absence of distal stricture. A maximum isometric contraction pressure less than 60 cm. water was regarded as impaired detrusor contractility. Detrusor instability was defined as involuntary detrusor contractions during filling or the inability to suppress a detrusor contraction after initiation of flow. Patients were categorized into 4 groups based on the urodynamic findings. RESULTS: Of 193 men (mean age 69.6+/-10.5 years) 40.9% had detrusor instability (group 1), 31.1% had impaired contractility (group 2), 10.8% had detrusor instability and impaired contractility (group 3), and 17.1% were urodynamically normal (group 4). Average patient age was significantly lower in group 4 than all other groups. Bladder capacity was lowest in group 1, and group 3 had the lowest voiding efficiency. Maximum flow rate, bladder compliance and symptom scores were not different among the 4 groups. The prevalence of detrusor instability with and without impaired contractility increased, while the proportion of patients without urodynamic abnormalities decreased with age. Bladder contractility did not correlate with age. CONCLUSIONS: The nonobstructed patient population comprises several groups that are functionally distinct while symptomatically similar. Thus, treatment of nonobstructed cases based on symptoms may lead to inappropriate pharmacological therapy and unsuccessful clinical outcomes.     

慢性前列腺炎患者的尿动力学检查（附32例报告）

目的：总结慢性前列腺炎患者可能存在的下尿路症状,并结合尿动力学分析各类症状出现的深层次原因,方法：对32例民性前列腺炎患者的尿流率,膀胱压力容积,压力－流率,前列腺压和肌电图进行综合性回顾分析,并与慢性细菌性和非细菌性前列腺炎组的尿动力学变化作了比较。结果：40．6％的患者存在不稳定性膀胱,34．4％,的患者有逼尿肌反邮进,46．9％的患者有膀胱出口梗阻,另有68．7％的患者存在逼尿肌－外括约肌协同失调,慢性细菌性和非细菌性前列腺炎组中的尿动力学差异无显著性意义。结论：慢性前列腺炎患者出现不同程度的尿频,尿急,尿等待和排尿费力等下尿路症状可能与前列腺局部充血,逼尿肌反射亢进,膀胱出口梗阻和逼尿肌－外括约肌协同失调有关。认识并解除这些相关因素可能有助于提高对慢性前列腺炎的综合疗效。     

Consistency of urodynamic parameters in children with detrusor instability: how many times should the bladder be filled?

INTRODUCTION: It is recommended that the bladder be filled at least twice to perform a standard urodynamic study. However, the procedure is time-consuming and distressing for both the patient and the professional. The impact of the number of fillings on urodynamic parameters in children with normal urodynamic results and those with detrusor instability is presented in this study. PATIENTS AND METHODS: Urodynamic data from 70 children with detrusor instability and 42 with normal urodynamic parameters who had undergone 3 consecutive fillings in a single session during a 2-year period were reviewed retrospectively. The variable parameters that were compared between the 2 groups were the mean bladder capacity ratio, maximum filling pressure and the number of contractions during the filling phase. RESULTS: In the normal group, no difference was found in bladder capacities between the 3 fillings, but there was a significant decrease in the maximum bladder filling pressures in the subsequent fillings. In children with detrusor instability, the number of contractions in the 1st filling was significantly higher than those in the subsequent fillings. Also in this group, a significant difference in the mean bladder capacities between fillings was noted as well as a decrease in the maximum bladder filling pressures in contrast to normal bladders. CONCLUSION: In patients with suspected detrusor instability the bladder should be filled at least twice for a reliable urodynamic assessment. Two normal fillings without contractions, with normal capacity and normal maximum bladder filling pressure are highly suggestive of a normal 3rd filling.     

Factors associated with voiding function in women with lower urinary tract symptoms: a mathematic model explanation

AIMS: The aim of this study was to explore the relationship between voiding function and factors such as age, gravidity, parity, menopause, and anterior vaginal wall relaxation. METHODS: One hundred twenty-five women were identified from urodynamic records, 83 premenopausal and 42 postmenopausal. All had had a sonographic assessment of the lower urinary tract and a full urodynamic study, including a pressure-flow study. None had diabetes mellitus, overt neurologic disease, pelvic surgery, anticholinergic medication or estrogen therapy, or voiding difficulty symptoms. Voiding parameters included the following urodynamic variables: maximum flow rate, average flow rate, residual urine, the ratio of residual urine to total bladder volume on spontaneous uroflowmetry, maximum flow rate, and detrusor pressure at maximum flow on a pressure-flow study. RESULTS: Uroflow rates were significantly correlated with age, parity, and urethral mobility. As a whole, the scatter plots of maximum and average flow rates versus voided volume on uroflowmetry displayed a significant correlation (P < 0.0001 and P < 0.0001, respectively). But, there was no association between maximum flow rate and detrusor pressure at maximum flow in the pressure flow study (P = 0.132). Age, menopause, parity, and urethral mobility may have affected the correlation on uroflowmetry but have no effect on pressure-flow plot. On subgroup analysis, significant correlation was identified only in women aged between 30 and 70, with parity greater than three, and urethral mobility greater than 70 degrees. These groups all had a reduced urethral pressure profile. CONCLUSIONS: Age, menopause, parity, and urethral mobility may change the hydrodynamics of the lower urinary tract and have varying impact on the voiding function by altering urethral distensibility. Moreover, poor detrusor power in the postmenopausal women may complicate the analysis of voiding function.     

