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Liapis I, Gammie A, Mohamed-Ahmed R, Yates D, Selai C, Cotterill N, Rantell A, Toozs-Hobson P. Can we increase the value of data from bladder diaries? International Consultation on Incontinence-Research Society 2023. Neurourol Urodyn 2024; 43:1311-1320. [PMID: 38149784 DOI: 10.1002/nau.25374] [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: 12/09/2023] [Accepted: 12/13/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND Bladder diaries represent a fundamental component in the assessment of patients presenting with lower urinary tract symptoms. Nevertheless, their importance often remains underappreciated and undervalued within clinical practice. This paper aims to conduct a comprehensive review of the existing literature concerning the utility of bladder diaries, underscore the criticality of their precision, elucidate the factors contributing to noncompliance with bladder diary completion, and investigate potential strategies for enhancing patient compliance. MATERIALS AND METHODS A review of the English-language scientific literature available in the domains of Medline, Embase, Emcare, Midirs, and Cinahl was conducted. This was supplemented by discussion at the International Consultation on Incontinence Research Society Proposal session to define knowledge and identify gaps in knowledge surrounding the utility of bladder diaries. The existing evidence and outcome of the relevant discussion held in the meeting are presented. RESULTS Bladder diaries (BD) serve to characterize the nature and severity of storage lower urinary tract symptoms (LUTS) and provide an objective record of an individual's urination patterns. They aid in the refinement and customization of treatment strategies based on the clinical responses documented in the diary, optimizing treatment outcomes. Notably, both BD and urodynamic studies (UDS) play complementary yet distinct roles in LUTS evaluation. BD offers a more comprehensive and accessible approach to assessing specific storage LUTS, particularly due to their affordability and widespread availability, especially in resource-limited settings. Nevertheless, the absence of a standardized BD format across global healthcare systems presents a significant challenge. Despite being recognized as reliable, noninvasive, validated, and cost-effective tools for evaluating patients with LUTS, the implementation and completion of BD have proven to be complex. The introduction of automated bladder diaries heralds an era of precise, real-time data collection, potentially enhancing the patient-clinician relationship. Completion of bladder diaries depends on an array of individual, social, and healthcare-specific factors. Compliance with bladder diary completion could be enhanced with clear instructions, patient education, regular follow-ups and positive re-enforcement. This study has identified four critical areas for future research: Addressing healthcare disparities between affluent and developing nations, enhancing the current functionality and effectiveness of bladder diaries, exploring the feasibility of incorporating bladder diaries into the treatment and education process and improving the quality and functionality of existing bladder diaries. CONCLUSION Bladder diaries play a pivotal role in the evaluation and management of patients with LUTS, providing a holistic perspective. When their complete potential is harnessed, they have the capacity to revolutionize the paradigm of LUTS management, ushering in a patient-centered era of care.
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Affiliation(s)
- Ilias Liapis
- Department of Urogynaecology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Andrew Gammie
- Bristol Urological Institute, Southmead Hospital, University of Bristol, Bristol, UK
| | | | - Derick Yates
- Library and Knowledge Service, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Caroline Selai
- Institute of Neurology, University College London, London, UK
| | - Nicky Cotterill
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Angela Rantell
- Department of Urogynaecology, King's College Hospital, London, UK
| | - Philip Toozs-Hobson
- Department of Urogynaecology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
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Baunacke M, Kontschak L, Menzel V, Grabbert M, Borkowetz A, Mehralivand S, Eisenmenger N, Huber J, Thomas C, Schultz-Lampel D. Declining utilization of urodynamic studies in urological care in Germany: time to say goodbye? World J Urol 2024; 42:440. [PMID: 39046605 PMCID: PMC11269447 DOI: 10.1007/s00345-024-05154-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 06/27/2024] [Indexed: 07/25/2024] Open
Abstract
INTRODUCTION The number of urodynamic studies (UDS) has been declining steadily in recent decades, yet the reasons behind this trend remain poorly understood. This study aims to investigate the structural aspects of UDS in urology and explore the factors contributing to this decline. MATERIAL & METHODS We surveyed all urological departments performing UDS as well as a representative sample of private practices in Germany in 2023. We examined structural situation, waiting times, capacities and limitations of UDS. All invasive urodynamic examinations were defined as UDS. RESULTS In 2019, 259/474 (55%) urological departments in Germany performed UDS. 206/259 (80%) urological departments responded to the survey. 163/200 (82%) urological departments stated that their capacities were exhausted, a main reason being lack of medical and nursing staff. 54.8% urological departments performed more than 50% of their UDS for referring physicians. Urological departments with a low number of UDS/year (≤ 100) showed a shorter waiting time (up to 4 weeks: 49% vs. 30%; p = 0.01), reduced UDS capacities (55% vs. 12%; p < 0.001) and these capacities were often not fully utilized (25% vs. 9%; p = 0.007). 122/280 (44%) office urologists responded to the survey. 18/122 (15%) office urologists performed UDS. Main reasons for not offering UDS were lack of personnel and low reimbursement. CONCLUSION In German urological departments, UDS capacities are consistently fully utilized, primarily due to staffing shortages. This trend towards centralization prompts questions about the role of UDS in urologists' training.
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Affiliation(s)
- Martin Baunacke
- Department of Urology, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
| | - Livia Kontschak
- Department of Urology, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Viktoria Menzel
- Department of Urology, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Markus Grabbert
- Department of Urology, University of Freiburg, 79106, Freiburg, Germany
| | - Angelika Borkowetz
- Department of Urology, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Sherif Mehralivand
- Department of Urology, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | | | - Johannes Huber
- Department of Urology, Philipps-University Marburg, 35043, Marburg, Germany
| | - Christian Thomas
- Department of Urology, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Daniela Schultz-Lampel
- Southwest Continence Center, Schwarzwald-Baar-Klinikum, 78052, Villingen-Schwenningen, Germany
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Gammie A, Wachter SD. Research priorities for diagnostic instrumentation in urinary incontinence. Proc Inst Mech Eng H 2024; 238:682-687. [PMID: 37667889 DOI: 10.1177/09544119231193884] [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] [Indexed: 09/06/2023]
Abstract
The International Consultation on Incontinence (ICI) captures current evidence on incontinence. The conference 'Incontinence: The Engineering Challenge XIII' in November 2021 heard an update on the most recent ICI summary on urodynamic testing. This paper summarises the ICI recommendations for future research in urodynamics, with a view to informing engineers of issues and challenges that could benefit from engineering solutions. Engineers are encouraged to contribute to the following areas of research, which will have a direct and positive effect on patients' quality of life and overall health: (a) Urine flow measurement: home- and app-based devices, machine learning analysis of flow shape, (b) Pressure measurement: normal values for and validation of new technologies, including air-filled, non-invasive and urethral pressure reflectometry, (c) Ultrasound imaging: bladder wall biomechanics, bladder shape analysis, (d) Assess normal and abnormal value ranges, and diagnostic performance and (e) Specific trials in understudied patient groups including those with symptoms resistant to treatment, children and the frail elderly.
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Zeng X, Liu MZ, Shen SH, Yang SQ, Zhang J, Shen H, Luo DY, Jin T. The design and evaluation of a quick checklist for urodynamic quality control: A prospective single-center small sample study. Neurourol Urodyn 2024; 43:382-389. [PMID: 38078752 DOI: 10.1002/nau.25357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 10/23/2023] [Accepted: 11/29/2023] [Indexed: 02/06/2024]
Abstract
PURPOSE To design a quick checklist for urodynamic study (UDS), aiming to reduce the occurrence of errors in the process, which may help to increase the quality of UDS. And further to analyze the effectiveness of this quick checklist for UDS quality control. METHODS First, a quick checklist for uroflow study and pressure-flow study was developed, based on the International Continence Society-Good Urodynamic Practice standards, our previous studies, and recent literature, as well as expert suggestions. Then, patients who underwent UDS between January 2023 to February 2023 were randomly assigned to a study group or a control group. For the study group, the quick checklist was used throughout the UDS process, while the control group did not. The main artefacts were chosen to verify the effectiveness of the quick checklist for improving the UDS quality. RESULTS The quick checklist comprised three subtypes: checklist for patients, checklist for environment and device, and checklist for UDS test process. 38 UDS traces per group were included. The incidence of missing the standard cough test decreased significantly from 18.4% to 0 (p = 0.012), with the checklist implementation. The baseline drift frequency rate also declined significantly from 39.5% to 5.3% (p < 0.05). Volume < 150 mL on uroflow study occurred in 68.4% of cases and its frequency rate decreased significantly with checklist implementation (p < 0.05). CONCLUSION A quick checklist for quality control of UDS was developed. The quick checklist as a convenient, quick, and easy used urodynamic quality control method, may help to reduce the technical artefacts and improve fundamental urodynamic quality control. Future research with a larger sample size is needed to confirm the effectiveness of the checklist.
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Affiliation(s)
- Xiao Zeng
- Laboratory of Reconstructive Urology, Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
- Pelvic Floor Diseases Center, West China Tianfu Hospital, Sichuan University, Chengdu, China
| | - Meng-Zhu Liu
- Laboratory of Reconstructive Urology, Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Si-Hong Shen
- Laboratory of Reconstructive Urology, Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Shi-Qin Yang
- Laboratory of Reconstructive Urology, Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Jie Zhang
- Laboratory of Reconstructive Urology, Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
- Pelvic Floor Diseases Center, West China Tianfu Hospital, Sichuan University, Chengdu, China
| | - Hong Shen
- Laboratory of Reconstructive Urology, Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
- Pelvic Floor Diseases Center, West China Tianfu Hospital, Sichuan University, Chengdu, China
| | - De-Yi Luo
- Laboratory of Reconstructive Urology, Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
- Pelvic Floor Diseases Center, West China Tianfu Hospital, Sichuan University, Chengdu, China
| | - Tao Jin
- Laboratory of Reconstructive Urology, Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
- Pelvic Floor Diseases Center, West China Tianfu Hospital, Sichuan University, Chengdu, China
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Sharifiaghdas F, Narouie B, Mirzakhanlouei A, Ahmadzade M, Rouientan H, Dadpour M. Evaluation of the results of urodynamic studies in patients with vesicoureteral reflux. Urologia 2024; 91:183-188. [PMID: 37750396 DOI: 10.1177/03915603231198556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
BACKGROUND To investigate urodynamic abnormalities associated with vesicoureteral reflux (VUR) in toilet-trained children. METHODS The data of 157 children who were diagnosed with vesicoureteral reflux and referred to our hospital between 2013 and 2022 were retrospectively examined. The urodynamic parameters were analyzed and correlated with age, gender, lower urinary tract symptoms (LUTS), reflux severity, and laterality. RESULTS Overall, 131 (83.4%) patients had abnormal urodynamic findings with a male-to-female ratio of 1:1.4. The most common pathological finding was detrusor overactivity (DO), identified in 101 (64.3%) patients, followed by dysfunctional voiding (DV) in 74 (50.3%) patients. Children with VUR grades II and III exhibited a greater percentage of abnormal urodynamic findings than children with grades IV and V. The prevalence of DO was higher in children younger than 10 years old with unilateral and lower-grade VURs. DV was more frequent in children older than 10 years, with bilateral VUR, and higher grade VUR. The prevalence of LUTS, bowel and bladder dysfunction (BBD), and urinary tract infection (UTI) was higher among children with abnormal urodynamic findings. CONCLUSIONS Children with VUR have a high incidence of urodynamic disorders. Urodynamic dysfunction may contribute to the pathogenesis of VUR, especially in mild cases.
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Affiliation(s)
- Farzaneh Sharifiaghdas
- Urology and Nephrology Research Center, Department of Urology, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Behzad Narouie
- Department of Urology, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Ali Mirzakhanlouei
- Urology and Nephrology Research Center, Department of Urology, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohadese Ahmadzade
- Urology and Nephrology Research Center, Department of Urology, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamidreza Rouientan
- Urology and Nephrology Research Center, Department of Urology, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Dadpour
- Urology and Nephrology Research Center, Department of Urology, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Jung G, Ryu H, Lee JW, Jeong SJ, Margolis E, Grover N, Lee S. Validation of an algorithm for sound-based voided volume estimation. Sci Rep 2024; 14:138. [PMID: 38168131 PMCID: PMC10761909 DOI: 10.1038/s41598-023-50499-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 12/20/2023] [Indexed: 01/05/2024] Open
Abstract
A voiding diary is commonly used in clinical practice to monitor urinary tract health. However, manual recording and use of a measuring cup can cause significant inaccuracy and inconvenience. Recently sound-based voided volume estimation algorithms such as proudP have shown potential to accurately measure the voided volumes of patients urination while overcoming these inconveniences. In order to validate the sound-based voided volume estimation algorithm, we chose bodyweight change after urination as a reference value. Total 508 subjects from the United States and Korea were enrolled. 584 data points that have matching bodyweights change data and urination sound data were collected, and fivefold cross validation was performed in order to evaluate the model on all data in the dataset. The mean voided volume estimated by the algorithm was 202.6 mL (SD: ± 114.8) while the mean bodyweight change after urination was 208.0 g (SD: ± 121.5), and there was a strong linear correlation with high statistical significance (Pearson's correlation coefficient = 0.92, p-value < 0.001). Two paired t-test showed the equivalence with bodyweight change data with 10 mL margin. Additionally, a Bland-Altman plot shows a mean difference of - 5.5 mL with LoA (- 98.0, 87.1). The results support high performance of the algorithm across the large population data from multi-site clinical trials.
