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Bladder Oversensitivity Is Associated with Bladder Outlet Obstruction in Men. J Pers Med 2022; 12:jpm12101675. [PMID: 36294814 PMCID: PMC9605007 DOI: 10.3390/jpm12101675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/07/2022] [Accepted: 09/29/2022] [Indexed: 01/24/2023] Open
Abstract
Objective: The aim of this study was to assess whether there is an objective association between bladder outlet obstruction (BOO) and abnormal sensation parameters during filling cystometry in men. Methods: This was a prospective study. Consecutive patients referred for urodynamic examination were assessed for eligibility. Patients with permanent catheters, BPH related surgery, neurologic disease, or inability to complete the urodynamic study were excluded. All patients underwent full physical examination, as well as renal and bladder ultrasound including prostate size estimation, post void residual volume, and PSA, and they completed the International Prostate Symptoms Score (IPSS) questionnaire. The cohort was divided into obstructed and un-obstructed groups according to the Bladder Outlet Obstruction Index. Results: Ninety of the 115 patients recruited were obstructed (78%). Obstructed patients had significantly higher PSA, larger prostate volume, and higher IPSS. Detrusor overactivity did not differ between the two groups (45.6% vs. 48.1%, p = 0.83). First, normal, strong, and urgent desires to void were significantly lower in obstructed men: median (IQR) 118 (57−128) vs. 180 (80−200), 171 (85−257) vs. 227 (125−350), 221 (150−383) vs. 307 (180−477), and 276 (197−480) vs. 344 (280−535), respectively. First desire to void (FDV) had the highest area under the curve (AUC = 0.83, 95% CI = 0.76−0.90, p < 0.001) for predicting BOO with a Youden index of 0.78 at 140 mL. Conclusions: Our results suggest that there is a strong association between bladder oversensitivity and BOO in men. Men with FDV <140 mL had a significantly increased probability of being obstructed. These findings may shed a light on the pathophysiological connection between obstruction and enhanced afferent signaling from the bladder.
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Verhovsky G, Rappaport YH, Baberashvili I, Neheman A, Zisman A, Stav K. Bladder outlet obstruction is associated with bladder oversensitivity in women. Int Urogynecol J 2020; 32:2771-2776. [PMID: 33084961 DOI: 10.1007/s00192-020-04561-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 10/02/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Bladder outlet obstruction (BOO) in women might be associated with significant lower urinary tract storage symptoms such as increased frequency, urgency, and incontinence. This prospective study was designed to assess whether there is an objective association between BOO and abnormal parameters during filling cystometry in women. METHODS A total of 169 consecutive women (mean age 56 ± 14 years) who were referred for urodynamic investigation were prospectively recruited. Comprehensive medical, obstetric, and gynecological histories were recorded. All patients underwent physical examination, renal and bladder ultrasound, and filled out the International Prostate Symptoms Score (IPSS) questionnaire. The cohort was divided into obstructed and un-obstructed groups based on pressure flow results (Obstruction: Qmax <12 ml/s and Pdet @ Qmax >25 cmH2O). RESULT There was no significant difference in the frequency of detrusor overactivity between the obstructed and non-obstructed group (37% vs 32%, p = 0.71). All bladder sensation volumes were significantly lower in obstructed women than non-obstructed women in univariate and multivariate logistic regression analyses. Of the sensation parameters, first desire to void (FDV) had the highest area under the curve (AUC = 0.75, 95% CI = 0.672-0.837, p < 0.001) for predicting BOO. FDV < 105 ml showed a strong association with BOO with OR = 9.84 (95% CI 4.122-23.508, p < 0.0001). On univariate and multivariate analyses adjusted to 50 cc reduction in sensation volume, all sensation parameters, were associated with bladder outlet obstruction. CONCLUSION Our results suggest that there might be a strong association between bladder oversensitivity and BOO in women. This may shed light on the pathophysiological connection between obstruction and enhanced afferent signaling from the bladder.
