Stephen Radley

CONVENTIONAL AND AMBULATORY URODYNAMIC FINDINGS IN WOMEN WITH SYMPTOMS SUGGESTIVE OF BLADDER OVERACTIVITY

PURPOSE We compared ambulatory urodynamics and conventional video cystometry findings in women with symptoms of bladder overactivity. MATERIALS AND METHODS In a prospective randomized crossover study 106 women with symptoms of urinary urgency with or without incontinence were comprehensively investigated by video cystometry and ambulatory urodynamics in random order. In addition, all women completed a validated symptoms questionnaire and voiding diary. RESULTS Involuntary detrusor activity was detected in 32 and 70 cases on video cystometry and ambulatory urodynamics, respectively (p <0.001). Video cystometry done according to International Continence Society standards diagnosed detrusor instability in 4 women with no involuntary detrusor activity on ambulatory urodynamics. Involuntary detrusor activity resulting in incontinence was observed in 39 cases on ambulatory urodynamics, including 20 (51%) with stable video cystometry results. Stress incontinence was diagnosed in 42 cases on video cystometry and in 34 on ambulatory urodynamics (p = 0.629). Increasingly severe urge and stress incontinence reported in the symptoms questionnaire correlated positively with the subsequent detection of detrusor overactivity and stress incontinence, respectively, on the 2 urodynamic tests. CONCLUSIONS In contrast to video cystometry, ambulatory urodynamics provides objective evidence of clinically important bladder overactivity in the majority of women with symptoms suggestive of bladder overactivity. The correlation of symptoms with ambulatory urodynamic findings implies that greater reliance may be placed on symptomatic diagnosis of bladder overactivity. Improved objective assessment of detrusor function provided by ambulatory urodynamics has implications for the definition of bladder overactivity and relevance of conventional cystometry in this context. In women who complain of urgency stable conventional cystometrography findings should be interpreted with caution.

Transurethral implantation of macroplastique for the treatment of female stress urinary incontinence secondary to urethral sphincter deficiency.

Objective: To assess the results of transurethral implantation of Macroplastique® in women with stress incontinence secondary to urethral sphincter deficiency using subjective and objective outcome measures. Methods: A total of 60 women with genuine stress incontinence secondary to intrinsic urethral sphincter deficiency were treated with transurethral implantation of Macroplastique. The patients had undergone a mean of 1.9 (range 0–7) previous episodes of continence surgery. Up to three treatment episodes were used, if necessary. The outcome was assessed by telephone interview (56 patients, mean follow–up period 19 months) and videocystometry (41 patients, mean follow–up period 16 months). Transurethral ultrasound scanning was performed in a further 9 patients. Results: Symptomatically, 19.6% of the women interviewed by telephone considered themselves cured of their incontinence or were no longer using pads. A further 41.1% said their symptoms had significantly improved. Pad usage was reduced from a median of five to three pads per day (p<0.001). Videocystometry in 41 women (mean follow–up period 16 months) was normal in 16 patients (39%) and showed genuine stress incontinence in 18 (43.9%) and detrusor instability in 12 patients (29.3%). Overall, 71.4% stated that they would undergo the procedure again under the same circumstances, and 80.4% would recommend this form of treatment to a friend with the same condition. Transurethral ultrasound scanning was performed in 9 patients (5 subjectively improved or cured, 1 patient with persistent symptoms but normal cystometry, and 3 patients with persistent genuine stress incontinence). Hyperechoic foci were seen surrounding the proximal urethra, consistent with implanted Macroplastique boluses. When completely encircling the urethra, the outcome was generally good. A total of 10 patients have undergone or are awaiting open surgery, and 3 are awaiting repeat implantation. Conclusion: Sustained improvement or cure of genuine stress incontinence has been achieved using Macroplastique in a large proportion of women with intrinsic sphincter deficiency, often following previous unsuccessful continence surgery. Transurethral ultrasound may prove to be a clinically useful imaging technique for the assessment and subsequent management of treatment failure following Macroplastique implantation.

Computer interviewing in urogynaecology: concept, development and psychometric testing of an electronic pelvic floor assessment questionnaire in primary and secondary care

Objective  To develop and evaluate a Web‐based, electronic pelvic floor symptoms assessment questionnaire (e‐PAQ) 1 for women.

Effect of methoxamine on maximum urethral pressure in women with genuine stress incontinence: a placebo-controlled, double-blind crossover study.

