Caroline Hendricken

Do Women With Pure Stress Urinary Incontinence Need Urodynamics

OBJECTIVES To evaluate the value of performing urodynamic investigations in the assessment of women with a history of pure stress urinary incontinence (SUI). METHODS Consecutive women with lower urinary tract symptoms were studied retrospectively. Urinary symptoms were determined from the frequency-volume chart and symptom section of the Kings Health Questionnaire. Only women with pure SUI symptoms were included. RESULTS A total of 3428 women aged 24-81 years were studied. Only 308 women (8.9%) could be classified as having pure SUI from the questionnaire. Of these, 241 of women (78.2%) had urodynamic stress incontinence, 23 women (7.5%) had detrusor overactivity, 9 women (2.9%) had mixed urodynamic diagnosis, and 35 women (11.4%) had inconclusive urodynamics. Postvoid residual volumes greater than 100 mL were noted in 24 (7.8%) women. CONCLUSIONS Our results show that urodynamic investigations provide useful information in the assessment of women with a history of pure SUI, because as many as 20% of them might not need surgery as the first line of treatment.

Rectal distension: The effect on bladder function

To assess how rectal distension affects urodynamics parameters and diagnosis.

Bladder sensations during filling cystometry are different according to urodynamic diagnosis

To determine the position and character of bladder filling sensations in women undergoing urodynamic investigations.

Are the measurements of water-filled and air-charged catheters the same in urodynamics?

Introduction and hypothesisThe aim of our study was to compare air-charged and water-filled catheters simultaneously in the measurement of the intravesical, abdominal and detrusor pressure during urodynamic investigations.MethodsConsecutive women with lower urinary tract symptoms, referred for urodynamics were prospectively studied. Readings of intravesical pressure (pves), abdominal pressure (pabd) and detrusor pressure (pdet), recorded by both the air-charged and water-filled catheters, were displayed simultaneously and compared at the end of filling, on standing, on sitting prior to voiding and at the maximum involuntary detrusor contraction. The signals (pressures) recorded by both types of catheter were compared using the Bland–Altman plot and paired samples t test.ResultsTwenty women with a mean age of 49 (range 36–72) were recruited. One patient with normal urodynamics was excluded in view of the poor quality trace. At each of the four comparison points, the air-charged catheters consistently produced higher mean pressures than the water-filled catheters. There were wide variations in the difference between the readings produced by the two types of catheter.ConclusionsPressures measured using air-charged catheters are not comparable with water-filled catheters and are therefore not interchangeable. Caution must be used when comparing urodynamic parameters using air-charged and water-filled catheters.

Antimuscarinic effects on current perception threshold: A prospective placebo control study†‡§

To evaluate the effect of Tolterodine on urethral and bladder afferent nerves in women with detrusor overactivity (DO) in comparison to placebo, by studying the changes in the current perception threshold (CPT).

Women’s perspective of botulinum toxin treatment for overactive bladder symptoms

Introduction and hypothesisThis study aimed to evaluate the women’s’ views and expectations about outcomes and complications of botulinum toxin treatment for overactive bladder (OAB) symptoms.MethodsConsecutive women with OAB symptoms and detrusor overactivity were requested to fill out a multiple choice questionnaire to assess whether they would consider botulinum and what outcomes as well as complications they would find acceptable to undergo this treatment.ResultsTwo hundred sixty-one women, mean age of 58 (range, 38–78) years, were studied. Two hundred twenty-four were treatment-naive women (group A), while 37 were no responders to anticholinergics (group B). Only 49.6% of women in group A and 54% in group B would accept botulinum toxin. No significant differences were found between treatment-naive women and non-responders to anticholinergics (p > 0.05).ConclusionsAcceptance of botulinum toxin treatment involves a complex interaction of efficacy and possible complications. The balance of these factors changes the acceptability of the treatment.