1
|
Singh G, Mittal A, Sinha S, Panwar VK, Bhadoria AS, Mandal AK. Urodynamics in the evaluation of lower urinary tract symptoms in young adult men: A systematic review. Indian J Urol 2023; 39:97-106. [PMID: 37304977 PMCID: PMC10249536 DOI: 10.4103/iju.iju_160_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 09/25/2022] [Accepted: 11/25/2022] [Indexed: 06/13/2023] Open
Abstract
Introduction This review aims to systematically evaluate the available evidence on the different urodynamic diagnoses of lower urinary tract symptoms (LUTS) in young adult men aged 18-50 years and to summarize the various urodynamic parameters based on these diagnoses. Methods This systematic review was conducted according to the Preferred Reporting Items for Systematic Review and Meta-analysis statement and the search was performed in PubMed, Embase, and Cochrane library from inception till September 2021. A total of 295 records were identified using a combination of keywords such as LUTS, urodynamics (UDS), and young males. The review was registered in PROSPERO (CRD42021214045). Results All the ten studies, which were included in this analysis, categorised the patients into either of the four primary diagnoses after the UDS - primary bladder neck obstruction (PBNO), dysfunctional voiding, detrusor underactivity (DU), or detrusor overactivity. Five of these studies used the conventional UDS, and in the other five a video UDS was performed. The most common abnormality on the conventional UDS was DU with a pooled estimate of 0.24 (95% confidence interval [CI] - 0.104-0.463, I2-95.35, (τ2-1.07). The most common abnormality on the video UDS was PBNO with a pooled estimate of 0.49 (95% CI - 0.413-0.580, I2-66.59, 2-0.09). The point estimates of various UDS parameters were also recorded. Conclusion A urodynamic diagnosis was possible in 79% and 98% of the young men who underwent a conventional UDS or a video UDS, respectively. However, the men subjected to the conventional UDS and the video UDS had significant differences in their primary urodynamic diagnostic label. These results will help to plan future trials for the evaluation and management of LUTS in young men.
Collapse
Affiliation(s)
- Gurpremjit Singh
- Department of Urology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Ankur Mittal
- Department of Urology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Sanjay Sinha
- Department of Urology, Apollo Hospital, Hyderabad, India
| | - Vikas Kumar Panwar
- Department of Urology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Ajeet Singh Bhadoria
- Department of Community Medicine and Biostatistics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Arup Kumar Mandal
- Department of Urology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| |
Collapse
|
2
|
Importance of Urodynamic Dysfunctions as Risk Factors for Recurrent Urinary Tract Infections in Patients with Multiple Sclerosis. URO 2023. [DOI: 10.3390/uro3010011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
Abstract
Objective: To analyze the role of urodynamic dysfunctions as risk factors for recurrent urinary tract infections (rUTIs) in patients with multiple sclerosis (MS). Material and methods: We conducted a prospective cohort study of 170 patients with MS who underwent a urodynamic study due to lower urinary tract symptoms. Patients were followed for one year, and 114 (84 women [74%] and 30 men [26%]; mean age 49 years) completed the study. Clinical variables and urodynamic findings (free uroflowmetry, cystometry, and pressure-flow study results) were recorded. Results indicated rUTIs was present in 37 patients (32%). Statistical analysis was performed using Fisher’s exact test, chi-square test, Student’s t-test, and multivariate regression analysis. Results: In univariate analysis, significant differences were observed between patients with and without rUTIs for the following clinical variables: symptom progression time, MS duration, Expanded Disability Status Scale score, and MS type. Regarding urodynamic findings, significant differences were observed in maximum flow rate (Qmax) (lower in patients with rUTIs), voided volume, bladder voiding efficiency, stress urinary incontinence (SUI) (greater rUTI frequency in affected patients), detrusor pressure at maximum flow, and bladder contractility index score. Multivariate analysis identified the urodynamic factors: low Qmax [Odds Ratio (OR) = 0.90 and SUI (OR = 2.95) as the independent predictors of rUTs. Conclusions: Two urodynamic variables: Qmax and SUI, are independent risk factors for rUTIs in MS patients. These two variables might be associated with Pelvic floor dysfunctions.