Dysfunctional voiding in women

PURPOSE: We characterized presenting symptoms and urodynamic findings in women with dysfunctional voiding. MATERIALS AND METHODS: We reviewed the charts of 26 women diagnosed with dysfunctional voiding. Those with a known or suspected history of neurological disease before evaluation were excluded from study. All patients completed an American Urological Association symptom index, and scores were classified as total, storage (irritative) and emptying (obstructive). The diagnosis of dysfunctional voiding was made on multichannel video urodynamics. There was increased external sphincter activity during voiding. Presenting symptoms and urodynamic findings in all cases were summarized. In addition, symptoms and urodynamic findings in patients later diagnosed with occult neurological disease were compared with those in patients without neurological disease. RESULTS: Mean patient age was 39.2 years (range 19 to 79). Mean total American Urological Association-7 score was 24.4 of 35. Frequency and urgency were the most common presenting symptoms in 82% of cases. Mean storage score was 11.3 of 15 and mean voiding score was 13.2 of 20. Urge and stress incontinence was noted in 6 (23%) and 4 patients (15%), respectively, while 11 (42%) had a history of recurrent urinary tract infection. Cystometrography revealed detrusor instability in 11 cases (42%), sensory urgency in 11 (42%) and impaired compliance in 2 (8%), including 1 with instability. There was great variability in voiding parameters. Mean maximum urinary flow plus or minus standard deviation was 10.4 +/- 6.2 cc per second, mean detrusor pressure at maximum urinary flow was 50.3 +/- 23.5 cm. water and mean post-void residual urine volume was 103.4 +/- 120.0 cc. Video urodynamics prompted neurological evaluation, which revealed occult neurological disease in 5 patients who were then reclassified with external-detrusor sphincter dyssynergia. CONCLUSIONS: Female patients presenting with lower urinary tract symptoms may have dysfunctional voiding patterns. Storage symptoms appear to be even more common than voiding symptoms in this study group. These patients tend to have decreased flow, increased voiding pressure and high post-void residual urine volume. However, there is wide variation in these parameters among individuals. Therefore, careful review of the voiding phase, including pelvic floor electromyography and the fluoroscopic appearance of the bladder outlet, is critical. Occult neurological disease should be suspected in patients with dysfunctional voiding.     

Urodynamic effects of α1-blocker tamsulosin on voiding dysfunction in patients with neurogenic bladder

BACKGROUND: The therapeutic role of alpha-blockers in the treatment of voiding disorders due to benign prostatic hyperplasia has been extensively examined. To investigate a possible effect of alpha1-blocker on urodynamic voiding parameters in patients with neurogenic bladder, we conducted a clinical trial using tamsulosin. METHODS: Twenty-four patients (14 men and 10 women) ranging from 24 to 82 years of age (mean age 61 years) with neurogenic bladder were analyzed. Urodynamic studies were performed before and after treatment with 0.4 mg tamsulosin daily for 4 weeks. RESULTS: On uroflowmetry, the average flow rate (from 4.6 +/- 3.3 to 6.7 +/- 3.0 mL/s, P = 0.04), maximum flow rate (from 9.4 +/- 6.8 to 14.1 +/- 7.0 mL/s, P = 0.016) and residual urine rate (from 46 +/- 29 to 32 +/- 21%, P = 0.02) improved significantly. In patients with detrusor contraction during voiding, detrusor opening pressure and detrusor pressure at maximum flow decreased significantly from 69.0 +/- 36.2 to 49.2 +/- 26.4 cmH2O (P = 0.046) and from 66.7 +/- 34.6 to 53.6 +/- 26.5 cmH2O (P = 0.007), respectively. On the other hand, in patients with detrusor areflexia, vesical opening pressure (from 78.2 +/- 23.4 to 61.6 +/- 25.2 cmH2O), or vesical pressure at maximum flow (from 68.6 +/- 23.2 to 62.9 +/- 25.2 cmH2O) did not change significantly after treatment. CONCLUSION: Tamsulosin reduces functional urethral resistance during voiding and improves flow rate in patients with neurogenic bladder. It has more beneficial urodynamic effects in patients with detrusor contraction during voiding than in patients with detrusor areflexia.     