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Affiliation(s)
- Guy Verhovsky
- Department of Urology, Shamir Medical Center (Assaf Harofeh Campus), Zerifin, Affiliated to the Sackler School of Medicine, Tel Aviv University, 7030000, Tel Aviv, Israel.
| | - Yishai Hode Rappaport
- Department of Urology, Shamir Medical Center (Assaf Harofeh Campus), Zerifin, Affiliated to the Sackler School of Medicine, Tel Aviv University, 7030000, Tel Aviv, Israel
| | - Ilia Baberashvili
- Department of Nephrology, Shamir Medical Center (Assaf Harofeh Campus), Zerifin, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amos Neheman
- Department of Urology, Shamir Medical Center (Assaf Harofeh Campus), Zerifin, Affiliated to the Sackler School of Medicine, Tel Aviv University, 7030000, Tel Aviv, Israel
| | - Amnon Zisman
- Department of Urology, Shamir Medical Center (Assaf Harofeh Campus), Zerifin, Affiliated to the Sackler School of Medicine, Tel Aviv University, 7030000, Tel Aviv, Israel
| | - Kobi Stav
- Department of Urology, Shamir Medical Center (Assaf Harofeh Campus), Zerifin, Affiliated to the Sackler School of Medicine, Tel Aviv University, 7030000, Tel Aviv, Israel
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Medina Lucena H, Tincello DG. Methods of assessing and recording bladder sensation: a review of the literature. Int Urogynecol J 2018; 30:3-8. [PMID: 30187093 PMCID: PMC6510803 DOI: 10.1007/s00192-018-3760-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 08/21/2018] [Indexed: 12/13/2022]
Abstract
Introduction and hypothesis The objective was to review different methods that have been used to assess bladder sensation and to provide an overview of the accuracy and objectivity of the measurement of the subjective perception of the bladder. Methods The MEDLINE and PubMed databases were searched to identify articles. References from those articles were also searched. Terms used for the search were: urinary bladder, sensation, cystometry, urodynamics, urinary incontinence and focus group. Eight hundred and fifty abstracts were identified from databases, and 12 from other sources. Twenty-two duplicate articles were removed. Irrelevant articles were excluded after reading their titles. Fifty-four articles were eligible, but 17 were excluded after reading the full text, leaving 37 articles where assessment of bladder sensation was the main aim. Results Six different methods of measuring bladder sensation have been described in the literature. Although the most frequently used was cystometry, this is an invasive tool and does not reproduce bladder behaviour during daily life because it records bladder sensation as episodic events. The visual analogue scale using a forced diuresis protocol seemed to be an excellent tool. It was non-invasive and evaluated bladder sensation continuously, from an empty to a full bladder. Conclusions In some of the studies, the samples were too small to draw any significant conclusions. There were also conflicting data on which tool was the most accurate, especially as each method of evaluating bladder sensation may influence the way it is described by participants.
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Affiliation(s)
- Hayser Medina Lucena
- Department of Health Sciences, University of Leicester, Centre for Medicine, University Road, Leicester, Leicestershire, LE1 7RH, UK.