Collapse
|
3
|
Valdevenito JP. About the definitions in: "Video-urodynamic characteristics of lower urinary tract dysfunctions in patients with chronic brain disorders. Chiang CH, Chen SF, Kuo HC. Neurourol Urodyn. 2021 Oct 4. doi: 10.1002/nau.24806". Neurourol Urodyn 2021; 41:514-515. [PMID: 34750846 DOI: 10.1002/nau.24830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 10/15/2021] [Indexed: 11/08/2022]
|
4
|
Gross O, Leitner L, Rasenack M, Schubert M, Kessler TM. Detrusor sphincter dyssynergia: can a more specific definition distinguish between patients with and without an underlying neurological disorder? Spinal Cord 2021; 59:1026-1033. [PMID: 33963273 PMCID: PMC8397615 DOI: 10.1038/s41393-021-00635-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 04/13/2021] [Accepted: 04/13/2021] [Indexed: 11/16/2022]
Abstract
Study design Cross-sectional study. Objectives To evaluate if specific definitions of detrusor sphincter dyssynergia (DSD) might distinguish between individuals with spinal cord injury (SCI) and those with no underlying neurological disorder (NO ND). Setting Single tertiary university SCI center. Methods A series of 153 individuals, 81 with traumatic SCI and 72 with NO ND, were prospectively evaluated and included in this study. All individuals underwent a clinical neuro-urological examination, a neurophysiological work-up and a video-urodynamic investigation and were diagnosed with DSD as defined by the International Continence Society (ICS). We determined the DSD grades/types according to the classifications by Yalla (grade 1–3), Blaivas (type 1–3) and Weld (type 1–2). Distribution of the DSD grades/types were compared between SCI and NO ND individuals. Associations between the various DSD grades/types and clinical parameters, such as risk factors for upper urinary tract damage (all individuals) or lower extremity motor scores, SCI injury levels and severity scores (only SCI group), were assessed. Results The distribution of all DSD types were similar between groups (p > 0.05). None of the DSD classifications allowed risk assessment for upper urinary tract damage. A significant association between DSD type and other clinical parameters could not be found (p > 0.05). Conclusions None of the investigated DSD definitions can distinguish between patients with SCI and with NO ND. The more complex DSD classifications by Yalla, Blaivas or Weld cannot compete with the ICS binary yes-no definition which is pragmatic and straightforward for managing patients in daily clinical practice. Sponsorship None.
Collapse
Affiliation(s)
- Oliver Gross
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Lorenz Leitner
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Maria Rasenack
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Martin Schubert
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Thomas M Kessler
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland.
| |
Collapse
|
5
|
Samijn B, Van Laecke E, Vande Walle J, Pascal A, Deschepper E, Renson C, Van den Broeck C. Uroflow measurement combined with electromyography testing of the pelvic floor in healthy children. Neurourol Urodyn 2018; 38:231-238. [PMID: 30311676 DOI: 10.1002/nau.23836] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 08/23/2018] [Indexed: 11/11/2022]
Abstract
AIMS To investigate if the standard protocol for uroflowmetry, recommended by the International Children's Continence Society, remains accurate when integrating EMG measurement by means of superficial electrodes. METHODS A cross-sectional study was conducted including healthy children. Group A performed two direct repetitions of uroflowmetry in combination with electromyography (uroflow/EMG). Group B performed a preceding measurement of isolated uroflowmetry, followed by two randomized measurements of uroflowmetry with and without EMG. Interpretation of uroflow curve was assessor blinded by a pediatric urologist and secondly performed using the flow index methodology. Statistical analysis compared different voids within each group and between group A and B. RESULTS Eighty-three children were included and 206 uroflow measurements were obtained. In both groups statistical findings confirmed the hypothesis that it is preferable to perform an additional measurement before the use of uroflow/EMG. Although both groups showed improvement between voids, the group with initial uroflow measurement followed by uroflow/EMG measurement showed more improvement in concern of curve pattern. An initially better first void in group A, but no statistical difference between the second void in group A and uroflow/EMG testing in group B further demonstrates a higher improvement in group B. This suggests the use of a precedent uroflowmetry without EMG is preferable to immediate testing with EMG. CONCLUSIONS It should be mandatory to perform one measurement in advance to ensure the reliability of the results. It is suggested to initiate the procedure with a single uroflowmetry measurement followed by one measurement of uroflow with EMG testing.
