Heleni Mastoroudes

Is there a difference between women with or without detrusor overactivity complaining of symptoms of overactive bladder

Overactive bladder syndrome (OAB) is a highly prevalent medical condition, which is linked to the urodynamic observation of detrusor overactivity (DO). Urodynamics detect DO in about half of female patients with OAB. Our study detects significant differences between female patients with OAB with and without DO. DO could be considered as a more severe form in the wide OAB spectrum and the two terms should not be used interchangeably. The detected differences should be taken into account in the design of studies for the assessment of new selective or combination treatments of OAB and in the provision of treatment in everyday clinical practice.

Prolapse and sexual function in women with benign joint hypermobility syndrome

To determine whether pelvic organ prolapse (POP) and sexual dysfunction are more severe in women with benign joint hypermobility syndrome (BJHS) than in the normal population.

The bladder diary: do women perceive it as a useful investigation?

OBJECTIVE The completion of a bladder diary is routinely undertaken as part of the initial assessment of women presenting with lower urinary tract symptoms. Anecdotally some women find it a nuisance to fill in a fluid volume chart. The QQ10 is a questionnaire which has been developed to evaluate the use of other questionnaires or investigations. This study aims to assess womens perception of completing a bladder diary as part of their investigative process and to identify reasons why some may fail to complete one. STUDY DESIGN All women attending a one-stop urogynaecology clinic were sent instructions to fill in a three-day bladder diary. Those who filled a diary in were asked to fill in a QQ10 questionnaire. Those who did not fill one in were asked to give a reason for not doing so. RESULTS 128 women attended the clinic over a study period. Of these 100 (78%) completed a diary and hence a modified QQ10 form and 28 women (22%) did not. The mean value score was found to be high, at 72.6 (SD 17.87) whilst the mean burden score was low at only 27.7 (SD. 21.14). The majority of women who did not fill one in claimed they had not received a diary in the first place. CONCLUSION Most women appear to fill in a diary. The high mean value score and the low mean burden score indicate that women do not find filling in a diary a particularly onerous task.

Can we predict detrusor overactivity in women with lower urinary tract symptoms? The King's Detrusor Overactivity Score (KiDOS)

OBJECTIVE Traditionally, urodynamic studies (UDS) have been used to assess lower urinary tract symptoms (LUTS), but their routine use is now discouraged. While urodynamic stress incontinence is strongly associated with the symptom of stress urinary incontinence (SUI) and a positive cough test, there is a weak relationship between symptoms of overactive bladder and detrusor overactivity (DO). The aim of our study was to develop a model to predict DO in women with LUTS. STUDY DESIGN This prospective study included consecutive women with LUTS attending a urodynamic clinic. All women underwent a comprehensive clinical and urodynamic assessment. The effect of each variable on the odds of DO was estimated both by univariate analysis and adjusted analysis using logistic regression. RESULTS 1006 women with LUTS were included in the study with 374 patients (37%) diagnosed with DO. The factors considered to be the best predictors of DO were urgency urinary incontinence, urge rating/void and parity (p-value<0.01). The absence of SUI, vaginal bulging and previous continence surgery were also good predictors of DO (p-value<0.01). We have created a prediction model for DO based on our best predictors. In our scoring system, presence of UUI scores 5; mean urge rating/void≥3 scores 3; parity≥2 scores 2; previous continence surgery scores -1; presence of SUI scores -1; and the complaint of vaginal bulging scores -1. If a criterion is absent, then the score is 0 and the total score can vary from a value of -3 to +10. The Receiver Operating Characteristic (ROC) analysis for the overall cut-off points revealed an area under the curve of 0.748 (95%CI 0.741, 0.755). CONCLUSION This model is able to predict DO more accurately than a symptomatic diagnosis alone, in women with LUTS. The introduction of this scoring system as a screening tool into clinical practice may reduce the need for expensive and invasive tests to diagnose DO, but cannot replace UDS completely.