P. Abrams

Bladder outlet obstruction index, bladder contractility index and bladder voiding efficiency: three simple indices to define bladder voiding function

The consultations sponsored by the WHO have indicated the confirmed value of urodynamics for the precise definition of lower urinary tract dysfunction in men [1]. In the older man it is generally accepted that the outcome of outlet tract surgery (e.g. TURP) is improved if patients with BOO are selected by urodynamic studies [2]. Most analytical work has concentrated on defining BOO from pressure-flow studies of voiding, and three well-known nomograms have been used to categorize Qmax (mL/s) 25 p d et Q m ax ( cm H 2 O )

The International Continence Society “Benign Prostatic Hyperplasia” Study: The Bothersomeness of Urinary Symptoms

PURPOSEnWe assessed the bothersomeness of lower urinary tract symptoms as reported by men, and investigated relationships among occurrence, degree of problem caused and age.nnnMATERIALS AND METHODSnQuestionnaire data from 1,271 men presenting with lower urinary tract symptoms in 12 countries were analyzed. Statistical methods included distributions, cross tabulations, chi-square analysis and Spearmans rank correlation coefficients.nnnRESULTSnAlthough prevalence and bothersomeness were moderately positively related, voiding symptoms were the most prevalent whereas the most bothersome were predominantly storage symptoms, including incontinence. While prevalence showed a broadly decreasing trend with age, bothersomeness was relatively unrelated to age.nnnCONCLUSIONSnThese findings suggest that symptom occurrence alone does not necessarily reflect the degree to which patients are bothered by lower urinary tract symptoms. Therefore, when deciding on treatment it is important not only to consider the presence and frequency of lower urinary tract symptoms but also the bother that they cause.

Is the Bladder a Reliable Witness for Predicting Detrusor Overactivity

PURPOSEnWe determined how well the symptoms of OAB syndrome correlate with urodynamic DO using International Continence Society definitions.nnnMATERIALS AND METHODSnThe study included adult males and females 18 years or older who attended a tertiary referral center for urodynamics from February 2002 to February 2004. Patients were selected based on OAB syndrome symptoms (urgency, urgency urinary incontinence and frequency). The percent of patients who had symptoms alone or in combination and DO was calculated.nnnRESULTSnThere was a better correlation in results between OAB symptoms and the urodynamic diagnosis of DO in men than in women. Of men 69% and 44% of women with urgency (OAB dry) had DO, while 90% of men and 58% of women with urgency and urgency urinary incontinence (OAB wet) had DO. Stress urinary incontinence seems to have accounted for the decreased rates in women since 87% of women with urgency urinary incontinence also had the symptom of stress urinary incontinence. The ICS definition does not specify what constitutes abnormal voiding frequency. Analysis of results showed that increasing voiding frequency did not have any effect on increasing the accuracy of diagnosis of DO except in women with 10 or more daytime micturition episodes.nnnCONCLUSIONSnThe bladder is a better and more reliable witness in men than in women with a greater correlation between OAB symptoms and urodynamic DO, more so in the OAB wet than in OAB dry patients.

Efficacy of desmopressin in the treatment of nocturia: a double‐blind placebo‐controlled study in men

Objectiveu2002To investigate the efficacy and safety of oral desmopressin in the treatment of nocturia in men.