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Grants
- 1711138269 Korea Medical Device Development Fund grant funded by the Korea government (the Ministry of Science and ICT, the Ministry of Trade, Industry and Energy, the Ministry of Health and Welfare, the Ministry of Food and Drug Safety)
- RS-2020-KD000141 Korea Medical Device Development Fund grant funded by the Korea government (the Ministry of Science and ICT, the Ministry of Trade, Industry and Energy, the Ministry of Health and Welfare, the Ministry of Food and Drug Safety)
- NTIS, RS-2020-KD000141 Korea Medical Device Development Fund grant funded by the Korea government (the Ministry of Science and ICT, the Ministry of Trade, Industry and Energy, the Ministry of Health and Welfare, the Ministry of Food and Drug Safety)
- No. NRF-2020R1F1A1072702 National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT)
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Affiliation(s)
- Gyoohwan Jung
- Department of Urology, Hanyang University College of Medicine, 222, Wangsimni-ro, Seongdong-gu, Seoul, Korea
| | - Hoyoung Ryu
- Department of Urology, Ewha Womans University College of Medicine, 52, Ewhayeodae-gil, Seodaemun-gu, Seoul, Korea
| | - Jeong Woo Lee
- Department of Urology, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, 7-13, Kyungheedae-ro 6-gil, Dongdaemun-gu, Seoul, Korea
| | - Seong Jin Jeong
- Department of Urology, Seoul National University Bundang Hospital, 173-82, Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, Korea, 13620
- Department of Urology, Seoul National University College of Medicine, 103 Daehakro, Seoul, 03080, Korea
| | - Eric Margolis
- Hackensack Meridian School of Medicine, 340, Kingland St., Nutley, NJ, 07110, USA
| | | | - Sangchul Lee
- Department of Urology, Seoul National University Bundang Hospital, 173-82, Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, Korea, 13620.
- Department of Urology, Seoul National University College of Medicine, 103 Daehakro, Seoul, 03080, Korea.
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Rosier PFWM, Valdevenito JP, Smith P, Sinha S, Speich J, Gammie A. ICS-SUFU standard: Theory, terms, and recommendations for pressure-flow studies performance, analysis, and reporting. Part 1: Background theory and practice. Neurourol Urodyn 2023; 42:1590-1602. [PMID: 37096828 DOI: 10.1002/nau.25192] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 04/04/2023] [Indexed: 04/26/2023]
Abstract
AIMS The working group (WG) initiated by the International Continence Society Standardization Steering Committee and supported by the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction has revised the (1997) ICS Standard for pressure flow studies. METHODS Based on the ICS standard for developing evidence-based standards, the WG developed this new ICS standard in the period from May 2020 to December 2022. A draft was posted on the ICS website in January 2023 to facilitate public discussion and the comments received have been incorporated into this final release. RESULTS The WG summarizes the theory and recommends the practice and the terms used for the diagnosis of voiding dysfunction for adult female and male patients without relevant neurological abnormalities, in part 1 of this standard. The WG has also recommended standard principles and parameters for objective and continuous grading of urethral resistance and detrusor voiding contraction on the basis of pressure flow studies in part 2. The recommendations for practice in this part have also the aim to increase the understanding of the physiology as well as the psychology of voiding. The potential effects of the laboratory situation of the test on the voiding as well as the role of the urodynamicist in this regard are discussed. The WG has recommended to use for diagnosis only the voidings that are considered representative by the patient. CONCLUSION A pressure flow study is the gold standard to assess voiding function and to quantify dysfunction. This part of the standard explains the clinical background, gives recommendations for the execution of a pressure flow study and lists relevant terms, parameters, and units of measurements.
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Affiliation(s)
- Peter F W M Rosier
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Juan P Valdevenito
- Department of Urology, Hospital Clinico Universidad de Chile, Santiago, Chile
| | - Phillip Smith
- Department of Surgery, UConn Health School of Medicine, Farmington, Connecticut, USA
| | - Sanjay Sinha
- Department of Urology, Apollo Hospital, Hyderabad, India
| | - John Speich
- Department of Mechanical and Nuclear Engineering, Virginia Commonwealth University, Richmond, Virginia, USA
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Chiang CH, Jiang YH, Kuo HC. Efficacy of single and repeated transurethral bladder neck incisions for female voiding dysfunction. World J Urol 2023; 41:2809-2815. [PMID: 37688637 DOI: 10.1007/s00345-023-04581-y] [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: 07/04/2023] [Accepted: 08/11/2023] [Indexed: 09/11/2023] Open
Abstract
OBJECTIVE This study aimed to assess the efficacy of single and repeat transurethral bladder neck incision (TUI-BN) for female voiding dysfunction caused by bladder outlet obstruction (BNO). Further, the predictive factors associated with better treatment outcomes were identified. METHODS Women with voiding difficulty due to BNO who underwent TUI-BN were included in this research. All patients underwent videourodynamics study at baseline and after TUI-BN. Successful outcome was defined as a voiding efficiency of ≥ 66.7% and a global response assessment score of ≥ 2 after treatment. Repeat TUI-BN was considered for patients with insufficient improvement. The outcomes of repeat surgery, surgical complications, and predictive factors of successful outcomes were evaluated. RESULTS In total 158 cases, the success rates were 61.4% and 45.2% after the first and second TUI-BN, respectively, with an overall cumulative rate of 70.3%. The success rates were comparable between patients with detrusor underactivity (DU) and those without (54.9% vs. 68.4%). The absence of a previous history of suburethral sling and a high baseline corrected maximum flow rate were a significant predictor of favorable outcomes. The cumulative rate of regaining self-voiding function was 95.1%. The incidence rates of vesico-vaginal fistula and de novo stress urinary incontinence requiring surgery were 1.2% and 2.5%, respectively. CONCLUSIONS Regardless of the presence of DU, TUI-BN is effective against female voiding dysfunction caused by BNO. Repeat procedures are beneficial and can improve self-voiding function. A high corrected maximum flow rate and the absence of a previous history of suburethral sling can contribute to greater success rates.
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Affiliation(s)
- Ching-Hsiang Chiang
- Department of Urology, Mennonite Christian Hospital, 44, Minquan Road, Hualien, Taiwan
| | - Yuan-Hong Jiang
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, 707, Section 3, Chung Yang Road, Hualien, Taiwan
| | - Hann-Chorng Kuo
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, 707, Section 3, Chung Yang Road, Hualien, Taiwan.
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Perrin A, Corcos J. The Utility of Urodynamic Studies in Neuro-Urological Patients. Biomedicines 2023; 11:biomedicines11041134. [PMID: 37189752 DOI: 10.3390/biomedicines11041134] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/01/2023] [Accepted: 04/03/2023] [Indexed: 05/17/2023] Open
Abstract
INTRODUCTION The utility of a clinical tool lies in its clinical performance evaluation and describes the relevance and usefulness of that tool in a medical setting. The utility of urodynamic and video-urodynamic studies in the management of specific urodynamic profiles in the diagnosis, treatment, and prognostic approach in neuro-urological patients is the focus of the current review. METHODS For this narrative review, a PubMed® search was performed by cross-referencing the keywords "urodynamics", "neurogenic bladder", "utility", "clinical utility" and "clinical performance" with various terms related to the management of neurogenic lower urinary tract dysfunction. Clinical practice guidelines and landmark reviews from the most renowned experts in the field were also used. ANALYSIS Assessment of the utility of urodynamic study was performed during the diagnostic, therapeutic and prognostic steps of the neuro-urological patients' management. We focused on its clinical performance in the identification and evaluation of several unfavorable events, such as neurogenic detrusor overactivity, detrusor-sphincter dyssynergia, elevated detrusor leak point pressure and the presence of vesico-ureteral reflux, which may be indicators for a higher risk for the development of urological comorbidities. CONCLUSION Despite the paucity of existing literature assessing the utility of urodynamic study-specifically video-urodynamic study-in neuro-urological patients, it does remain the gold standard to assess lower urinary tract function precisely in this patient category. With regard to its utility, it is associated with high clinical performance at every step of management. The feedback on possible unfavorable events allows for prognostic assessment and may lead us to question current recommendations.
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Affiliation(s)
- Andry Perrin
- Department of Urology, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada
| | - Jacques Corcos
- Department of Urology, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada
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10
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Transurethral Incision of the Bladder Neck with or without Additional Procedure Resumes Spontaneous Voiding in Female Voiding Dysfunction-A Long-Term Retrospective Follow-Up. J Clin Med 2023; 12:jcm12041514. [PMID: 36836048 PMCID: PMC9964962 DOI: 10.3390/jcm12041514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 02/10/2023] [Accepted: 02/13/2023] [Indexed: 02/17/2023] Open
Abstract
AIM This study evaluated the long-term effectiveness of transurethral incision of the bladder neck (TUI-BN) with or without an additional procedure for female voiding dysfunction. METHODS Women with voiding difficulty who underwent TUI-BN in the last 12 years were included. All patients underwent a videourodynamics study (VUDS) at baseline and after TUI-BN. A successful outcome was defined as having a voiding efficiency (VE) increase by ≥50% after treatment. Patients with insufficient improvement were chosen for repeated TUI-BN, urethral onabotulinumtoxinA injection, or transurethral external sphincter incision (TUI-ES). The current voiding status, surgical complications, and additional surgeries were evaluated. RESULTS A total of 102 women with VUDS evidence of a narrow bladder neck during voiding were enrolled. The long-term success rate of the first TUI-BN was 29.4% (30/102) and increased to 66.7% (34/51) after combining TUI-BN and an additional procedure. The overall long-term success rates were 74.6% in women with detrusor underactivity (DU), 52.0% in detrusor overactivity and low contractility, 50.0% in bladder neck obstruction, 20.0% in hypersensitive bladder, and 75% in stable bladder (p = 0.022). Patients with a lower maximum flow rate (Qmax), (p = 0.002), lower voided volume (p < 0.001), lower corrected Qmax (p < 0.001), lower ladder contractility index (p = 0.003), lower voiding efficiency (p < 0.001), but larger post-void residual volume (p < 0.001) had a satisfactory surgical outcome. Spontaneous voiding was achieved in 66 (64.7%) patients, de novo urinary incontinence in 21 (20.6%), and vesicovaginal fistula in 4 (3.9%), all were repaired. CONCLUSIONS TUI-BN alone or in combination with an additional procedure was safe, effective, and durable in patients with DU to resume spontaneous voiding.
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Zeng X, Xia Z, Peng L, Wu J, Li J, Yang J, Chen J, Jiang C, Zhong D, Shen Y, Niu J, Xiao X, Wen L, Shen H, Luo D. Quality of urodynamics: a national cross-sectional study in China. Chin Med J (Engl) 2023; 136:236-238. [PMID: 36952621 PMCID: PMC10106133 DOI: 10.1097/cm9.0000000000002203] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Indexed: 03/25/2023] Open
Affiliation(s)
- Xiao Zeng
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Ziyuan Xia
- Biotechnology Research Center, College of Architecture and Environment, Sichuan University, Chengdu, Sichuan 614001, China
| | - Liao Peng
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Jiapei Wu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Jiayi Li
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| | - Jianhui Yang
- Department of Urology, Yinzhou No. 2 Hospital, Ningbo, Zhejiang 315040, China
| | - Juan Chen
- Department of Urology, Shaanxi Provincial People's Hospital, Xi’an, Shaanxi 710068, China
| | - Changqin Jiang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, China
| | - Dewen Zhong
- Department of Urology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, Fujian 364000, China
| | - Yang Shen
- Department of Obstetrics and Gynecology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu 210009, China
| | - Jumin Niu
- Department of Obstetrics, Shenyang Women's and Children's Hospital, Shenyang, Liaoning 110005, China
| | - Xiao Xiao
- Department of Urology, Chongqing General Hospital, Chongqing 400014, China
| | - Li Wen
- Department of Urology, Central South University Xiangya School of Medicine Affiliated Haikou Hospital, Haikou, Hainan 570208, China
| | - Hong Shen
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Deyi Luo
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
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12
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Choi W, Cha KH, Park H, Huh S, Ko SH, Shin YI, Min JH. Urodynamic Study in Multiple System Atrophy: A Retrospective Observational Study. BRAIN & NEUROREHABILITATION 2023; 16:e7. [PMID: 37033007 PMCID: PMC10079477 DOI: 10.12786/bn.2023.16.e7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/15/2023] [Accepted: 03/17/2023] [Indexed: 04/05/2023] Open
Abstract
This retrospective study aimed to evaluate the characteristics of neurogenic bladder in patients with multiple systemic atrophy and distinguish between cerebellar and parkinsonian-type urodynamic patterns. We reviewed 19 patients diagnosed with multiple systemic atrophy with low urinary tract symptoms who underwent an urodynamic study at Pusan National University Yangsan Hospital between March 2010 and February 2022. This study did not account for the differences observed between the multiple system atrophy subtypes in the voiding phase. Urodynamic study is an effective tool to understand the complicated bladder pattern in patients with multiple system atrophy.