| | - Douglas G Tincello
- Department of Health Sciences, University of Leicester, Centre for Medicine, University Road, Leicester, Leicestershire, LE1 7RH, UK
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Medina Lucena H, Tincello DG. Validation of a water-load protocol to define the pattern of bladder sensation. Int Urogynecol J 2018; 30:767-772. [PMID: 30121702 PMCID: PMC6491398 DOI: 10.1007/s00192-018-3735-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 07/23/2018] [Indexed: 12/21/2022]
Abstract
Introduction and hypothesis The aim of this study was to confirm reliability of a water-load diuresis protocol and to assess the utility of bladder sensation curves. Methods For confirmation of fixed diuresis rate (phase 1), 12 volunteers consumed 250–300 ml of water every 15 min and recorded bladder sensation on a visual analogue scale (VAS) every 5 min to maximum sensation over two filling cycles: voids 1 and 2 (V1 and V2). The test was performed twice. For test–retest validation (phase 2), 24 participants underwent the same protocol drinking 300 ml of water every 15 min. Diuresis rates and voided volumes were compared between cycles and across tests. Results In phase 1, there was no difference in median void volume (V1 735 ml, V2 678 ml p = 0.433) or median diuresis rates (V2 12.1 ml/min, V3 14.4 ml/min p = 0.136) between cycles. When comparing those who drank 250–300 ml/15 min, there was less variability in those drinking 300-ml aliquots, so this was standardised for later experiments; 95% upper confidence limit of variability of the diuresis rate was calculated as 4.5 ml/min. Any test with a greater difference was rejected as invalid. In phase 2, only 16 participants were analysed. There was no difference in median void volumes between tests [V1 763 ml and 820 ml (p = 0.109) and V2 788 ml and 796 ml (p = 0.266)] or in diuresis rates between test 1 (12.33 ml/min) and 2 (14.40 ml/min) (p = 0.056). Median area under the curve was similar between test 1 404.96 and test 2 418.63. Conclusions This refined protocol reliably produced stable diuresis with a water load of 300 ml/15 min, excluding those with a difference in diuresis rate > 4.5 ml/min.
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Affiliation(s)
- Hayser Medina Lucena
- Department of Health Sciences, University of Leicester, Centre for Medicine, University Road, Leicester, Leicestershire, LE1 7RH, UK.
| | - Douglas G Tincello
- Department of Health Sciences, University of Leicester, Centre for Medicine, University Road, Leicester, Leicestershire, LE1 7RH, UK
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CYSTOMANOMETRY – ONE OF THE ASSESSMENT METHODS OF THE URODYNAMIC INDEXES IN PATIENTS WITH INFILTRATIVE CERVICAL CANCER. EUREKA: HEALTH SCIENCES 2016. [DOI: 10.21303/2504-5679.2016.00116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Aim: To evaluate contractile function of urinary bladder in patients with infiltrative cervical cancer after nerve-sparing radical hysterectomy (NSRH).
Patients and Methods: Ninety patients with infiltrative cervical cancer were treated with nerve-sparing radical hysterectomy (n=45, NSRH group), or radical hysterectomy (RHE III) without preservation of pelvic autonomic plexuses (n=45, RHE group). Cystomanometry was carried out using urodynamic apparatus “Uro-Pro” by standard method.
Results: Using cystomanometry, we have evaluated the main urodynamic indexes such as pressure upon bladder filling (P1), first vesical tenesmus pressure (P2); change of detrusor pressure upon change of bladder volume (P), volume of urinary bladder (V), and complience of urinary bladder wall (C) at preoperative period and postoperative period in both groups of patients. While at preoperative period P1 indexes did not differ significantly between the groups, after NSRH performance, P1 values were significantly higher than P1 values in the group of patients treated with RHE III (8,29±1,1 cm H2O versus 3,51±0,8 cm H2O (р<0,05)). P2 indexes in patients from both groups before and after surgical treatment differed significantly and were 6,82±0,4 cm H2O and 12,27±1,2 cm H2O (р<0,05) in NSRH group, and 5,44±0,6 cm H2O and 10,62±1,1 cm H2O (р<0,05) in RHE III group. The P value in both patients groups before and after the surgical treatments was significantly different, and demonstrated a gradual elevation of urinary bladder pressure, especially in the patients from RHE III treated group. Urinary bladder volume at preoperative and postoperative periods in NSRH-treated group remained practically unaltered (209,78±14,2 ml and 216,86±14,9 ml (р>0,5) respectively), while in the patients from RHE III-treated group after surgical treatment an urinary bladder volume significantly decreased from 188,4±10,5 ml to 161,9±9,8 ml (р<0,05). An analysis of compliance of urinary bladder wall (C) has shown that after surgical treatment in RHE group C value decreased by 75% while in NSE group this index decreased just by 25%.
Conclusions: The data of urodynamic study evidence the better preservation of urinary bladder functions in patients with infiltrative cervical cancer after NSRH than in the patients treated with RHE III.