Collapse
Affiliation(s)
- Bieke Samijn
- Department of Uro-gynaecology, Ghent University, Ghent, Belgium.,Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium.,Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Erik Van Laecke
- Department of Uro-gynaecology, Ghent University, Ghent, Belgium.,Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Johan Vande Walle
- Department of Pediatric Nephrology and Rheumatology, Ghent University Hospital, Ghent, Belgium
| | - Aurelie Pascal
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | | | - Catherine Renson
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | | |
Collapse
|
6
|
Krhut J, Zachoval R, Rosier PFWM, Shelly B, Zvara P. ICS Educational Module: Electromyography in the assessment and therapy of lower urinary tract dysfunction in adults. Neurourol Urodyn 2017; 37:27-32. [PMID: 28419532 DOI: 10.1002/nau.23278] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 03/10/2017] [Indexed: 12/15/2022]
Abstract
AIM To present the teaching module "Electromyography in the assessment and therapy of lower urinary tract dysfunction in adults." This teaching module embodies a presentation, in combination with this manuscript. This manuscript serves as a scientific background review; the evidence base made available on ICS website to summarize current knowledge and recommendations. METHODS This review has been prepared by a Working Group of The ICS Urodynamics Committee. The methodology used included comprehensive literature review, consensus formation by the members of the Working Group, and review by members of the ICS Urodynamics Committee core panel. RESULTS Electromyography (EMG) is a method to record spontaneous or artificially induced electrical activity of the nerve-muscle unit or to test nerve conductivity. EMG of the anal sphincter using surface electrode is most widely used screening technique to detect detrusor-sphincter dyssynergia in urology. It is non-invasive and easy to perform. EMG methods using needle electrodes are reserved for diagnostics in well selected group of mainly neurogenic patients. These methods require expertise in the field of general EMG and are usually performed by neurologist and neuro-physiologist. The evidence in many aspects of use of EMG in urology remains sparse. CONCLUSIONS Currently EMG methods rarely play a decision making role in selecting proper treatment of lower urinary tract dysfunction. With the current efforts to improve phenotyping of these patients in order to provide individualized treatment, the role of EMG could increase.
Collapse
Affiliation(s)
- Jan Krhut
- Department of Urology, Ostrava University, University Hospital, Ostrava, Czech Republic
| | - Roman Zachoval
- Department of Urology, Thomayer Hospital and 1st and 3rd Faculty of Medicine of Charles University, Prague, Czech Republic
| | - Peter F W M Rosier
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Beth Shelly
- Beth Shelly Physical Therapy, Moline, Illinois
| | - Peter Zvara
- Department of Urology and Biomedical Laboratory, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
7
|
Leitner L, Walter M, Sammer U, Knüpfer SC, Mehnert U, Kessler TM. Urodynamic Investigation: A Valid Tool to Define Normal Lower Urinary Tract Function? PLoS One 2016; 11:e0163847. [PMID: 27736908 PMCID: PMC5063299 DOI: 10.1371/journal.pone.0163847] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 08/18/2016] [Indexed: 01/22/2023] Open
Abstract
Objectives To evaluate whether urodynamic investigation (UDI), the gold standard to assess refractory lower urinary tract symptoms (LUTS), is appropriate to select healthy volunteers with apparent normal lower urinary tract function as control subjects for comparative studies. Subjects and Methods 42 healthy subjects (22 women, mean age 32±10 years; 20 men, mean age 37±12 years) without LUTS were included into this prospective single-centre cohort study. All subjects recorded a 3-day bladder diary, completed validated questionnaires regarding LUTS, and underwent neuro-urological assessment as well as free uroflowmetry. Same session repeat UDI was performed according to “Good Urodynamic Practice” recommended by the International Continence Society, but using an air-charged instead of a water-filled catheter, and evaluated by a blinded investigator. Results All 3-day bladder diaries, LUTS questionnaires, neuro-urological assessments and free uroflowmetries were within normal limits. Overall (either during the first or second UDI), same session repeat UDI revealed pathological findings in 71% (30/42): Detrusor overactivity was detected in 14% (3/22) and 30% (6/20), post void residual >100mL in 14% (3/22) and 25% (5/20), bladder outlet obstruction in 9% (2/22) and 20% (4/20) and detrusor sphincter dyssynergia in 77% (17/22) and 65% (13/20) of our women and men, respectively. Repeatability of detrusor overactivity (κ = 0.78, 95% CI: 0.54–1.02) and detrusor sphincter dyssynergia (κ = 0.77, 95% CI: 0.55–0.98) showed substantial agreement between both UDIs. All other assessed urodynamic parameters had wide 95% limits of agreement for differences in the parameters indicating poor repeatability. Conclusions More than 70% of our healthy subjects showed pathological urodynamic findings. Although UDI is the gold standard to assess refractory LUTS, it seems not to be applicable in healthy subjects to define normal lower urinary tract function. Therefore, we do not recommend using UDI to select healthy control subjects.