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Affiliation(s)
- Woosik Choi
- Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Kyoung-Hyeon Cha
- Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Haeri Park
- Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Sungchul Huh
- Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Sung-Hwa Ko
- Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Yong-Il Shin
- Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Ji Hong Min
- Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
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13
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Zeng X, Shen SH, Shen H, Luo DY. Statistical process control for the analysis of quality control in urodynamics: A potential new approach for quality review of urodynamics. Neurourol Urodyn 2023; 42:289-296. [PMID: 36321794 DOI: 10.1002/nau.25081] [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: 06/04/2022] [Revised: 09/10/2022] [Accepted: 10/19/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE To analyze quality control in urodynamic studies, using a proportion control chart (p-chart) for statistical process control. MATERIALS AND METHODS This single-center study was conducted at the Urodynamic Center of West China Hospital, Sichuan University. We randomly selected 15 samples from each month in 2020, and 180 urodynamic traces were finally enrolled. We used the p-chart of statistical process control for analysis. We calculated the proportion of the incidence of a selected set of artefacts in the monthly urodynamic study process, including non-standard zero setting, no cough test, incomplete records of all measurements by urodynamicists, catheter displacement, and baseline drift. Through the specific calculation formula of statistical process control, we obtained the values of the center line, lower control limit, and upper control limit. RESULTS All data points of each artefact were within zone A. However, one outlier was found in the p-chart of all artefacts in October, which might have been caused by inexperienced operators. CONCLUSIONS Statistical process control may play an important role in the process control of urodynamic studies and guide us in identifying the cause of poor quality in process management.
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Affiliation(s)
- Xiao Zeng
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Si-Hong Shen
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Hong Shen
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - De-Yi Luo
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
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14
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Stritt K, Lucca I, Roth B, Grilo N. Is EDSS Enough to Predict Risk of Upper Urinary Tract Damage in Patients with Multiple Sclerosis? Biomedicines 2022; 10:biomedicines10123001. [PMID: 36551757 PMCID: PMC9775948 DOI: 10.3390/biomedicines10123001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 11/23/2022] Open
Abstract
Lower urinary tract dysfunction is often observed in patients with multiple sclerosis (MS) and may be responsible for an increased risk of upper urinary tract (UUT) damage. Although there are well-known urodynamic risk factors for UUT damage, no clinical prediction parameters are clearly identified. We aimed to confirm the accuracy of the Expanded Disability Status Scale (EDSS) in predicting urodynamic risk factors for UUT deterioration and to assess other clinical parameters potentially predicting urodynamic risk factors. We retrospectively reviewed 201 patients with MS referred for primary neuro-urological work-up, including a video-urodynamic study (VUDS) from August 2009 to February 2020. Multivariate modeling revealed EDSS, male gender, and a number of LUTS as clinical parameters significantly associated with urodynamic risk factors for UUT damage (p = 0.06, p = 0.01, p = 0.02, respectively). A nomogram combining EDSS, male gender, and a number of different LUTS was created to predict the presence of at least one urodynamic risk factor for UUT damage. In conclusion, the presence of high EDSS combined with male gender and several different LUTS is significantly associated with urodynamic risk factors and can be used to stratify MS patients for further neuro-urological assessment and treatment.
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15
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Long Depaquit T, Michel F, Gaillet S, Savoie PH, Karsenty G. [Home uroflowmetry technics and clinical relevance: A narrative review]. Prog Urol 2022; 32:1531-1542. [PMID: 35961806 DOI: 10.1016/j.purol.2022.07.142] [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: 04/19/2022] [Revised: 06/12/2022] [Accepted: 07/10/2022] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Urine flowmetry (UF) is a key non-invasive urodynamic test for the evaluation of the voiding phase in patients with lower urinary tract symptoms (LUTS). Traditional free urodynamic testing (FUT) performed on a one-time basis in the office is limited by difficulty in capturing normal voiding and high intrapatient variability in urine flow parameters. Home measurement of urine flow by the patient could be a way to obtain multiple data in real-life conditions, addressing its limitations. The objective of this article was to review the literature on the different techniques of home uroflowmetry (HUF) and their clinical interest in comparison with FUT. MATERIAL AND METHODS A search on the PubMed database using the key words "Urodynamics, Uroflowmetry, non-invasive urodynamics, Ambulatory urodynamics, bladder outlet obstruction, male LUTS" was performed to find articles in English or French that had been published with no time limit and March 2022. The sorting by reading the abstract allowed the selection of all articles describing and/or evaluating a HUF technique that were read entirely according to the same collection grid to propose a narrative synthesis. RESULTS Thirty-one articles were identified, selected, and analyzed. Simple and inexpensive techniques by timing or use of funnels reliably and reproducibly estimate the average and maximum urine flow in relation to the FUT, without providing a complete flow curve. More sophisticated electronic or sonometric methods, some using connected mobile applications, present results that are more consistent with ICS recommendations for flow measurement. With the possibility of studying the average of several values of the maximum urinary flow (Qmax) captured during micturition in physiological conditions, some studies suggest a gain in diagnostic value in the evaluation of the emptying phase and lower urinary tract symptoms in men. However, the literature is sparse, old and the clinical benefits are not yet proven. CONCLUSION There is a wide range of techniques for measuring urine flow in the patient's home, all of which aim to fill the gaps in conventional urine flow measurement. Further studies are needed to demonstrate the acceptability of this type of measurement by patients, the existence of a real clinical benefit, to assess the cost/benefit balance and finally to define a possible place for home uroflowmetry in daily practice, compared with traditional free flowmetry and invasive urodynamics (pressure-flow test).
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Affiliation(s)
- T Long Depaquit
- Service d'urologie, HIA Sainte-Anne, 2 boulevard Sainte-Anne BP600, 83000 Toulon, France; Service d'urologie et de transplantation rénale, hôpital de La Conception, AP-HM, Marseille, France; Aix-Marseille université, Marseille, France.
| | - F Michel
- Service d'urologie et de transplantation rénale, hôpital de La Conception, AP-HM, Marseille, France; Aix-Marseille université, Marseille, France
| | - S Gaillet
- Service d'urologie et de transplantation rénale, hôpital de La Conception, AP-HM, Marseille, France
| | - P-H Savoie
- Service d'urologie, HIA Sainte-Anne, 2 boulevard Sainte-Anne BP600, 83000 Toulon, France
| | - G Karsenty
- Service d'urologie et de transplantation rénale, hôpital de La Conception, AP-HM, Marseille, France; Aix-Marseille université, Marseille, France
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16
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Swatesutipun V, Tangpaitoon T. The safety cutoff storage pressure for preventing upper urinary tract damage in neurogenic bladder from spinal cord pathology and risk factor analysis. Neurourol Urodyn 2022; 41:991-1001. [PMID: 35320589 DOI: 10.1002/nau.24911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 02/25/2022] [Accepted: 02/27/2022] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Low-compliance bladder or high bladder pressure undoubtedly leads to hydronephrosis and renal impairment. As four decades have elapsed since a previous study found a detrusor leak-point pressure (DLPP) >40 cm H2 O to result in hydronephrosis, we suspected the possibility of hydronephrosis or vesicoureteral reflux occurring at any point below the 40 cm H2 O DLPP reference. Therefore, this study aimed to determine the storage detrusor pressure value and risk factors related to upper urinary tract damage (UUTD). MATERIALS AND METHODS This study retrospectively reviewed the hospital records of 110 patients who visited the Neurogenic Bladder TU Service of Excellence Unit, Thammasat University Hospital, Pathum Thani, Thailand, and were diagnosed with neurogenic bladder between 2016 and 2020. The inclusion criteria were as follows: patients who were diagnosed with neurogenic bladder from spinal cord problems (spinal dysraphism, spinal cord disease [tumor, degenerative, arteriovenous malformation, etc.], or traumatic spinal cord injury) and underwent a complete examination, including urodynamic study and renal ultrasound. The exclusion criteria were as follows: patients who had previous pelvic irradiation, other concomitant neurological disease (stroke, Parkinson's disease, etc.), or other urological diseases (stone, tumor, etc.), and those who had an indwelling suprapubic or urethral catheter. We identified the cutoff point for storage pressure related to UUTD using receiver operating characteristic (ROC) curve analysis to identify the value that produced maximum sensitivity and specificity. To identify risk factors for developing UUTD, we included seven risk factors: intravesical pressure, poor compliance, detrusor overactivity (DO), detrusor sphincter dyssynergia (DSD), level of the spinal cord pathology, male sex, and spontaneous voiding in univariable and multivariable regression analyses. RESULTS Of the 110 patients who met the inclusion criteria, 22 were excluded from the study. Fifty-nine patients had a normal upper urinary tract, and 29 had UUTD. The mean age, sex, voiding pattern, type of spinal cord pathology, and level of spinal cord lesions were not different between the two groups. After performing ROC curve analysis, a cutoff value for daily storage pressure ≥15 cm H2 O provided 79.31% sensitivity and 67.80% specificity (area under the ROC curve: 0.73) for UUTD development. From univariable analysis, low compliance (cutoff values at <12.5 and <20 ml/cm H2 O) and a storage pressure ≥15 cm H2 O was related to UUTD with statistical significance (risk ratio [RR]: 3.16, 2.3, and 3.6, respectively [p < 0.05]). After performing multivariable analysis, a storage pressure ≥15 cm H2 O and both cutoff values for low compliance were related to UUTD with statistical significance (RR: 3.9, 2.4, and 3.2, respectively [p < 0.05]). However, other factors, including male sex, spontaneous voiding, suprasacral lesion, DSD, and DO, were not related to UUTD. CONCLUSION Our results demonstrated that low compliance and a storage pressure ≥15 cm H2 O were significantly associated with UUTD. Various bladder-management strategies have been developed to prevent UUTDs. However, the main concept continues to be the maintenance of a low storage pressure.
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Affiliation(s)
- Valeerat Swatesutipun
- Department of Surgery, Division of Urology, Thammasat University Hospital, Pathum Thani, Thailand
| | - Teerayut Tangpaitoon
- Department of Surgery, Division of Urology, Thammasat University Hospital, Pathum Thani, Thailand
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17
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Wyndaele JJ, Wyndaele M, Rapidi CA, Krassioukov A. What do X-ray images of the bladder during video urodynamics show us in patients with spinal cord injury? Spinal Cord 2022; 60:408-413. [PMID: 35197572 DOI: 10.1038/s41393-022-00771-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 02/06/2022] [Accepted: 02/08/2022] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Retrospective anonymized cohort study. OBJECTIVES To study X-ray images of video urodynamics (VUD) in patients with spinal cord injury (SCI). SETTING Single-center study. METHODS X-ray images during VUD were categorized. Relation with the American Spinal Injury Association Impairment Scale (AIS), time since and level of SCI, cystometric data, method of bladder management, findings of flexible cystoscopy, and renal ultrasound were evaluated. Changes over time were studied. RESULTS In 231 consecutive patients, VUD was done at a mean of 8.5 years after SCI. X3-ray bladder appearance was categorized as normal/standard, tonic, or flaccid. In 19 patients, specific findings were seen: diverticula, cystocele, vesicoureteral reflux. X-ray images differed by maximum cystometric capacity, presence of neurogenic detrusor overactivity, and maximum detrusor pressure during detrusor overactivity, but not by bladder compliance. There was no difference in the categories found in different levels and completeness of SCI. In the 23 patients able to void no pathology was seen on urethral images. Renal ultrasound was normal in >99%. In 86 patients, repeated testing after 72 ± 143 weeks showed changed findings in 30%. Cystoscopy showed significantly more local pathologies. CONCLUSION Complications in the lower urinary tract were seen on imaging only in a limited number of our cohort. As our findings represent a real-life example of the actual yield of VUD in patients with neurogenic bladder due to SCI treated following the international guidelines, further multicentre evaluation is needed to determine when imaging should be used or not.