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Veit-Rubin N, Cartwright R, Esmail A, Digesu GA, Fernando R, Khullar V. The location of pain and urgency sensations during cystometry. Neurourol Urodyn 2016; 36:620-625. [PMID: 26879227 DOI: 10.1002/nau.22975] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Accepted: 01/26/2016] [Indexed: 11/10/2022]
Abstract
AIMS The relationship between bladder pain and urinary urgency sensations is poorly understood. We analyzed the relationship between locations and intensities of urgency and pain sensations felt during filling cystometry. METHODS Participants completed the King's Health Questionnaire (KHQ) to indicate presence of bladder pain or urgency. During cystometry, participants scored the intensity of urgency and pain, both in the suprapubic and the urethral region, on a VAS scale of 0-10 at a baseline, at first desire, normal desire, strong desire to void, and at maximum cystometric capacity during filling. We allocated the participants to six groups; those reporting urgency or not, pain or not, both symptoms and neither. Friedman's Test was used to ascertain if all scores increased significantly, the Wilcoxon Signed Rank Test was used to demonstrate the difference between scores, and agreement for findings during cystometry was tested with Mann-Whitney U. RESULTS A total of 68 women participated; 38 participants reported pain, 57 reported urgency, and 33 reported both symptoms. Pain and urgency scores significantly increased during cystometry (P < 0.0001). For participants reporting pain, suprapubic pain was rated significantly higher than urethral pain. Participants reporting both symptoms, felt more urgency than pain, and again pain more suprapubically than urethrally. Participants reporting only urgency scored suprapubic and urethral urgency similarly at all desires. CONCLUSIONS Pain and urgency are well differentiated sensations and are felt at different locations although pain is seemingly easier localized. Neurourol. Urodynam. 36:620-625, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Nikolaus Veit-Rubin
- Department of Urogynaecology, St. Mary's Hospital, Imperial College London, London, United Kingdom
| | - Rufus Cartwright
- Department of Urogynaecology, St. Mary's Hospital, Imperial College London, London, United Kingdom
| | - Alisha Esmail
- Department of Urogynaecology, St. Mary's Hospital, Imperial College London, London, United Kingdom
| | - G Alessandro Digesu
- Department of Urogynaecology, St. Mary's Hospital, Imperial College London, London, United Kingdom
| | - Ruwan Fernando
- Department of Urogynaecology, St. Mary's Hospital, Imperial College London, London, United Kingdom
| | - Vikram Khullar
- Department of Urogynaecology, St. Mary's Hospital, Imperial College London, London, United Kingdom
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Das R, Buckley JD, Williams MT. Descriptors of sensation confirm the multidimensional nature of desire to void. Neurourol Urodyn 2013; 34:161-6. [PMID: 24249522 DOI: 10.1002/nau.22520] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 10/10/2013] [Indexed: 11/10/2022]
Abstract
AIMS To collect and categorize descriptors of "desire to void" sensation, determine the reliability of descriptor categories and assess whether descriptor categories discriminate between people with and without symptoms of overactive bladder. METHODS This observational, repeated measures study involved 64 Australian volunteers (47 female), aged 50 years or more, with and without symptoms of overactive bladder. Descriptors of desire to void sensation were derived from a structured interview (conducted on two occasions, 1 week apart). Descriptors were recorded verbatim and categorized in a three-stage process. Overactive bladder status was determined by the Overactive Bladder Awareness Tool and the Overactive Bladder Symptom Score. McNemar's test assessed the reliability of descriptors volunteered between two occasions and Partial Least Squares Regression determined whether language categories discriminated according to overactive bladder status. Post hoc Chi squared analysis and relative risk calculation determined the size and direction of overactive bladder prediction. RESULTS Thirteen language categories (Urgency, Fullness, Pressure, Tickle/tingle, Pain/ache, Heavy, Normal, Intense, Sudden, Annoying, Uncomfortable, Anxiety, and Unique somatic) encapsulated 344 descriptors of sensation. Descriptor categories were stable between two interviews. The categories "Urgency" and "Fullness" predicted overactive bladder status. Participants who volunteered "Urgency" descriptors were twice as likely to have overactive bladder and participants who volunteered "Fullness" descriptors were almost three times as likely not to have overactive bladder. CONCLUSIONS The sensation of desire to void is reliably described over sessions separated by a week, the language used reflects multiple dimensions of sensation, and can predict overactive bladder status.