Collapse
Affiliation(s)
- Lorenz Leitner
- Neuro-Urology, Spinal Cord Injury Center & Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland
- Department of Urology, University Hospital Basel, Basel, Switzerland
| | - Matthias Walter
- Neuro-Urology, Spinal Cord Injury Center & Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland
| | - Ulla Sammer
- Neuro-Urology, Spinal Cord Injury Center & Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland
| | - Stephanie C. Knüpfer
- Neuro-Urology, Spinal Cord Injury Center & Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland
| | - Ulrich Mehnert
- Neuro-Urology, Spinal Cord Injury Center & Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland
| | - Thomas M. Kessler
- Neuro-Urology, Spinal Cord Injury Center & Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland
- * E-mail:
| |
Collapse
|
8
|
Brucker BM, Fong E, Shah S, Kelly C, Rosenblum N, Nitti VW. Urodynamic differences between dysfunctional voiding and primary bladder neck obstruction in women. Urology 2012; 80:55-60. [PMID: 22748864 DOI: 10.1016/j.urology.2012.04.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Revised: 04/06/2012] [Accepted: 04/09/2012] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine the clinical and urodynamic differences in the presentation and the value of simultaneous fluoroscopy in dysfunctional voiding (DV) and primary bladder neck obstruction (PBNO); the 2 most common causes of non-neurogenic "functional" bladder outlet obstruction in women. METHODS A review of our urodynamic study database (March 2003 to August 2009) was conducted. DV was diagnosed when increased external sphincter activity was found during voluntary voiding on electromyography (EMG) or fluoroscopy. PBNO was diagnosed when a failure of bladder neck opening was noted on fluoroscopy during voiding. The demographics, symptoms, and urodynamic study parameters were collected. Comparisons were done using chi-square and 2-tailed t-tests. RESULTS DV was diagnosed in 34 women and PBNO in 16. The patients with DV were younger than those with PBNO (40.9 vs 59.2 years, P < .001). Women with DV showed a clinical trend toward having more storage symptoms than those with PBNO and fewer voiding symptoms. Patients with DV had a greater mean maximal flow rate (12 vs 7 mL/s, P = .027) and lower mean postvoid residual urine volume (125 vs 400 mL, P = .012). No significant differences were found in maximal detrusor pressure, detrusor pressure at maximal flow rate, or detrusor overactivity. EMG showed increased activity during voiding in 79.4% of those with DV and 14.3% of those with PBNO (P < .001). CONCLUSION Clinically, women with DV and PBNO had similar presentations, although those with PBNO had poorer emptying. The flow rates and patterns seemed to differ between those with DV and PBNO, although the voiding pressures were similar. EMG alone would have given the wrong diagnosis in 20.6% of those with DV (false negative) and 14.3% of those with PBNO (false positive). When fluoroscopy is used to define these entities, the accuracy of EMG to differentiate them is questionable.
Collapse
Affiliation(s)
- Benjamin M Brucker
- Department of Urology, New York University Langone Medical Center, New York, New York 10016, USA.
| | | | | | | | | | | |
Collapse
|
9
|
Chai TC, Kraus SR. Evaluation of Stress Predominant Urinary Incontinence. CURRENT BLADDER DYSFUNCTION REPORTS 2012. [DOI: 10.1007/s11884-012-0140-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
10
|
Brucker BM, Nitti VW. Evaluation of Urinary Retention in Women: Pelvic Floor Dysfunction or Primary Bladder Neck Obstruction. CURRENT BLADDER DYSFUNCTION REPORTS 2012. [DOI: 10.1007/s11884-012-0146-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
|