The role of urodynamics in the treatment of lower urinary tract symptoms in women

PURPOSE OF REVIEW: Urodynamic investigation was developed as an extension of patient history and physical examination in order to reveal the pathology of a patient's complaints. Much progress in standardizing definitions and procedures has been made in recent years. In particular, stress urinary incontinence and overactive bladder can be differentiated with urodynamics. The developed parameters, however, cannot distinguish the various types of stress urinary incontinence. Moreover the definition and diagnosis of voiding dysfunction is not clear. Finally our understanding of bladder sensations and the impact on voiding behaviour has only started to emerge. This review is about last year's publications that focus on urodynamics and lower urinary tract symptoms in women. RECENT FINDINGS: Defining bladder outlet obstruction is based on voiding pressure, urinary flow speed and residual urine but standardization is lacking. Urodynamics to reveal occult stress urinary incontinence in patients with pelvic organ prolapse needs standardization of the reducing manoeuvres. The quest for urodynamic tools for distinguishing intrinsic sphincter deficiency from urethral hypermobility continues. Urodynamics are still not good enough to discriminate between treatment options for stress urinary incontinence. The use of urodynamics in overactive bladder is developing and has elicited new findings. Voiding habit seems to be independent from bladder sensations. Also bladder sensations appear to be imperfectly correlated with bladder filling. Even bladder volumes do not predict entirely bladder fullness sensations. SUMMARY: In order to use urodynamics as a proper clinical tool, defining subtypes of stress urinary incontinence and standardization of urodynamics in pelvic organ prolapse and bladder outlet obstruction in women is needed.     

De novo detrusor underactivity after laparoscopic radical prostatectomy

Objective: The aim of this study was to investigate bladder function following laparoscopic radical prostatectomy, with a focus on de novo detrusor underactivity. Methods: Records on pre‐ and postoperative urodynamic studies were retrospectively investigated in 110 patients who underwent laparoscopic radical prostatectomy. Patients exhibiting de novo detrusor underactivity were selected on the basis of an overt strain voiding pattern during the postoperative pressure flow study with detrusor pressure at a maximum flow rate <10 cm H₂O accompanied by an increase in abdominal pressure. In these patients, a follow‐up urodynamic study was performed to assess subsequent long‐term changes in the bladder function. Results: Of the 110 patients, 10 (9.1%) were observed to exhibit de novo detrusor underactivity during the postoperative urodynamic study. During the voiding phase of the pre‐ and postoperative pressure flow study in these 10 patients, the mean detrusor pressure at maximum flow rate showed a significant decrease postoperatively from 57.6 to 3.0 cm H₂O (P < 0.001), although the mean abdominal pressure at maximum flow rate significantly increased from 23.1 to 102.5 cm H₂O (P < 0.001). The follow‐up urodynamic study performed on seven patients at 36 months following surgery revealed no significant change in each urodynamic parameter. De novo detrusor underactivity persisted even over the long term following surgery, and no improvement in bladder function was observed. Conclusions: Detrusor contractility may be impaired during radical prostatectomy. Postoperative detrusor underactivity following radical prostatectomy seems to be an irreversible phenomenon persisting even over the long term.     

Radiotelemetered cystometry in pigs: validation and comparison of natural filling versus diuresis cystometry

PURPOSE: Cystometry has previously been performed in awake animals using vesical and abdominal catheters, and artificial bladder filling. Conventional urodynamic recordings may be obtained in this manner, albeit under nonphysiological and potentially stressful conditions. Therefore, we developed a technique to perform continuous, ambulatory cystometric monitoring in pigs. MATERIALS AND METHODS: A dual pressure radiotelemetry device was surgically implanted in 22 large white pigs. Vesical and abdominal pressures were recorded and validated, subtracted detrusor pressures were derived and natural fill and diuresis cystometry was compared. RESULTS: Continuous recordings were obtained for 1 to 24 hours, and the devices remained in the animals for up to 3 months. There were few complications and incrustation of the intravesical catheter tip occurred but it did not appear to affect recorded pressures. The pressure data were validated by comparison with filling pressures during bladder distention and simultaneous conventional cystometry at the end of the experimental period. Comparison of natural filling and diuresis cystometrograms showed that natural bladder filling results in higher maximum detrusor pressure during voiding (38.1 versus 33.9 cm. H2O, p <0.05), higher detrusor pressure after contractions (42.6 versus 32.2 cm. H2O, p <0.05) and more frequent detection of unstable contractions in pigs with detrusor instability secondary to experimental manipulation of the lower urinary tract (77.8% versus 45.0%, p <0.05). CONCLUSIONS: This technique allows continuous cystometric monitoring in less stressed animals under more physiological conditions for relatively long periods and, thus, allows prolonged assessment of bladder function in pigs in response to pathological and pharmacological manipulations. Nonphysiological rates of bladder filling have been shown to result in detrusor inhibition, which emphasizes the importance of ambulatory cystometry when describing bladder function.