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Affiliation(s)
- Rebekah Das
- Nutritional Physiology Research Centre, Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
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Are the measurements of water-filled and air-charged catheters the same in urodynamics? Int Urogynecol J 2013; 25:123-30. [DOI: 10.1007/s00192-013-2182-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Accepted: 06/23/2013] [Indexed: 10/26/2022]
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Das R, Buckley J, Williams M. Dimensions of sensation assessed in urinary urgency: a systematic review. J Urol 2013; 190:1165-72. [PMID: 23643596 DOI: 10.1016/j.juro.2013.04.076] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Urinary urgency is an adverse sensory experience. Confirmation of the multidimensional nature of other adverse sensory experiences such as pain and dyspnea has improved the understanding of neurophysiological and perceptual mechanisms leading to innovations in assessment and treatment. It has been suggested that the sensation of urgency may include multiple dimensions such as intensity, suddenness and unpleasantness. In this systematic review we determine which dimensions of sensation have been assessed by instruments used to measure urinary urgency. MATERIALS AND METHODS A systematic search was undertaken of MEDLINE, Embase, AMED, CINAHL, Ageline, Web of Science, InformIT Health and Scopus databases to identify studies that included assessments of urinary urge or urgency. Articles were included in the analysis if they were primary studies that described the method used to measure urge/urgency in adults and published in English in peer reviewed publications since January 1, 2000. Articles were excluded from study if urgency was measured only in conjunction with other symptoms (eg frequency or incontinence) or if there was no English version of the instrument. Secondary analyses and systematic reviews were retained to hand search references for additional primary studies. Data were extracted for the instruments used to measure urge/urgency. For each instrument the items specific to urinary urgency were reviewed using a prospectively developed categorization process for the sensory dimension and the measurement metric. Items used to assess urinary urgency were collated in a matrix (sensory dimensions vs assessment metric). The most frequently used dimensions, metrics and combinations were descriptively analyzed. RESULTS After removal of duplicate articles 1,048 full text articles were screened and 411 were excluded, leaving 637 eligible articles from which data were extracted. A total of 216 instruments were identified which were 1 of 6 types, namely 1) wider symptom questionnaires, 2) urgency specific questionnaires, 3) ordinal scales, 4) visual analog scales, 5) event records or 6) body maps. These 216 instruments contained a total of 309 urgency specific items. Of the instruments 51% did not define a dimension of sensation and 26% did not define the metric used. From the remaining instruments 8 dimensions of sensation and 5 types of metrics were identified. From most common to least common, the sensory dimensions assessed were behavioral response, intensity, suddenness, bother, affective response, unpleasantness, quality (descriptors) and problems associated with sensation. Metrics were magnitude, frequency, presence, time frame or location. The most common sensory dimension/metric combinations were frequency of a behavioral response (14% of items) and magnitude of bother caused by the sensation (8% of items). CONCLUSIONS The hypothesis that urinary urgency is multidimensional is supported by the range of dimensions assessed with available instruments. To clarify the nature of urinary urgency compared with the normal desire to void, prospective studies are required to determine whether sensory dimensions are distinct, and which may delineate between normal and pathological sensation.
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Affiliation(s)
- Rebekah Das
- Centre for Nutritional Physiology, Sansom Institute for Health Research, School of Health Sciences, University of South Australia, City East Campus, Adelaide, South Australia, Australia.