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18
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Hoey RF, Medina-Aguiñaga D, Khalifa F, Ugiliweneza B, Wang D, Zdunowski S, Fell J, Naglah A, El-Baz AS, Herrity AN, Harkema SJ, Hubscher CH. Thoracolumbar epidural stimulation effects on bladder and bowel function in uninjured and chronic transected anesthetized rats. Sci Rep 2022; 12:2137. [PMID: 35136100 PMCID: PMC8826941 DOI: 10.1038/s41598-022-06011-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 01/18/2022] [Indexed: 11/09/2022] Open
Abstract
Pre-clinical studies have shown that spinal cord epidural stimulation (scES) at the level of pelvic and pudendal nerve inputs/outputs (L5-S1) alters storage and/or emptying functions of both the bladder and bowel. The current mapping experiments were conducted to investigate scES efficacy at the level of hypogastric nerve inputs/outputs (T13-L2) in male and female rats under urethane anesthesia. As found with L5-S1 scES, T13-L2 scES at select frequencies and intensities of stimulation produced an increase in inter-contraction interval (ICI) in non-injured female rats but a short-latency void in chronic T9 transected rats, as well as reduced rectal activity in all groups. However, the detrusor pressure during the lengthened ICI (i.e., urinary hold) remained at a low pressure and was not elevated as seen with L5-S1 scES, an effect that's critical for translation to the clinic as high fill pressures can damage the kidneys. Furthermore, T13-L2 scES was shown to stimulate voiding post-transection by increasing bladder activity while also directly inhibiting the external urethral sphincter, a pattern necessary to overcome detrusor-sphincter dyssynergia. Additionally, select scES parameters at T13-L2 also increased distal colon activity in all groups. Together, the current findings suggest that optimization of scES for bladder and bowel will likely require multiple electrode cohorts at different locations that target circuitries coordinating sympathetic, parasympathetic and somatic outputs.
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Affiliation(s)
- Robert F Hoey
- Department of Anatomical Sciences and Neurobiology, University of Louisville School of Medicine, Louisville, KY, USA.,Physical Medicine and Rehabilitation Department, MetroHealth Rehabilitation Institute of Ohio, Cleveland, OH, USA
| | - Daniel Medina-Aguiñaga
- Department of Anatomical Sciences and Neurobiology, University of Louisville School of Medicine, Louisville, KY, USA
| | - Fahmi Khalifa
- Bioengineering Department, University of Louisville J. B. Speed School of Engineering, Louisville, KY, USA
| | - Beatrice Ugiliweneza
- Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, KY, USA.,Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA.,Department of Health Management and Systems Science, School of Public Health and Information Science, University of Louisville, Louisville, KY, USA
| | - Dengzhi Wang
- Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, KY, USA.,Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA
| | - Sharon Zdunowski
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA
| | - Jason Fell
- Department of Anatomical Sciences and Neurobiology, University of Louisville School of Medicine, Louisville, KY, USA
| | - Ahmed Naglah
- Bioengineering Department, University of Louisville J. B. Speed School of Engineering, Louisville, KY, USA
| | - Ayman S El-Baz
- Bioengineering Department, University of Louisville J. B. Speed School of Engineering, Louisville, KY, USA
| | - April N Herrity
- Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, KY, USA.,Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA
| | - Susan J Harkema
- Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, KY, USA.,Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA
| | - Charles H Hubscher
- Department of Anatomical Sciences and Neurobiology, University of Louisville School of Medicine, Louisville, KY, USA. .,Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA.
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19
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Gammie A, Hashim H, Abrams P. Bristol UTraQ: A proposed system for scoring the technical quality of urodynamic traces. Neurourol Urodyn 2022; 41:672-678. [PMID: 35032349 DOI: 10.1002/nau.24872] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/09/2021] [Accepted: 12/25/2021] [Indexed: 11/08/2022]
Abstract
AIM To develop and test a scoring system for the technical quality of a urodynamic trace METHODS: Rasch analysis was used to select the most discriminating questions relating to good urodynamic practices. The questions were taken from International Continence Society standard documents and tested on 60 traces of varying quality and from different sources. RESULTS Twenty-five questions were selected by this process. These were tested with 10 traces by seven scorers, and with 60 traces by a single scorer. A pass quality score of 75% resulted in good discrimination between good and poor traces. Further editing and clarification resulted in a final score sheet of 23 Yes/No questions. CONCLUSION A proposed scoring system, "Bristol UTraQ," for the technical quality of urodynamic traces has been developed and tested. We suggest a score above 75% indicates acceptable trace technical quality. High technical quality is the essential first step in ensuring that urodynamic studies can answer the urodynamic questions for every patient. Plans for further validation are outlined.
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Affiliation(s)
- Andrew Gammie
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | - Hashim Hashim
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | - Paul Abrams
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
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20
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Rosen DP, Husmann DA, Mynderse LA, Kelly TF, Alizad A, Fatemi M. Detrusor overactivity assessment using ultrasound bladder vibrometry. Physiol Meas 2021; 42:10.1088/1361-6579/ac2c5c. [PMID: 34598174 PMCID: PMC8609921 DOI: 10.1088/1361-6579/ac2c5c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 10/01/2021] [Indexed: 11/12/2022]
Abstract
Objective. Detrusor overactivity (DO) is a urodynamic observation characterized by fluctuations in detrusor pressure (Pdet) of the bladder. Although detecting DO is important for the management of bladder symptoms, the invasive nature of urodynamic studies (UDS) makes it a source of discomfort and morbidity for patients. Ultrasound bladder vibrometry (UBV) could provide a direct and noninvasive means of detecting DO, due to its sensitivity to changes in elasticity and load in the bladder wall. In this study, we investigated the feasibility and applying UBV toward detecting DO.Approach. UBV and urodynamic study (UDS) measurements were collected in 76 neurogenic bladder patients (23 with DO). Timestamped group velocity squared (cg2) data series were collected from UBV measurements. ConcurrentPdetdata series were identically analyzed for comparison and validation. A processing approach is developed to separate transient fluctuations in the data series from the larger trend of the data and a DO index is proposed for characterizing the transient peaks observed in the data.Main Results.Applying the DO index as a classifier for DO produced sensitivities and specificities of 0.70 and 0.75 forcg2data series and 0.70 and 0.83 forPdetdata series respectively.Significance. It was found that DO can be feasibly detected from data series of timestamped UBV measurements. Collectively, these initial results are promising, and further refinement to the UBV measurement process is likely to improve and clarify its capabilities for noninvasive detection of DO.
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Affiliation(s)
- David P. Rosen
- Department of Physiology and Biomedical Engineering, Mayo
Clinic College of Medicine & Science, Rochester, MN, USA
| | - Douglas A. Husmann
- Department of Urology, Mayo Clinic College of Medicine
& Science, Rochester, MN, USA
| | - Lance A. Mynderse
- Department of Urology, Mayo Clinic College of Medicine
& Science, Rochester, MN, USA
| | - Troy F. Kelly
- Department of Physiology and Biomedical Engineering, Mayo
Clinic College of Medicine & Science, Rochester, MN, USA
| | - Azra Alizad
- Department of Physiology and Biomedical Engineering, Mayo
Clinic College of Medicine & Science, Rochester, MN, USA
- Department of Radiology, Mayo Clinic College of Medicine
& Science, Rochester, MN, USA
| | - Mostafa Fatemi
- Department of Physiology and Biomedical Engineering, Mayo
Clinic College of Medicine & Science, Rochester, MN, USA
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21
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El Helou E, Naba J, Youssef K, Mjaess G, Sleilaty G, Helou S. Mobile sonouroflowmetry using voiding sound and volume. Sci Rep 2021; 11:11250. [PMID: 34045577 PMCID: PMC8159949 DOI: 10.1038/s41598-021-90659-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 05/17/2021] [Indexed: 11/17/2022] Open
Abstract
Uroflowmetry (UF) is a common clinic-based non-invasive test to diagnose Lower Urinary Tract Dysfunction (LUTD). Accurate home-based uroflowmetry methods are needed to conveniently conduct repeated uroflowmetries when patients are physiologically ready to urinate. To this end, we propose and evaluate a novel mobile sonouroflowmetry (SUF) method that estimates the urinary flow rate from a sound signal recorded using a mobile phone. By linearly mapping the total sound energy to the total voided volume, the sound energy curve is transformed to a flow rate curve allowing the estimation of the flow rate over time. An evaluation using data from 44 healthy young men showed high similarity between the UF and SUF flow rates with a mixed-effects model correlation coefficient of 0.993 and a mean root mean square error of 2.37 ml/s. Maximum flow rates were estimated with an average absolute error of 2.41 ml/s. Future work on mobile uroflowmetry can use these results as an initial benchmark for flow rate estimation accuracy.
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Affiliation(s)
- Elie El Helou
- Faculty of Medicine, Saint Joseph University, Beirut, Lebanon.
| | - Joy Naba
- Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Karim Youssef
- College of Engineering and Technology, American University of the Middle East, Egaila, Kuwait
| | - Georges Mjaess
- Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | | | - Samar Helou
- Global Center for Medical Engineering and Informatics, Osaka University, Osaka, Japan.
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22
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Lee SM, Gammie A, Abrams P. Assessment of quality in urodynamics: Cough versus valsalva. Neurourol Urodyn 2021; 40:1021-1026. [PMID: 33792955 DOI: 10.1002/nau.24661] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 02/26/2021] [Accepted: 03/08/2021] [Indexed: 11/06/2022]
Abstract
INTRODUCTION To ensure quality, the International Continence Society recommends asking the patient to cough every minute or 50 ml of infused volume. However, on occasions, it was noticed that if cough transmission was poor, Valsalva maneuvers could show pressure transmission was satisfactory. Hence, a study was designed to compare the two methods. METHODS Cough and Valsalva maneuver pressures were compared in 40 patients, 20 consecutive men and 20 consecutive women, undergoing urodynamics at three time points: baseline (20 ml filling), prevoid and postvoid. RESULTS At baseline, the percentage difference between pabd and pves was significantly lower for Valsalva maneuvres compared with coughs for all patients (median 5.1% vs. 10.2%). This association was consistent in male patients, but not for female. At prevoid, this was reversed with coughs providing more consistent pressure spikes than Valsalva maneuvers (median 7.0% vs. 24.1%), for all patients. Postvoid, no difference was noted in either men or women. CONCLUSIONS Quality control during urodynamics is important to ensure diagnostic accuracy. This is the first study to compare two methods of quality control, coughs, and Valsalva maneuvers. Coughs are a useful indicator of pressure transmission quality at all time points throughout urodynamic studies. However, at low volumes, Valsalva maneuvers give a better indication of quality, with lower variability, whereas at cystometric capacity coughs performed better. Therefore, if poor pressure transmission occurs with cough during urodynamics, particularly at low volumes, it is recommended that a Valsalva maneuver is used to further assess whether pressure transmission and thus urodynamic quality is satisfactory.
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Affiliation(s)
- Su-Min Lee
- Bristol Urological Insitute, Southmead Hospital, Bristol, UK
| | - Andrew Gammie
- Bristol Urological Insitute, Southmead Hospital, Bristol, UK
| | - Paul Abrams
- Bristol Urological Insitute, Southmead Hospital, Bristol, UK
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23
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IUGA report on reporting urodynamics in women. Int Urogynecol J 2021; 33:801-807. [PMID: 33694003 DOI: 10.1007/s00192-021-04742-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 12/14/2020] [Indexed: 10/21/2022]
Abstract
INTRODUCTION AND AIM Urodynamics (UDS) is the current gold standard investigation for explaining pathology in lower urinary tract dysfunction. The role of UDS is to answer a urodynamic question based on reproducing the patient's symptoms. Despite the introduction of several standardization documents on terminology and methodology for performing UDS and the standard of equipment required, there remains no standardization on how to report and therefore how to interpret UDS findings. The lack of guidance in this specific area may undermine the value of this extremely important tool in the patient evaluation. The aim of this article is to propose a standardized proforma and checklist for the reporting of UDS studies; the main text discusses the rationale for the proforma. METHODS This document underwent four rounds of review by the working group and external review by Andrew Gammie. Between each round the document was re-circulated for comment and the comments collated and then reviewed for adoption or rejection based on consensus prior to the document going for further external review. The comments of the external review were then collated and again circulated for consideration prior to adoption based on consensus and the paper put out to review by an IUGA committee public consultation prior to being submitted for publication. RESULTS This article sets out the rationale for a standardized proforma for reporting female UDS. CONCLUSION This document gives a standardized approach to reporting of UDS. The importance of this is based on UDS being part of a process and not an isolated event. Standardized reporting, like the WHO checklist, gives a framework to ensure that the test has been ordered appropriately and that the final report refers to the indication rather than merely the observations. As such, a standardized report has a better chance of being interpreted appropriately for the woman's symptoms.