The aim of the study was to evaluate the potential role for a selective α1‐adrenoceptor agonist in the treatment of urinary stress incontinence. A randomised, double‐blind, placebo‐controlled, crossover study design was employed. Half log incremental doses of intravenous methoxamine or placebo (saline) were administered to a group of women with genuine stress incontinence while measuring maximum urethral pressure (MUP), blood pressure, heart rate, and symptomatic side effects. Methoxamine evoked non‐significant increases in MUP and diastolic blood pressure but caused a significant rise in systolic blood pressure and significant fall in heart rate at maximum dosage. Systemic side effects including piloerection, headache, and cold extremities were experienced in all subjects. The results indicate that the clinical usefulness of direct, peripherally acting sub‐type‐selective α1‐adrenoceptor agonists in the medical treatment of stress incontinence may be limited by associated piloerection and cardiovascular side effects. Neurourol. Urodynam. 20:43–52, 2001.

Incontinence during intercourse: myths unravelled

Introduction and hypothesisThis study aimed to establish the prevalence of urinary leakage during intercourse, the extent to which urinary leakage impacts on sex life and the correlation between different urodynamic diagnosis and coital leakage.MethodsFour hundred eighty women attending between 1 January 2006 and December 2010 with urinary incontinence and subsequently undergoing urodynamic assessment were included. Data were collected as part of routine clinical care using the electronic Pelvic floor Assessment Questionnaire and correlated with urodynamic findings.ResultsSixty percent of women with urinary incontinence reported leakage during intercourse. Overall quality of life in women with urinary incontinence was strongly correlated to the impact of urinary symptoms on sex life. Parameters of sexual function were no different in women with different urodynamic diagnosis.ConclusionWorsening urinary incontinence has a deleterious effect on sexual function. Urodynamic diagnosis does not correlate with the nature of underlying sexual problems, orgasm or penetration incontinence.

Transurethral implantation of silicone polymer for stress incontinence: evaluation of a porcine model and mechanism of action in vivo

Objective To evaluate the anatomical location, histological appearances and mechanism of action of sili‐cone polymer (Macroplastique®) after transurethral implantation.

Electronic pelvic floor symptoms assessment: tests of data quality of ePAQ-PF

The objective of the study was to test the data quality, scaling assumptions and scoring algorithms underlying the electronic personal assessment questionnaire—pelvic floor (ePAQ-PF). A cross-sectional survey of 599 women with pelvic floor disorders was carried out. Tests of data quality included secondary factor analysis, internal reliability, descriptive statistics, levels of missing data, floor and ceiling effects, item-to-total correlation scores, item discriminant and convergent validity. Secondary factor analysis verified the domain structure of ePAQ-PF. All 19 domains were internally reliable with Cronbach’s α scores ranging from 0.71 to 0.93. Missing response rates ranged from 0.2% to 1.3%, and all items were found to be most highly correlated with their own corrected scale. Results confirmed the factor structure, data quality and scoring and scaling assumptions of ePAQ-PF, thereby verifying its suitability for measuring symptoms, bother and quality of life in women with pelvic floor disorders.

Does sacral nerve stimulation improve global pelvic function in women

Many women undergoing sacral neuromodulation for faecal incontinence have coexisting pelvic floor dysfunction. We used a global pelvic‐floor assessment questionnaire to evaluate the effect of sacral neuromodulation on non‐bowel related symptomatology.

Serotonin-induced potentiation of cholinergic responses to electrical field stimulation in normal and neurogenic overactive human detrusor muscle

The smooth muscle cells of the urinary tract are again the subject of much study, as is reflected by the papers in this section. Authors from Sheffield evaluate the effects of 5‐HT on the potentiation of cholinergic responses in isolated strips of detrusor muscle. In another study authors from France compare the effects of tamsulosin and alfuzosin on neurally evoked increases of bladder neck and seminal vesicle pressures in rats. The smooth muscle of the renal artery is assessed by authors from Germany, where they investigate the involvement of signal‐transducing GTP‐binding proteins in renal artery smooth muscle contraction.

Pharmacodynamics of anticholinergic agents measured by ambulatory urodynamic monitoring: A study of methodology†

The aim of the study was to establish a methodology whereby ambulatory urodynamic monitoring (AUM) may be used in the assessment of the effects of darifenacin on urodynamic measures of detrusor function and symptoms associated with detrusor instability. Six patients (one man and five women) with detrusor instability (DI) on conventional urodynamic monitoring were recruited into this placebo‐controlled crossover study. The study was divided into two periods of 7 days of treatment with either darifenacin 5 mg t.d.s. or placebo with the patient crossing over to the alternative treatment after a washout period of 7 days. On the 7th day of each treatment, AUM was carried out. Parameters used to quantify detrusor activity on AUM were the number, amplitude, and duration of detrusor contractions and the total area under the detrusor pressure/time curve. “Events” recorded were urge, leakage episodes, voids, and pain. Six comparable hours of AUM for each treatment period could be analyzed in four patients and 4 hr in one. In three of the five patients, reduction in activity on AUM while on darifenacin was apparent. Symptom data closely matched the changes in detrusor activity measured on AUM.