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Winters JC, Dmochowski RR, Goldman HB, Herndon CDA, Kobashi KC, Kraus SR, Lemack GE, Nitti VW, Rovner ES, Wein AJ. Urodynamic studies in adults: AUA/SUFU guideline. J Urol 2012; 188:2464-72. [PMID: 23098783 DOI: 10.1016/j.juro.2012.09.081] [Citation(s) in RCA: 142] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE The authors of this guideline reviewed the literature regarding use of urodynamic testing in common lower urinary tract symptoms. The findings are intended to assist clinicians in the appropriate selection of urodynamic tests, following an evaluation and symptom characterization. MATERIALS AND METHODS A systematic review of the literature using the MEDLINE® and EMBASE databases (searched from 1/1/90 to 3/10/11) was conducted to identify peer-reviewed publications relevant to using urodynamic tests for diagnosis, determining prognosis, guiding clinical management decisions and improving patient outcomes in patients with various urologic conditions. The review yielded an evidence base of 393 studies after application of inclusion/exclusion criteria. These publications were used to create the evidence basis for characterizing the statements presented in the guideline as Standards, Recommendations or Options. When sufficient evidence existed, the body of evidence for a particular treatment was assigned a strength rating of A (high), B (moderate) or C (low). In the absence of sufficient evidence, additional information is provided as Clinical Principles and Expert Opinion. RESULTS The evidence-based guideline statements are provided for diagnosis and overall management of common LUTS conditions. CONCLUSIONS The Panel recognizes that each patient presenting with LUTS is unique. This Guideline is intended to serve as a tool facilitating the most effective utilization of urodynamic testing as part of a comprehensive evaluation of patients presenting with LUTS.
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Affiliation(s)
- J Christian Winters
- American Urological Association Education and Research, Inc., Linthicum, Maryland, USA
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Bhide AA, Digesu GA, Fernando R, Khullar V. Use of mirabegron in treating overactive bladder. Int Urogynecol J 2012; 23:1345-8. [DOI: 10.1007/s00192-012-1724-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Accepted: 02/09/2012] [Indexed: 10/28/2022]
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Heeringa R, van Koeveringe GA, Winkens B, van Kerrebroeck PEV, de Wachter SGG. Do patients with OAB experience bladder sensations in the same way as healthy volunteers? A focus group investigation. Neurourol Urodyn 2012; 31:521-5. [PMID: 22396435 DOI: 10.1002/nau.21232] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2011] [Accepted: 09/20/2011] [Indexed: 11/10/2022]
Affiliation(s)
- R Heeringa
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands
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Heeringa R, van Koeveringe GA, Winkens B, van Kerrebroeck PEV, de Wachter SGG. Degree of urge, perception of bladder fullness and bladder volume--how are they related? J Urol 2011; 186:1352-7. [PMID: 21855937 DOI: 10.1016/j.juro.2011.05.050] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Indexed: 10/17/2022]
Abstract
PURPOSE We evaluated the reliability of the degree of urge and perception of bladder fullness scales, the relationship between the scales and bladder volume, and possible differences between bladder sensations experienced in a controlled or an uncontrolled setting. MATERIALS AND METHODS Volunteers and patients with overactive bladder symptoms participated in the protocols. They were asked to grade bladder sensation on a 4-point urge scale of no sensation to need to void now and assess the perception of fullness on a visual analog scale of empty to full bladder. This was assessed in a 3-day bladder diary and during controlled, noninvasive bladder filling. RESULTS Each scale was reliable and significantly related to bladder volume (p <0.001). Agreement between the scales and voided volume was poor. Patients and volunteers grade bladder fullness and degree of urge higher in an uncontrolled than in a controlled setting. CONCLUSIONS The perception of bladder fullness and the degree of urge have a significant relation to bladder volume in controlled and uncontrolled settings. Due to poor agreement between the scales and actual voided volume these scales cannot replace measuring voided volume. The perception of bladder sensation depends on the setting. Bladder sensation at the hospital might underestimate the bother of symptoms experienced by a patient in daily life.