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24
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Herrity AN, Aslan SC, Ugiliweneza B, Mohamed AZ, Hubscher CH, Harkema SJ. Improvements in Bladder Function Following Activity-Based Recovery Training With Epidural Stimulation After Chronic Spinal Cord Injury. Front Syst Neurosci 2021; 14:614691. [PMID: 33469421 PMCID: PMC7813989 DOI: 10.3389/fnsys.2020.614691] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 12/03/2020] [Indexed: 12/27/2022] Open
Abstract
Spinal cord injury (SCI) results in profound neurologic impairment with widespread deficits in sensorimotor and autonomic systems. Voluntary and autonomic control of bladder function is disrupted resulting in possible detrusor overactivity, low compliance, and uncoordinated bladder and external urethral sphincter contractions impairing storage and/or voiding. Conservative treatments managing neurogenic bladder post-injury, such as oral pharmacotherapy and catheterization, are important components of urological surveillance and clinical care. However, as urinary complications continue to impact long-term morbidity in this population, additional therapeutic and rehabilitative approaches are needed that aim to improve function by targeting the recovery of underlying impairments. Several human and animal studies, including our previously published reports, have documented gains in bladder function due to activity-based recovery strategies, such as locomotor training. Furthermore, epidural stimulation of the spinal cord (scES) combined with intense activity-based recovery training has been shown to produce volitional lower extremity movement, standing, as well as improve the regulation of cardiovascular function. In our center, several participants anecdotally reported improvements in bladder function as a result of training with epidural stimulation configured for motor systems. Thus, in this study, the effects of activity-based recovery training in combination with scES were tested on bladder function, resulting in improvements in overall bladder storage parameters relative to a control cohort (no intervention). However, elevated blood pressure elicited during bladder distention, characteristic of autonomic dysreflexia, was not attenuated with training. We then examined, in a separate, large cross-sectional cohort, the interaction between detrusor pressure and blood pressure at maximum capacity, and found that the functional relationship between urinary bladder distention and blood pressure regulation is disrupted. Regardless of one’s bladder emptying method (indwelling suprapubic catheter vs. intermittent catheterization), autonomic instability can play a critical role in the ability to improve bladder storage, with SCI enhancing the vesico-vascular reflex. These results support the role of intersystem stimulation, integrating scES for both bladder and cardiovascular function to further improve bladder storage.
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Affiliation(s)
- April N Herrity
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United States.,Department of Neurological Surgery, University of Louisville, Louisville, KY, United States
| | - Sevda C Aslan
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United States.,Department of Neurological Surgery, University of Louisville, Louisville, KY, United States
| | - Beatrice Ugiliweneza
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United States.,Department of Neurological Surgery, University of Louisville, Louisville, KY, United States
| | - Ahmad Z Mohamed
- Department of Urology, University of Louisville, Louisville, KY, United States
| | - Charles H Hubscher
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United States.,Department of Anatomical Sciences and Neurobiology, University of Louisville, Louisville, KY, United States
| | - Susan J Harkema
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United States.,Department of Neurological Surgery, University of Louisville, Louisville, KY, United States
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25
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Medina‐Aguinaga D, Hoey RF, Munoz A, Altamira‐Camacho M, Quintanar JL, Hubscher CH. Choice of cystometric technique impacts detrusor contractile dynamics in wistar rats. Physiol Rep 2021; 9:e14724. [PMID: 33463913 PMCID: PMC7814486 DOI: 10.14814/phy2.14724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 12/15/2020] [Accepted: 12/22/2020] [Indexed: 11/24/2022] Open
Abstract
The objective of the current animal study was to investigate factors contributing to the different phases of the cystometrogram (CMG) in order to address disparities in research data reported in the current literature. Three experiments in 20 female Wistar rats were designed to investigate (1) the effects of anesthesia on the contractile pattern of the bladder during micturition; (2) the impact of the physical characteristics of the CMG technique upon the accuracy of intra-vesical pressure recordings; and (3) identification of physiological and methodological factors associated with the emptying and rebound phases during CMG. Variables tested included awake versus urethane-anesthetized conditions, use of a single catheter for both filling and intra-vesical pressure (Pves) recording versus a separate two catheter approach, and comparisons between ureter, bladder dome, and urethral catheter placements. Both awake and anesthetized conditions contributed to variations in the shape and magnitude of the CMG pressure curves. In addition, catheter size, acute incision of the bladder dome for catheter placement, use of the same catheter for filling and Pves recordings, as well as the placement and positioning of the tubing, all contributed to alterations of the physiological properties and characteristic of the various CMG phases, including the frequent occurrence of an artificial rebound during the third phase of micturition. The present results demonstrate how different experimental conditions lead not only to variability in Pves curves, but consistency of the measurements as well, which needs to be accounted for when interpreting CMG outcome data.
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Affiliation(s)
- Daniel Medina‐Aguinaga
- Department of Anatomical Sciences & NeurobiologyUniversity of LouisvilleLouisvilleKYUSA
- Department of Physiology & PharmacologyUAAAguascalientesMexico
| | - Robert F. Hoey
- Department of Anatomical Sciences & NeurobiologyUniversity of LouisvilleLouisvilleKYUSA
| | - Alvaro Munoz
- Department of Foundations of KnowledgeCentro Universitario del NorteUniversity of GuadalajaraColotlanMexico
| | | | | | - Charles H. Hubscher
- Department of Anatomical Sciences & NeurobiologyUniversity of LouisvilleLouisvilleKYUSA
- Kentucky Spinal Cord Research CenterLouisvilleKYUSA
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Hubscher CH, Wyles J, Gallahar A, Johnson K, Willhite A, Harkema SJ, Herrity AN. Effect of Different Forms of Activity-Based Recovery Training on Bladder, Bowel, and Sexual Function After Spinal Cord Injury. Arch Phys Med Rehabil 2020; 102:865-873. [PMID: 33278365 DOI: 10.1016/j.apmr.2020.11.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 10/15/2020] [Accepted: 11/02/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To investigate whether the urogenital and bowel functional gains previously demonstrated post-locomotor step training after chronic spinal cord injury could have been derived due to weight-bearing alone or from exercise in general. DESIGN Prospective cohort study; pilot trial with small sample size. SETTING Urogenital and bowel scientific core facility at a rehabilitation institute and spinal cord injury research center in the United States. PARTICIPANTS Men and women (N=22) with spinal cord injury (American Spinal Injury Association Impairment Scale grades of A-D) participated in this study. INTERVENTIONS Approximately 80 daily 1-hour sessions of either stand training or nonweight-bearing arm crank ergometry. Comparisons were made with previously published locomotor training data (step; N=7). MAIN OUTCOME MEASURES Assessments at both pre- and post-training timepoints included cystometry for bladder function and International Data Set Questionnaires for bowel and sexual functions. RESULTS Cystometry measurements revealed a significant decrease in bladder pressure and limited improvement in compliance with nonweight-bearing exercise but not with standing. Although International Data Set questionnaires revealed profound bowel dysfunction and marked deficits in sexual function pretraining, no differences were identified poststand or after nonweight-bearing exercise. CONCLUSIONS These pilot trial results suggest that, although stand and weight-bearing alone do not benefit pelvic organ functions after spinal cord injury, exercise in general may contribute at least partially to the lowering of bladder pressure and the increase in compliance that was seen previously with locomotor training, potentially through metabolic, humoral, and/or cardiovascular mechanisms. Thus, to maximize activity-based recovery training benefits for functions related to storage and emptying, an appropriate level of sensory input to the spinal cord neural circuitries controlling bladder and bowel requires task-specific stepping.
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Affiliation(s)
- Charles H Hubscher
- Department of Anatomical Sciences and Neurobiology, University of Louisville, Louisville, KY; Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY.
| | - Jennifer Wyles
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY; Department of Neurological Surgery, University of Louisville, Louisville, KY
| | - Anthony Gallahar
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY; Department of Neurological Surgery, University of Louisville, Louisville, KY
| | - Kristen Johnson
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY; Department of Neurological Surgery, University of Louisville, Louisville, KY
| | - Andrea Willhite
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY; Department of Neurological Surgery, University of Louisville, Louisville, KY
| | - Susan J Harkema
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY; Department of Neurological Surgery, University of Louisville, Louisville, KY
| | - April N Herrity
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY; Department of Neurological Surgery, University of Louisville, Louisville, KY
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27
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Kern NG, Gray M, Corbett S, Leroy S, Wildasin A, Al-Omar O. Usability and safety of the new 5 French air-charged catheter for performing urodynamic studies on pediatric patients. Neurourol Urodyn 2020; 39:2425-2432. [PMID: 32914894 DOI: 10.1002/nau.24506] [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: 06/13/2020] [Revised: 08/23/2020] [Accepted: 08/29/2020] [Indexed: 11/05/2022]
Abstract
AIMS To assess the performance and safety of the T-DOC® 5 French air-charged urodynamic catheters in pediatric patients and obtain feedback from providers related to usability performance. METHODS Patients ages 12 years and younger undergoing urodynamics were prospectively recruited from two institutions. The T-DOC® 5 French air-charged catheters were used. Issues with catheter placement, adverse events (AEs), and pain scores were assessed. A follow-up telephone call was made to assess for post-urodynamic AEs. Providers completed a clinical user questionnaire. Likert scale was used (1 = most negative and 5 = most positive response) and reported in mean (range). RESULTS A total of 28 patients completed the study. The mean age was 55 months (5-130) (10 females, 18 males). One problem was noted with the insertion of an abdominal catheter, secondary to stool impaction. Catheters stayed in place on all subjects, except for one related to patient hyperactivity. There were no AEs during the studies. In total four reported post-urodynamics AEs (one hematochezia, three dysuria). Among nine patients, pain level on the bladder and abdominal insertion was 3.6/10 (0-10) and 3.1/10 (0-10). Five providers completed the questionnaire. The overall ease of use was rated 4.3/5 (3-5). The ease of insertion was 4.1/5 (2-5) and set-up/clean-up time was 4.4/5 (3-5). Tracing stability, subtraction accuracy, and artifact sensitivity were all perceived favorably (respectively 4.8/5 [4-5], 4.6/5 [4-5], and 4.4/5 [4-5]). CONCLUSIONS The T-DOC® 5 French air-charged catheter was considered safe and effective in pediatric patients. No AEs occurred during the studies. Providers, using the catheters, reported favorably on catheter usage.