Evaluation and Treatment of Lower Urinary Tract Symptoms in Older Men

PURPOSEnThe 6th International Consultation on New Developments in Prostate Cancer and Prostate Diseases met from June 24-28, 2005 in Paris, France to review new developments in benign prostatic disease.nnnMATERIALS AND METHODSnA series of committees were asked to produce recommendations on the evaluation and treatment of lower urinary tract symptoms in older men. Each committee was asked to base recommendations on a thorough assessment of the available literature according to the International Consultation on Incontinence level of evidence and grading system adapted from the Oxford system.nnnRESULTSnThe Consultation endorsed the appropriate use of the current terminology lower urinary tract symptoms/benign prostatic hyperplasia/benign prostate enlargement and benign prostatic obstruction, and recommended that terms such as clinical benign prostatic hyperplasia or the benign prostatic hyperplasia patient be abandoned, and asked the authorities to endorse the new nomenclature. The diagnostic evaluation describes recommended and optional tests, and in general places the focus on the impact (bother) of lower urinary tract symptoms on the individual patient when determining investigation and treatment. The importance of symptom assessment, impact on quality of life, physical examination and urinalysis is emphasized. The frequency volume chart is recommended when nocturia is a bothersome symptom to exclude nocturnal polyuria. The recommendations are summarized in 2 algorithms, 1 for basic management and 1 for specialized management of persistent bothersome lower urinary tract symptoms.nnnCONCLUSIONSnThe use of urodynamics and transrectal ultrasound should be limited to situations in which the results are likely to benefit the patient such as in selection for surgery. It is emphasized that imaging and endoscopy of the urinary tract have specific indications such as dipstick hematuria. Treatment should be holistic, and may include conservative measures, lifestyle interventions and behavioral modifications as well as medication and surgery. Only treatments with a strong evidence base for their clinical effectiveness should be used.

The standardization of terminology in nocturia: report from the standardization subcommittee of the International Continence Society

P. VAN KER REBROECK 1 , P. ABRAMS 2 , D. CHAIKIN 3 , J. DONOVAN 4 , D. FONDA 5 , S. JACKSON 6 , P. JENNUM 7 , T. JOHNSON 8 , G.R. LOSE 9 , A. MATTIASSON 10 , G.L. ROBER TSON 11 and J. WEISS 12 1 Chairman of the International Continence Society Standardization Committee, Department of Urology, University Hospital Maastricht, the Netherlands, 2 Bristol Urological Institute, Southmead Hospital, Bristol, UK, 3 Morristown Memorial Hospital, Morristown NJ, and Department of Urology, Weill Medical College of Cornell University, USA, 4 Department of Social Medicine, University of Bristol, Bristol, UK, 5 Aged Care Services, Caulfield General Medical Centre, Victoria, Australia, 6 Department of Gynaecology, John Radcliffe Hospital, Oxford, UK, 7 Department of Clinical Neurophysiology, University of Copenhagen and Sleep Laboratory, Glostrup, Denmark, 8 Rehabilitation Research and Development Center, Atlanta VA Medical Centre, Georgia, USA, 9 Department of Obstetrics and Gynaecology, Glostrup County Hospital, University of Copenhagen, Denmark, 10 Department of Urology, Lund University Hospital, Lund, Sweden, 11 Northwestern University Medical School, Chicago, USA, 12 Department of Urology, Weill Medical College of Cornell University and The New York Presbyterian Hospital, New York, NY, USA

The Significance of the Symptoms Associated with Bladder Outflow Obstruction

The symptomatology and urodynamic findings of 318 male patients (45–84 years) with suspected bladder outflow obstruction have been analysed. Inflow cystometry showed that 57% of patients had unstable

Development and psychometric evaluation of the ICIQ Vaginal Symptoms Questionnaire: the ICIQ‐VS

Objectivesu2002 To develop and validate a self‐completion questionnaire for comprehensive assessment of the severity and impact of vaginal symptoms and related sexual matters, particularly those attributed to pelvic organ prolapse. To provide an instrument that can characterise the severity of these symptoms, measure their impact and evaluate treatment outcome.

The natural history of lower urinary tract dysfunction in men: the influence of detrusor underactivity on the outcome after transurethral resection of the prostate with a minimum 10-year urodynamic follow-up.

In the first paper in this section the authors from the Bristol Urological Institute investigated 224 men with detrusor underactivity, and evaluated the effect of this condition on the outcome of TURP. This quite unique study found that TURP is not helpful in this condition. They underscored their view that reliance on symptoms and uroflowmetry is not enough when patients are being considered for TURP, and recommended routine preoperative urodynamic assessment.

The role of neuromodulation in the management of urinary urge incontinence

Neuromodulation is increasingly becoming an important part of the treatment strategy for bladder dysfunction. In this issue a group of urologists have analysed outcome measures from all patients in pivotal clinical trials who have had this treatment, and have suggested that sacral nerve stimulation has an vital role in the management of refractory overactive bladder and retention problems.