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Affiliation(s)
- Rhea Heeringa
- Department of Urology, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands
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Vijaya G, Digesu GA, Derpapas A, Hendricken C, Fernando R, Khullar V. Antimuscarinic effects on current perception threshold: a prospective placebo control study. Neurourol Urodyn 2011; 31:75-9. [PMID: 22038939 DOI: 10.1002/nau.21194] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2011] [Accepted: 06/27/2011] [Indexed: 11/09/2022]
Abstract
AIMS 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). METHODS Women with overactive bladder symptoms and idiopathic DO were recruited and randomized in a double-blind manner between placebo and tolterodine extended release. All women underwent CPT testing of the bladder and urethra using a Neurometer constant current stimulator. CPT values were determined at three frequencies, including 2,000 Hz (corresponding to Aβ-fibers), 250 Hz (corresponding to Aδ-fibers), and 5 Hz (corresponding to C fibers) before and 7 days on treatment. CPT values before and on treatment were compared using a Wilcoxon Signed Rank test. RESULTS Twenty women (mean age 46 years) were studied. There was no statistical difference between the two groups in terms of age, ethnicity, severity of symptoms and pre-treatment CPT values. Only in the tolterodine group there was a significantly increased CPT value at 5 and 250 Hz upon both urethral and bladder stimulation after 1 week of treatment. When compared with placebo, women taking tolterodine had significantly increased Bladder CPT values at 5 Hz (P-value <0.05). The electrical stimulation with 5 Hz was described as urgency. CONCLUSIONS This is a randomized placebo control study evaluating the effect of antimuscarinics on sensory nerve function in women with DO. Our results support the animal studies that antimuscarinics have an effect on sensory function.
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Affiliation(s)
- Gopalan Vijaya
- Department of Urogynaecology, St. Mary's Hospital, Imperial College, London, United Kingdom.
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De Wachter SG, Heeringa R, van Koeveringe GA, Gillespie JI. On the nature of bladder sensation: the concept of sensory modulation. Neurourol Urodyn 2011; 30:1220-6. [PMID: 21661031 DOI: 10.1002/nau.21038] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2010] [Accepted: 10/22/2010] [Indexed: 01/23/2023]
Abstract
AIMS Going to the toilet is an essential everyday event. Normally, we do not give much thought to the sensations and factors that trigger voiding behavior: we just go. For many people, this apparently simple task is complicated and dominates their life. They have strong sensations and sudden desires to void, often resulting in incontinence. It is therefore important that we understand the origins for this functional change and identify means to alleviate it. METHODS Literature survey. RESULTS A considerable body of work has focused on this problem and ideas and concepts on the nature of bladder sensations are embedded in the literature. In this paper we argue the necessity to return to first principles and a re-examination of the problem. We explore the use of focus groups to identify relevant bladder sensation and what triggers 'bladder' behavior. We argue that there are differences in what can be described as 'introspective bladder sensations' and the sensations reported immediately before a void, 'void sensations'. Finally, we propose an alternative model describing how peripheral information generating 'introspective sensations' and 'void sensations' might be different but interrelated sensations. By exploring such ideas and identifying such complexity it is our intention to stimulate debate and generate further research in the field in order to understand better the physiology of bladder sensation and the pathology of increased urge, frequency and incontinence. CONCLUSIONS Review of the literature on bladder sensation and the established ideas suggests that we might be missing something and the problem of normal and increased sensation and of urgency may be much more complex.
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Affiliation(s)
- S G De Wachter
- Department of Urology, Maastricht University Medical Center, Maastricht, The Netherlands.
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Heeringa R, de Wachter SGG, van Kerrebroeck PEV, van Koeveringe GA. Normal bladder sensations in healthy volunteers: A focus group investigation. Neurourol Urodyn 2011; 30:1350-5. [PMID: 21608021 DOI: 10.1002/nau.21052] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Accepted: 11/17/2010] [Indexed: 11/08/2022]
Affiliation(s)
- Rhea Heeringa
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands
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Cartwright R, Srikrishna S, Cardozo L, Robinson D. Validity and reliability of the patient’s perception of intensity of urgency scale in overactive bladder. BJU Int 2010; 107:1612-7. [DOI: 10.1111/j.1464-410x.2010.09684.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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