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Affiliation(s)
- Nora G Kern
- University of Virginia, Charlottesville, Virginia, USA
| | - Mikel Gray
- University of Virginia, Charlottesville, Virginia, USA
| | - Sean Corbett
- University of Virginia, Charlottesville, Virginia, USA
| | - Susan Leroy
- University of Virginia, Charlottesville, Virginia, USA
| | - Amy Wildasin
- West Virginia University, Morgantown, West Virginia, USA
| | - Osama Al-Omar
- West Virginia University, Morgantown, West Virginia, USA
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28
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Lewis AL, Young GJ, Selman LE, Rice C, Clement C, Ochieng CA, Abrams P, Blair PS, Chapple C, Glazener CM, Horwood J, McGrath JS, Noble S, Taylor GT, Lane JA, Drake MJ. Urodynamics tests for the diagnosis and management of bladder outlet obstruction in men: the UPSTREAM non-inferiority RCT. Health Technol Assess 2020; 24:1-122. [PMID: 32902375 DOI: 10.3310/hta24420] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Lower urinary tract symptoms (LUTS) in men may indicate bladder outlet obstruction (BOO) or weakness, known as detrusor underactivity (DU). Severe bothersome LUTS are a common indication for surgery. The diagnostic tests may include urodynamics (UDS) to confirm whether BOO or DU is the cause, potentially reducing the number of people receiving (inappropriate) surgery. OBJECTIVES The primary objective was to determine whether a care pathway including UDS is no worse for symptom outcome than one in which it is omitted, at 18 months after randomisation. Rates of surgery was the key secondary outcome. DESIGN This was a pragmatic, multicentre, two-arm (unblinded) randomised controlled trial, incorporating a health economic analysis and qualitative research. SETTING Urology departments of 26 NHS hospitals in England. PARTICIPANTS Men (aged ≥ 18 years) seeking further treatment, potentially including surgery, for bothersome LUTS. Exclusion criteria were as follows: unable to pass urine without a catheter, having a relevant neurological disease, currently undergoing treatment for prostate or bladder cancer, previously had prostate surgery, not medically fit for surgery and/or unwilling to be randomised. INTERVENTIONS Men were randomised to a care pathway based on non-invasive routine tests (control) or routine care plus invasive UDS (intervention arm). MAIN OUTCOME MEASURES The primary outcome was International Prostate Symptom Score (IPSS) at 18 months after randomisation and the key secondary outcome was rates of surgery. Additional secondary outcomes included adverse events (AEs), quality of life, urinary and sexual symptoms, UDS satisfaction, maximum urinary flow rate and cost-effectiveness. RESULTS A total of 820 men were randomised (UDS, 427; routine care, 393). Sixty-seven men withdrew before 18 months and 11 died (unrelated to trial procedures). UDS was non-inferior to routine care for IPSS 18 months after randomisation, with a confidence interval (CI) within the margin of 1 point (-0.33, 95% CI -1.47 to 0.80). A lower surgery rate in the UDS arm was not found (38% and 36% for UDS and routine care, respectively), with overall rates lower than expected. AEs were similar between the arms at 43-44%. There were more cases of acute urinary retention in the routine care arm. Patient-reported outcomes for LUTS improved in both arms and satisfaction with UDS was high in men who received it. UDS was more expensive than routine care. From a secondary care perspective, UDS cost an additional £216 over an 18-month time horizon. Quality-adjusted life-years (QALYs) were similar, with a QALY difference of 0.006 in favour of UDS over 18 months. It was established that UDS was acceptable to patients, and valued by both patients and clinicians for its perceived additional insight into the cause and probable best treatment of LUTS. LIMITATIONS The trial met its predefined recruitment target, but surgery rates were lower than anticipated. CONCLUSIONS Inclusion of UDS in the diagnostic tests results in a symptom outcome that is non-inferior to a routine care pathway, but does not affect surgical rates for treating BOO. Results do not support the routine use of UDS in men undergoing investigation of LUTS. FUTURE WORK Focus should be placed on indications for selective utilisation of UDS in individual cases and long-term outcomes of diagnosis and therapy. TRIAL REGISTRATION Current Controlled Trials ISRCTN56164274. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 42. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Amanda L Lewis
- Bristol Randomised Trials Collaboration, Bristol Trials Centre, University of Bristol, Bristol, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Grace J Young
- Bristol Randomised Trials Collaboration, Bristol Trials Centre, University of Bristol, Bristol, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Lucy E Selman
- Bristol Randomised Trials Collaboration, Bristol Trials Centre, University of Bristol, Bristol, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Caoimhe Rice
- Bristol Randomised Trials Collaboration, Bristol Trials Centre, University of Bristol, Bristol, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Clare Clement
- Bristol Randomised Trials Collaboration, Bristol Trials Centre, University of Bristol, Bristol, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Cynthia A Ochieng
- Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Paul Abrams
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | - Peter S Blair
- Bristol Randomised Trials Collaboration, Bristol Trials Centre, University of Bristol, Bristol, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | | | - Jeremy Horwood
- Bristol Randomised Trials Collaboration, Bristol Trials Centre, University of Bristol, Bristol, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Sian Noble
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - J Athene Lane
- Bristol Randomised Trials Collaboration, Bristol Trials Centre, University of Bristol, Bristol, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Marcus J Drake
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
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Rogel R, Lorenzo L, Avargues A, Lujan S, Broseta E, Arlandis S. ANalogical UroFlowmetry (ANUF): Correspondence Between This New Visual Pictogram and Uroflowmetry in Men With Lower Urinary Tract Symptoms: A new approach for the study of male micturition dynamics. Urology 2020; 146:236-241. [PMID: 32866510 DOI: 10.1016/j.urology.2020.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 07/27/2020] [Accepted: 08/16/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To study the correlation between a new visual tool (ANalogical UroFlowmetry (ANUF)) and uroflowmetry (UF) parameters when performed to assess male lower urinary tract symptoms (MLUTS). METHODS We configured an original pictogram composed of 4 different urine streams. In the setting of a University Hospital based prospective study where 545 men were enrolled between September 2018 and January 2019. Variables collected were age, UF pattern, Qmax, average flow rate (Qave), voided volume, postvoid residual, and selected image. The Spearman's rank test, ANOVA, and Tukey test, as well as the lineal regression model were used. RESULTS A total of 358 patients fulfilled the inclusion criteria. Mean age was 64.6 ± 12 years. Mean value and standard deviationfor the Qmax were 20.4 ± 10.5 mL/s for Image1; 15.5 ± 6.4 mL/s for Image2; 13.5 ± 6.0 mL/s for Image3 and 10.4 ± 5.4 mL/s for Image4. Statistically significant negative correlations were found between ANUF and Qmax (r = -0.317; P<.0001), and ANUF and Qave (r = -0.305; P<.0001). Qmax mean values among images were statistically different when compared in pairs, except Image1 and Image2 (P= .153). The confidence intervals calculated through the lineal regression model for the Qmax and each image were Image1) 17.8, confidence interval [CI] 95%: [14.9-21.5] mL/s; Image2) 14.3, CI 95%: [13.0-15.7] mL/s; Image3) 12.3, CI 95%: [11.5-13.1] mL/s and Image4) 9.1, CI 95%: [8.1-10.3] mL/s. CONCLUSION According to our results, ANUF is a useful and inexpensive tool presenting a correlation with the Qmax as well a correspondence of each image with a range of Qmax and its mean value.
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Affiliation(s)
- Ramon Rogel
- Department of Urology, La Fe University Hospital and Polytechnic, Valencia, Spain.
| | - Laura Lorenzo
- Department of Urology, La Fe University Hospital and Polytechnic, Valencia, Spain
| | - Ana Avargues
- Department of Urology, La Fe University Hospital and Polytechnic, Valencia, Spain
| | - Saturnino Lujan
- Department of Urology, La Fe University Hospital and Polytechnic, Valencia, Spain
| | - Enrique Broseta
- Department of Urology, La Fe University Hospital and Polytechnic, Valencia, Spain
| | - Salvador Arlandis
- Department of Urology, La Fe University Hospital and Polytechnic, Valencia, Spain
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Abstract
PURPOSE OF REVIEW This manuscript reviews recent technological advances in ambulatory urodynamics. RECENT FINDINGS Ambulatory urodynamics is currently recommended by the International Continence Society as a second-line diagnostic tool in patients with nondiagnostic traditional urodynamics. Novel techniques involving telemetric monitoring are in development, which utilize catheter-free wireless systems to address several recognized shortcomings of inoffice urodynamic studies. Current research in catheter-free bladder pressure measurements involves either an intravesical, intradetrusor, or transdetrusor approach. Real-time bladder volume estimation may be performed using ultrasonography, near-infrared spectroscopy, or bladder volume conductance measurement. Ambulatory urodynamics can measure bladder function in the "real world" setting, capturing physiological bladder filling and emptying and allowing patients to reproduce the activities that may trigger their symptoms. Telemetric devices being developed represent further advances in this field and focus upon improving diagnostic capabilities, evaluating patient response to treatment, and facilitating closed-loop bladder control with neuroprosthetic integration.
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Affiliation(s)
- Neil J Kocher
- Cleveland Clinic, Glickman Urological & Kidney Institute, Cleveland, OH, USA
| | - Margot S Damaser
- Cleveland Clinic, Glickman Urological & Kidney Institute, Cleveland, OH, USA
- Advanced Platform Technology Center, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, USA
- Department of Biomedical Engineering, Cleveland Clinic, Lerner Research Institute, Cleveland, OH, USA
| | - Bradley C Gill
- Cleveland Clinic, Glickman Urological & Kidney Institute, Cleveland, OH, USA.
- Division of Urology, Surgical Service, Louis Stokes Cleveland Veterans Affairs Medical Center, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
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31
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Chen G, Liao L, Wang Y, Ying X. Urodynamic findings during the filling phase in neurogenic bladder patients with or without vesicoureteral reflux who have undergone sacral neuromodulation. Neurourol Urodyn 2020; 39:1410-1416. [DOI: 10.1002/nau.24354] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 03/26/2020] [Accepted: 03/27/2020] [Indexed: 12/29/2022]
Affiliation(s)
- Guoqing Chen
- Department of UrologyChina Rehabilitation Research Center Beijing China
- Department of UrologyCapital Medical University Beijing China
| | - Limin Liao
- Department of UrologyChina Rehabilitation Research Center Beijing China
- Department of UrologyCapital Medical University Beijing China
| | - Yiming Wang
- Department of UrologyChina Rehabilitation Research Center Beijing China
- Department of UrologyCapital Medical University Beijing China
| | - Xiaoqian Ying
- Department of UrologyChina Rehabilitation Research Center Beijing China
- Department of UrologyCapital Medical University Beijing China
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32
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Aiello M, Jelski J, Lewis A, Worthington J, McDonald C, Abrams P, Gammie A, Harding C, Biers S, Hashim H, Lane JA, Drake MJ. Quality control of uroflowmetry and urodynamic data from two large multicenter studies of male lower urinary tract symptoms. Neurourol Urodyn 2020; 39:1170-1177. [PMID: 32187720 DOI: 10.1002/nau.24337] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 03/04/2020] [Indexed: 11/10/2022]
Abstract
AIM The International Continence Society (ICS) has standardized quality control and interpretation of uroflowmetry and urodynamics. We evaluated traces from two large studies of male lower urinary tract symptoms (UPSTREAM and UNBLOCS) against ICS standards of urodynamic equipment and practice. METHODS Ten percent of uroflowmetry and urodynamics traces were selected at random from hospital sites. A data capture template was designed from the ICS Fundamentals of Urodynamic Practice checklist. Two pretrained blinded assessors extracted the data, with a third assessor to arbitrate. Departmental records of calibration checks and equipment maintenance were scrutinized. RESULTS Seven out of twenty-five (28%) departments reported no calibration checks. Four sites (16%) could not provide annual service records. In 32 out of 296 (10.8%) uroflowmetry traces, findings were affected by artifact. One hundred ten urodynamic study traces were reviewed; in 11 records (10%), key pressure traces were incompletely displayed. In 30 (27.2%), reference zero was not set to atmospheric pressure. Resting pressures were outside the expected range for 36 (32.7%). Pressure drift was seen in 18 traces (16.4%). At pressure-flow study commencement, permission to void was omitted in 15 (13.6%). Cough testing after voiding was done in 71.2%, but the resulting cough spikes were significantly different in 16.5%. Erroneous diagnosis of bladder outlet obstruction (BOO) was identified in six cases (5.5%). CONCLUSIONS Erroneous diagnosis of BOO is a serious error of interpretation, as it could lead to unnecessary surgery. Other errors of standardization, testing, and interpretation were identified with lower risk of adverse implications. Inconsistent documentation of service records mean equipment accuracy is uncertain.
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Affiliation(s)
- Martino Aiello
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | - Joseph Jelski
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | - Amanda Lewis
- Bristol Randomised Trials Collaboration (BRTC), Bristol Trials Centre, University of Bristol, Bristol, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jo Worthington
- Bristol Randomised Trials Collaboration (BRTC), Bristol Trials Centre, University of Bristol, Bristol, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Charlotte McDonald
- Bristol Randomised Trials Collaboration (BRTC), Bristol Trials Centre, University of Bristol, Bristol, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Paul Abrams
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | - Andrew Gammie
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | - Chris Harding
- Urology Department, Freeman Hospital, Newcastle upon Tyne, UK
| | - Suzanne Biers
- Urology Department, Addenbrooke's Hospital, Cambridge, UK
| | - Hashim Hashim
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | - J Athene Lane
- Bristol Randomised Trials Collaboration (BRTC), Bristol Trials Centre, University of Bristol, Bristol, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Marcus J Drake
- Urology Department, Freeman Hospital, Newcastle upon Tyne, UK.,Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Gammie A, Drake MJ. The fundamentals of uroflowmetry practice, based on International Continence Society good urodynamic practices recommendations. Neurourol Urodyn 2019; 37:S44-S49. [PMID: 30614059 DOI: 10.1002/nau.23777] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 07/01/2018] [Indexed: 11/10/2022]
Abstract
AIMS To review the recommendations on uroflowmetry in the International Continence Society (ICS) Standardization documents in order to identify a systematic approach to the delivery and interpretation of free flow rate testing in clinical practice. METHODS Expectations of service and good practice in uroflowmetry described in the ICS standards on Urodynamic Practice, Urodynamic Equipment, and Terminology for Lower Urinary Tract Function were identified and summarized. RESULTS Urodynamic centers should provide a suitable uroflowmetry testing environment. Equipment should be calibrated and maintained according to manufacturer requirements. Patients should be well-informed in advance of the test. They should be advised to avoid: knocking the machine; allowing the stream to move; squeezing the urethra; and body movements. It is generally appropriate to get more than one flow trace for each patient. Voided volume should be representative for the patient, for example by comparing with values recorded on a Bladder Diary. Post void residual (PVR) should be measured soon after testing. After the test, the urodynamicist should review the trace and ensure maximum flow rate and end of micturition are correctly identified in case the equipment has inappropriately taken the values from a trace artefact. CONCLUSIONS The summary provides a systematic approach to ensure a representative, high quality, non-invasive flow test is carried out for individual patients.
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Affiliation(s)
- Andrew Gammie
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | - Marcus J Drake
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
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Dobberfuhl AD, Zhang X, Comiter CV. The mechanical stop test and isovolumetric detrusor contractile reserve are associated with immediate spontaneous voiding after transurethral resection of prostate. Int Urol Nephrol 2019; 52:239-246. [PMID: 31673936 DOI: 10.1007/s11255-019-02322-y] [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: 07/25/2019] [Accepted: 10/18/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE To identify urodynamic factors associated with the mechanical stop test and immediate spontaneous voiding following transurethral resection of prostate (TURP). METHODS We identified 90 men who underwent TURP over a 12-month period. Forty-three (mean age 68 years) underwent urodynamic evaluation prior to TURP. Isovolumetric detrusor contractile pressure (Piso) was obtained using the mechanical stop test during the voiding phase, and used to calculate detrusor contractile reserve (Pres = Piso - Pdet@Qmax). Primary outcome was spontaneous voiding after TURP. RESULTS Preoperative catheter-free spontaneous voiding was present in 63% of men (27/43) with a urodynamic (mean ± SD): Qmax 6.2 ± 2.7 mL/s, Pdet@Qmax 102 ± 47 cmH2O, Piso 124 ± 49 cmH2O, Pres 22 ± 16 cmH2O, bladder outlet obstruction index (BOOI) 90 ± 49, and bladder contractility index (BCI) 132 ± 44. The remaining 16 catheter-dependent men demonstrated a urodynamic (mean ± SD): Qmax 3.6 ± 3.3 mL/s, Pdet@Qmax 87 ± 38 cmH2O, Piso 99 ± 51 cmH2O, Pres 10 ± 18 cmH2O, BOOI 82 ± 36, and BCI 106 ± 48. Following TURP, 67% of men voided spontaneously with their first void trial, and in receiver operator analysis of urodynamic measures (Pdet@Qmax, Piso, Pres, BOOI and BCI), only Pres was significantly associated with immediate spontaneous voiding after TURP (threshold Pres ≥ 9 cmH2O, AUC = 0.681, p = 0.035). CONCLUSIONS In men who underwent TURP, a Pres ≥ 9 cmH2O was associated with immediate spontaneous voiding and may be easily incorporated into the postoperative pathway.
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Affiliation(s)
- Amy D Dobberfuhl
- Department of Urology, Stanford University School of Medicine, 300 Pasteur Drive, Grant S-287, Stanford, CA, 94305, USA.
| | - Xinyuan Zhang
- Department of Urology, Stanford University School of Medicine, 300 Pasteur Drive, Grant S-287, Stanford, CA, 94305, USA
| | - Craig V Comiter
- Department of Urology, Stanford University School of Medicine, 300 Pasteur Drive, Grant S-287, Stanford, CA, 94305, USA
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35
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Aharony S, Przydacz M, Van Ba OL, Corcos J. Does asymptomatic bacteriuria increase the risk of adverse events or modify the efficacy of intradetrusor onabotulinumtoxinA injections? Neurourol Urodyn 2019; 39:203-210. [DOI: 10.1002/nau.24169] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 09/09/2019] [Indexed: 11/10/2022]
Affiliation(s)
- Shachar Aharony
- Department of Urology, Jewish General Hospital McGill University Montreal Quebec Canada
| | - Mikolaj Przydacz
- Department of Urology, Jewish General Hospital McGill University Montreal Quebec Canada
- Department of Urology Jagiellonian University Medical College Krakow Poland
| | - Ornella L. Van Ba
- Department of Urology, Jewish General Hospital McGill University Montreal Quebec Canada
| | - Jacques Corcos
- Department of Urology, Jewish General Hospital McGill University Montreal Quebec Canada
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36
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Chen A, De E, Argoff C. Small Fiber Polyneuropathy Is Prevalent in Patients Experiencing Complex Chronic Pelvic Pain. PAIN MEDICINE 2019; 20:521-527. [PMID: 29447372 DOI: 10.1093/pm/pny001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To demonstrate the prevalence of small fiber polyneuropathy (SFPN) in patients with refractory chronic pelvic pain (CPP). DESIGN Retrospective study of prospective database. SUBJECTS Participants were complex CPP patients recruited from subspecity referral clinics defined as those who were refractory to initial treatment and/or exhibited comorbid pain syndromes at initial presentation. METHODS Comprehensive treatment history for CPP was obtained, and participants referred as above; 3-mm punch biopsies were obtained of the lower extremity and sent to diagnostic reference labs to evaluate for SFPN. The reported lab sensitivity and specificity for SFPN are 78-92% and 65-90%, respectively. RESULTS Twenty-five of 39 patients (64%) were positive for SFPN. Comorbid conditions noted in our population included gastroesophageal reflux disease (46%), migraine (38%), irritable bowel syndrome (33%), lower back pain (33%), fibromyalgia (38%), endometriosis (15%), interstitial cystitis (18%), vulvodynia (5%), and other chronic pain syndromes (36%). CONCLUSIONS The prevalence of SFPN in our specialty referral patients with complex CPP is remarkably high vs published general population prevalence data (53/100,000). Identification of SFPN in this complex population shifts the focus from undefined syndromes to symptom complexes with linked potentially treatable mechanisms (e.g., SFPN, central sensitization). Most CPP patients with SFPN are undiagnosed. Considering the diagnosis may expand treatment options beyond conventional or so-called adjuvant analgesics. Treatment may expand to therapies such as IV lidocaine, IVIG, or other immunomodulatory options. In addition, the value to the patient of receiving a diagnosis for a multisystem or refractory pain syndrome, often attributed to negative psychologic factors, cannot be underestimated. Identifying SFPN should be contemplated in CPP patients who present with multisystem pain or who have not responded to initial evaluation and management.
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Affiliation(s)
- Annie Chen
- Department of Urology, Albany Medical Center, Albany, New York
| | - Elise De
- Department of Urology, Massachusetts General Hospital, Boston, Massachusetts.,Albany Medical Center, Albany, New York, USA
| | - Charles Argoff
- Department of Neurology, Albany Medical College, Albany, New York, USA
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Baumeister P, Kozomara M, Seifert B, Mehnert U, Kessler TM. Detrusor overactivity is missed by stopping urodynamic investigation at a bladder volume of 500 mL. BJU Int 2019; 124:870-875. [PMID: 31298777 DOI: 10.1111/bju.14868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To investigate whether detrusor overactivity (DO) is missed in a relevant percentage of patients if the urodynamic investigation (UDI) is stopped at a filling volume of 500 mL due to the fear of bladder overdistention, in patients with lower urinary tract symptoms and high bladder capacity. PATIENTS AND METHODS A consecutive series of 1598 patients with a bladder capacity of >500 mL in the bladder diary undergoing UDI due to lower urinary tract dysfunction (LUTD) was prospectively investigated. UDI was performed according to Good Urodynamic Practices recommended by the International Continence Society. UDI was stopped at strong desire to void or in case of autonomic dysreflexia, vesico-uretero-renal reflux, bladder pain or discomfort. RESULTS Of the 1598 patients (594 women, 1004 men), 1282 (80%) and 316 (20%) had neurogenic and non-neurogenic LUTD, respectively. Overall, DO was detected in 66% (1048/1598), in 71% (910/1282) with neurogenic and in 44% (138/316) with non-neurogenic LUTD. DO occurred in 16% (263/1598, 95% confidence interval [CI] 14.7-18.4%) only at a bladder volume >500 mL. This phenomenon was significantly (P < 0.001) more frequent in patients with neurogenic (18% [236/1282], 95% CI 16.4-20.6%) compared with non-neurogenic (9% [27/316], 95% CI 5.9-12.1%) LUTD. CONCLUSIONS In both neurological and non-neurological patients with high bladder capacity, we strongly recommend not to stop UDI at a bladder volume of 500 mL, as DO might be missed in a relevant percentage leading to inappropriate patient treatment.
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Affiliation(s)
- Philipp Baumeister
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland.,Department of Urology, Cantonal Hospital Luzern, Luzern, Switzerland
| | - Marko Kozomara
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland.,Department of Urology, University Hospital Zürich, Zürich, Switzerland
| | - Burkhardt Seifert
- Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zürich, Switzerland
| | - Ulrich Mehnert
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Thomas M Kessler
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
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Yao J, Li Q, Li X, Qin H, Liang S, Liao X, Chen X, Li W, Yan J. Simultaneous Measurement of Neuronal Activity in the Pontine Micturition Center and Cystometry in Freely Moving Mice. Front Neurosci 2019; 13:663. [PMID: 31293380 PMCID: PMC6603236 DOI: 10.3389/fnins.2019.00663] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 06/11/2019] [Indexed: 01/23/2023] Open
Abstract
Understanding the complex neural mechanisms controlling urinary bladder activity is an extremely important topic in both neuroscience and urology. Simultaneously recording of the bladder activity and neural activity in related brain regions will largely advance this field. However, such recording approach has long been restricted to anesthetized animals, whose bladder function and urodynamic properties are largely affected by anesthetics. In our recent report, we found that it is feasible to record bladder pressure (cystometry) and the related cortical neuron activity simultaneously in freely moving mice. Here, we aimed to demonstrate the use of this combined method in freely moving mice for recording the activity of the pontine micturition center (PMC), a more difficultly approachable small region deeply located in the brainstem and a more popularly studied hub for controlling bladder function. Interestingly, we found that the duration of urination events linearly correlated to the time course of neuronal activity in the PMC. We observed that the activities of PMC neurons highly correlated with spike-like increases in bladder pressure, reflecting bladder contractions. We also found that anesthesia evoked prominent changes in the dynamics of the Ca2+ signals in the PMC during the bladder contraction and even induced the dripping overflow incontinence due to suppression of the neural activity in the PMC. In addition, we described in details both the system for cystometry in freely moving mice and the protocols for how to perform this combined method. Therefore, this work provides a powerful approach that enables the simultaneous measurement of neuronal activity of the PMC or any other brain sites and bladder function in freely behaving mice. This approach offers a promising possibility to examine the neural mechanisms underlying neurogenic bladder dysfunction.
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Affiliation(s)
- Jiwei Yao
- Department of Urology, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Qianwei Li
- Department of Urology, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Xianping Li
- Brain Research Center and State Key Laboratory of Trauma, Burns, and Combined Injury, Third Military Medical University, Chongqing, China
| | - Han Qin
- Brain Research Center and State Key Laboratory of Trauma, Burns, and Combined Injury, Third Military Medical University, Chongqing, China
| | - Shanshan Liang
- Brain Research Center and State Key Laboratory of Trauma, Burns, and Combined Injury, Third Military Medical University, Chongqing, China
| | - Xiang Liao
- Brain Research Center and State Key Laboratory of Trauma, Burns, and Combined Injury, Third Military Medical University, Chongqing, China
| | - Xiaowei Chen
- Brain Research Center and State Key Laboratory of Trauma, Burns, and Combined Injury, Third Military Medical University, Chongqing, China
| | - Weibing Li
- Department of Urology, Southwest Hospital, Third Military Medical University, Chongqing, China.,Department of Urology and Nephrology, The Third Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Junan Yan
- Department of Urology, Southwest Hospital, Third Military Medical University, Chongqing, China
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Sheng W, Kirschner-Hermanns R. Comparison of air-filled and water-filled catheters for use in cystometric assessment. Int Urogynecol J 2019; 30:2061-2067. [PMID: 30888456 DOI: 10.1007/s00192-019-03914-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 02/23/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION AND HYPOTHESIS To determine whether pressure readings measured with air-filled catheter (AFC) and water-filled catheter (WFC) systems are equivalent during cystometric assessment, especially in case of pressure measurements at Valsalva manoeuvres and coughs. METHODS Twenty-five subjects were recruited. The commercially available 7-Fr TDOC AFC, which simultaneously reads water and air pressures in the bladder and rectum, was used to compare filling and voiding data recordings. Data were compared using paired t-tests, Bland-Altman plots and linear correlation methods, respectively. RESULTS Pressure readings measured by the two systems showed a good correlation at Valsalva manoeuvres [R2 = 0.988, 0.968 for vesical pressure (Pves) and abdominal pressure (Pabd), respectively] and at coughs (R2 = 0.972, 0.943 for Pves and Pabd, respectively). There was a statistically significant difference between the two different measurement modalities at coughs (p < 0.01), initial resting pressure (p < 0.01) and the maximum pressure at detrusor overactivity (p < 0.01). This indicated that the difference between the two measurement modalities during Valsalva manoeuvres could reach up to 5.2 cmH2O and 8.1 cmH2O in Pves and Pabd measurements, respectively. During coughs, the difference could reach up to 20 cmH2O and 19.5 cmH2O in Pves and Pabd measurements, respectively. CONCLUSIONS Pressure recordings from AFC and WFC systems appear to be interchangeable for some urodynamics parameters such as Pves at Valsalva manoeuvres if the baseline pressure is compensated, but not for fast-changing pressure signals such as coughs. This has to be considered when pressures are being taken with the AFC.
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Affiliation(s)
- Wei Sheng
- Department of Urology/Neuro-Urology, University Clinic, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany.
| | - Ruth Kirschner-Hermanns
- Department of Urology/Neuro-Urology, University Clinic, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany.,Neuro-Urology, Neurological Rehabilitation Center, Godeshoehe, Bonn, Germany
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40
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Kuo HC, Lee YK. Therapeutic Efficacy and Quality of Life Improvement in Women with Detrusor Underactivity Following Transurethral Incision of the Bladder Ne. UROLOGICAL SCIENCE 2019. [DOI: 10.4103/uros.uros_39_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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41
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Arlandis S, Morán E, Martínez-Cuenca E, Bonillo M, Martínez-García R, Rosier P. Adaptation to Spanish of the ICS Good Urodynamic Practices. Actas Urol Esp 2018; 42:625-631. [PMID: 29907261 DOI: 10.1016/j.acuro.2018.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 02/13/2018] [Indexed: 10/14/2022]
Abstract
The standardisation working group of the International Continence Society has updated the Good Urodynamic Practice directives. This evidence-based ICS-GUP2016 has defined the terminology and standards of Urodynamic practice, for the laboratory and for individual practice, in quality control during cystometry and pressure-flow analysis. In addition, the working group included recommendations prior to the test and information about how to prepare the patient, as well as recommendations for the reporting of urodynamics. Based on earlier International Continence Society standardisations and current evidence, the practice of uroflowmetry, cystometry and pressure-flow study have been detailed with a view to ensuring that this Good Urodynamic Practice update contributes towards improving clinical and research quality in urodynamics.
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42
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Ong HL, Kuo HC. Bladder dysfunction does not affect long-term success rate of the retropubic suburethral sling procedure in women with stress urinary incontinence. Low Urin Tract Symptoms 2018; 11:O168-O173. [PMID: 30484955 DOI: 10.1111/luts.12244] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 09/24/2018] [Accepted: 10/15/2018] [Indexed: 01/22/2023]
Abstract
OBJECTIVE This study investigated the long-term success rate of retropubic suburethral sling in the treatment of women with stress urinary incontinence (SUI) and different bladder function. METHODS Surgical outcomes of women with SUI undergoing a retropubic suburethral sling procedure between October 1989 and November 2014 were analyzed retrospectively. Bladder function was evaluated in every patient preoperatively using videourodynamic studies. Patients were classified as having stable bladder, detrusor overactivity (DO), or detrusor underactivity (DU). Baseline urodynamic parameters were analyzed and long-term therapeutic outcomes were compared among these three groups. RESULTS In all, 403 patients underwent sling procedure for SUI. Of these, 291 (72.2%) had a stable bladder, 78 (19.4%) had DO, and 34 (8.4%) had DU. Mean (± SD) patient age was 60.2 ± 11.8 years, and the median follow-up was 97 months (interquartile range 24-325 months). Postoperatively, the overall continence rate was 83.4% (336/403). After surgery, 71 patients (17.6%) complained of dysuria, 14 (3.5%) complained of urgency incontinence, 25 (6.2%) had recurrent SUI requiring a secondary sling procedure, and urethrolysis was performed in 13 (3.2%). In the stable bladder, DO, and DU groups, the 5-year continence rates were 88.6%, 84.1%, and 79.4%, respectively (P = 0.59), whereas the 10-year continence rates were 83.8%, 72.9%, and 79.4%, respectively. Kaplan-Meier survival analysis indicated that the long-term success rate was similar among the three groups (P = 0.39). CONCLUSIONS The overall continence rate was 83.4% and the 10-year continence rate was satisfactory in all bladder function subgroups. Treatment outcomes were the same for women with SUI but different bladder function.
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Affiliation(s)
- Hueih Ling Ong
- Department of Urology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Hann-Chorng Kuo
- Department of Urology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
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43
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Dobberfuhl AD. Evaluation and treatment of female stress urinary incontinence after pelvic radiotherapy. Neurourol Urodyn 2018; 38 Suppl 4:S59-S69. [DOI: 10.1002/nau.23839] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 09/19/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Amy D. Dobberfuhl
- Department of UrologyStanford University School of MedicineStanfordCalifornia
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44
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Wen JG, Djurhuus JC, Rosier PF, Bauer SB. ICS educational module: Cystometry in children. Neurourol Urodyn 2018; 37:2306-2310. [PMID: 30203421 DOI: 10.1002/nau.23729] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 05/16/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Jian G. Wen
- Pediatric Urodynamic Centre; the First Affiliated Hospital of Zhengzhou University; Zhengzhou China
- Department of Pediatric Surgery; the First Affiliated Hospital of Xinxiang Medical University; Weihui China
| | | | - Peter F.W.M. Rosier
- Department of Urology; University Medical Centre Utrecht; Utrecht The Netherlands
| | - Stuart B. Bauer
- Department of Urology; Boston Children's Hospital; Boston Massachusetts
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45
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Drake MJ, Doumouchtsis SK, Hashim H, Gammie A. Fundamentals of urodynamic practice, based on International Continence Society good urodynamic practices recommendations. Neurourol Urodyn 2018; 37:S50-S60. [DOI: 10.1002/nau.23773] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 07/01/2018] [Indexed: 11/05/2022]
Affiliation(s)
- Marcus J. Drake
- Translational Health Sciences; Bristol Medical School; Bristol UK
- Bristol Urological Institute; Southmead Hospital; Bristol UK
| | | | - Hashim Hashim
- Bristol Urological Institute; Southmead Hospital; Bristol UK
| | - Andrew Gammie
- Bristol Urological Institute; Southmead Hospital; Bristol UK
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46
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Guzman-Negron JM, Marks BK, Pizarro-Berdichevsky J, Vasavada SP, Goldman HB. Fluoro-urodynamic Image Interpretation Is Not Altered by Using Dilute Intravesical Contrast. Urology 2018; 120:80-85. [PMID: 30016633 DOI: 10.1016/j.urology.2018.05.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 05/24/2018] [Accepted: 05/30/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To determine if using one 250 mL bottle of intravesical contrast followed by sterile saline alters interpretation of fluoroscopic images during fluoro-urodynamics. MATERIALS AND METHODS Subjects were randomized to receive 250 mL of intravesical contrast followed by sterile saline until maximal cystometric capacity vs non-dilute intravesical contrast alone during fluoro-urodynamics. Interpreters, blinded to study group, graded images on an ordinal rank scale rating confidence in image interpretation. Primary endpoint was differences in image interpretation between the two groups using visual grading characteristics curves and contrast-to-noise ratios (CNR). Secondary endpoints were obtaining anthropometric data such as body mass index and waist circumference to determine predictors of CNR in a multivariate multiple regression analysis. RESULTS 26 subjects were randomized to receive dilute intravesical contrast and 22 non-dilute contrast; two subjects were unable to complete the study. There was no difference in baseline characteristics between the two groups. Visual grading characteristics demonstrated no difference in readability of the fluoroscopic images between groups and CNR was not statistically different between the two groups. No correlation was identified between CNR and waist circumference or body mass index. CONCLUSION Interpretation of fluoro-urodynamic images and image quality was not altered with using of 250 mL of contrast followed by saline. Expert reviewers did not perceive a difference in their confidence to distinguish between the two groups. Fluoro-urodynamics can be reliably performed using only 250 mL of contrast without compromising the ability to read the fluoroscopic images.
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Affiliation(s)
| | - Brian K Marks
- Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH 44194; Center for Urologic Care, Concord Hospital, Concord, NH 03301
| | - Javier Pizarro-Berdichevsky
- Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH 44194; Urogynecology Unit, Sotero del Rio Hospital and Division Obstetricia y Ginecologia Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Sandip P Vasavada
- Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH 44194
| | - Howard B Goldman
- Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH 44194
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Wen JG, Djurhuus JC, Rosier PFWM, Bauer SB. ICS educational module: Pressure flow study in children. Neurourol Urodyn 2018; 37:2311-2314. [PMID: 29931789 DOI: 10.1002/nau.23730] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 05/14/2018] [Indexed: 11/09/2022]
Abstract
AIMS To introduce the standard procedure and results interpretation of pressure/flow study (PFS) in children. METHODS The literature on PFS in children in PubMed for the last 20 years was reviewed. The updated knowledge on PFS in children in children regarding indication, preparation, technique, and interpretation were summarized. RESULTS This educational module explains when and how to do a PFS and how to analyze the results. All requirements and instructions for the PFS in children described in this document follow ICS reports on Good Urodynamic Practice and urodynamic equipment performance as well as guidelines from the ICCS. PFS can be obtained subsequent to filling cystometry with no specific additional equipment (apart from a flowmeter) or patient preparation needed. It requires both vesical and intra-abdominal pressures being recorded. Information from clinical history, physical examination, voiding diaries, and free uroflowmetry with or without perineal patch EMG and pertinent imaging results should be available before undertaking urodynamic testing. CONCLUSIONS Following ICS and ICCS guidelines, PFS is an easy procedure and a useful tool to provide information on voiding function in children.
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Affiliation(s)
- Jian G Wen
- Pediatric Urodynamic Centre, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Department of Pediatric Surgery, The First Affiliated Hospital of Xinxiang Medical University, Weihui, China
| | - Jens C Djurhuus
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - Peter F W M Rosier
- Department of Urology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Stuart B Bauer
- Department of Urology, Boston Children's Hospital, Boston, Massachusetts
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Welk B, Schneider MP, Thavaseelan J, Traini LR, Curt A, Kessler TM. Early urological care of patients with spinal cord injury. World J Urol 2018; 36:1537-1544. [DOI: 10.1007/s00345-018-2367-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 06/04/2018] [Indexed: 10/14/2022] Open
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Herrity AN, Williams CS, Angeli CA, Harkema SJ, Hubscher CH. Lumbosacral spinal cord epidural stimulation improves voiding function after human spinal cord injury. Sci Rep 2018; 8:8688. [PMID: 29875362 PMCID: PMC5989228 DOI: 10.1038/s41598-018-26602-2] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 05/15/2018] [Indexed: 01/05/2023] Open
Abstract
Deficits in urologic function after spinal cord injury (SCI) manifest both as a failure to store and empty, greatly impacting daily life. While current management strategies are necessary for urological maintenance, they oftentimes are associated with life-long side effects. Our objective was to investigate the efficacy of spinal cord epidural stimulation (scES) as a promising therapy to improve bladder control after SCI. A bladder mapping study was undertaken for sixteen sessions over the course of four months in an individual with chronic, motor complete SCI. Varying combinations of stimulating cathode electrodes were initially tested during filling cystometry resulting in the identification of an effective configuration for reflexive bladder emptying at the caudal end of the electrode array. Subsequent systematic testing of different frequencies at a fixed stimulus intensity and pulse width yielded lowest post-void residual volumes at 30 Hz. These stimulation parameters were then tested in four additional research participants and found to also improve reflexive voiding efficiency. Taken together with SCI studies on step, stand, voluntary motor control and cardiovascular regulation, these findings further corroborate that scES has an all-encompassing potential to increase the central state of excitability, allowing for the control of multiple body functions, including the urological system.
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Affiliation(s)
- A N Herrity
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA.,Department of Neurological Surgery, University of Louisville, Louisville, KY, USA
| | - C S Williams
- Department of Urology, University of Louisville, Louisville, KY, USA
| | - C A Angeli
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA.,Frazier Rehab Institute, Louisville, KY, USA
| | - S J Harkema
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA.,Department of Neurological Surgery, University of Louisville, Louisville, KY, USA.,Frazier Rehab Institute, Louisville, KY, USA
| | - C H Hubscher
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA. .,Department of Anatomical Sciences and Neurobiology, University of Louisville, Louisville, KY, USA.
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Globerman D, Gagnon LH, Tang S, Brennand E, Kim-Fine S, Robert M. A prospective study investigating the diagnostic agreement between urodynamics and dynamic cystoscopy in women presenting with mixed urinary incontinence. Int Urogynecol J 2018; 30:823-829. [PMID: 29845305 DOI: 10.1007/s00192-018-3671-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 05/09/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Patient history is often insufficient to identify type of urinary incontinence (UI). Multichannel urodynamic testing (UDS) is often used to clarify the diagnosis. Dynamic cystoscopy (DC) is a novel approach for testing bladder function. The primary objective of this study was to investigate the diagnostic agreement of UDS and DC in evaluating women with mixed urinary incontinence (MUI). METHODS Women presenting with MUI were approached for enrollment if UDS and DC were planned for further investigation. Investigators were blinded to history and comparative test results. McNemar's test and kappa coefficient were calculated to assess agreement between UDS and DC. Receiver operating characteristic (ROC) analysis was used to explore the best possible filling sensation cutoffs for DC that would best predict the filling sensation cutoffs from UDS. RESULTS Sixty participants were included, of whom, four were excluded for protocol violation. For the primary outcome measure of agreement, UDS and DC were concordant in 44/56 of stress urinary incontinence (SUI) cases (79%) with a κ= 0.54 and in 43/56 of urinary urge incontinence (UUI) cases (77%) with a κ= 0.54, indicating moderate, nearly substantial agreement. ROC analysis identified the best prediction of DC first urge to void as 148 cm3, strong urge 215 cm3, and maximum capacity at 246 cm3. These parameters were used to compare UDS UUI to DC UUI and resulted in a κ = 0.61 (p = 0.37), indicating substantial agreement. CONCLUSIONS When compared with UDS, DC shows moderate agreement for detection of SUI and substantial agreement for detection of UUI.
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Affiliation(s)
- Dobrochna Globerman
- Department of Obstetrics and Gynecology, Division of Urogynecology, University of Manitoba, Winnipeg, MB, Canada.
| | - Louise-Helene Gagnon
- Department of Obstetrics and Gynecology, Division of Urogynecology, University of Toronto, Toronto, ON, Canada
| | - Selphee Tang
- Department of Obstetrics and Gynecology, Division of Urogynecology, University of Calgary, Calgary, AB, Canada
| | - Erin Brennand
- Department of Obstetrics and Gynecology, Division of Urogynecology, University of Calgary, Calgary, AB, Canada
| | - Shunaha Kim-Fine
- Department of Obstetrics and Gynecology, Division of Urogynecology, University of Calgary, Calgary, AB, Canada
| | - Magali Robert
- Department of Obstetrics and Gynecology, Division of Urogynecology, University of Calgary, Calgary, AB, Canada
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