Ambulatory urodynamic monitoring of women with overactive bladder syndrome during single voiding cycle

Do the Ultrasonographic Measures of Midurethral Sling Location Relate With Surgical Outcomes?

IMPORTANCE

The proper placement of a midurethral sling (MUS) is the key factor for a successful surgical outcome.

OBJECTIVE

This study aimed to evaluate the relationship of perineal ultrasonographic measures of the tape location with subjective and objective outcomes after MUS surgery at midterm follow-up of women.

METHODS

The tape percentile (TP; total urethral length/bladder neck tape distance×100) and urethra tape distance (UTD; the shortest distance from the longitudinal smooth muscle complex of the urethra to the midpoint of the tape) were correlated with midterm surgical success. Patient satisfaction measured with the visual analog scale (VAS) was considered as the primary outcome. The presence of stress urinary incontinence on direct questioning, the Urinary Distress Inventory 6 (UDI-6) scores, findings of the cough stress test, free uroflowmetry, postvoid residual volume, and single-cycle voiding ambulatory urodynamic monitoring (AUM) were the other outcomes.

RESULTS

Seventy-eight women were evaluated at a mean follow-up of 4.4 ±3.3 years. Women who were highly satisfied (VAS ≥ 8) had a significantly higher TP (64.7% vs 50.8%, P < 0.001) and lower UTD (3.6 vs 4.5 mm, P = 0.018). Irritative, stress, and obstructive scores at UDI-6 increased as the tape was located closer to the bladder neck (P < 0.001, P < 0.001 and P = 0.044, respectively), and stress symptoms decreased with a tape closer to the urethra (P < 0.001). Women with detrusor overactivity at AUM were found to have a lower TP (P < 0.001).

CONCLUSION

The perineal ultrasonographic evaluation of tape location with UTD and TP seems to be well correlated with the women's midterm MUS surgical outcomes.

The association of coital incontinence with clinical factors and single voiding cycle ambulatory urodynamic monitoring findings in women

Introduction

Coital incontinence (CI) is a frequent problem in women with urinary incontinence (UI) with significant impact on female sexuality and quality of life. The underlying mechanism is controversial; it has been known that CI is associated with both stress urinary incontinence (SUI) and detrusor overactivity (DO). However, recently it has been reported that CI is mainly related with SUI and urethral incompetence, but not with DO. Ambulatory urodynamic monitoring (AUM) has been shown to be a sensitive tool for the detection of DO. The aim of this study was to investigate the clinical risk factors for CI and the association of CI with urodynamic diagnoses at single voiding cycle AUM.

Methods

Records of sexually active women with urinary incontinence attending the urogynaecology unit of a university hospital, who completed the PISQ-12 were reviewed retrospectively (n = 1,005). Patients were grouped using the 6th question; patients answering “never” to this question were considered as continent during coitus (n = 591) and patients reporting any urinary leakage at coitus were considered to have CI (n = 414). Demographics, clinical examination findings, incontinence severity measured by the Sandvik Incontinence Severity Index, scores of Turkish validated questionnaires (PFDI-20, IIQ-7, OAB-V8, and PISQ-12) and single voiding cycle AUM findings were compared, and univariate and multivariate logistic regression analyses were performed.

Results

Among all sexually active women with UI, 41.2% had CI; UI was more severe, symptom bother was higher, related quality of life (p &lt; 0.001) and sexual function were worse (≤0.018) in these women. Younger age (OR 0.967, p &lt; 0.001), history of vaginal delivery (OR 2.127, p = 0.019), smoking (OR 1.490, p = 0.041), postural UI (OR 2.012, p = 0.001), positive cough stress test (OR 2.193, p &lt; 0.001), and positive SEST (OR 1.756, p = 0.01) were found as independent clinical factors associated with CI. Urodynamic SUI (OR 2.168, p = 0.001) and MUI (OR 1.874, p = 0.002) were found as significant and independent urodynamic diagnoses associated with CI, whereas no association was found with DO or UUI.

Conclusion

Both clinical and AUM findings supported that CI is a more severe form of UI that it is mainly related with SUI and urethral incompetence, but not with UUI or DO.

Urodynamic and Bladder Diary Factors Predict Overactive Bladder-wet in Women: A Comparison With Overactive Bladder-dry

Purpose

To identify factors predicting the presence of overactive bladder syndrome (OAB)-wet, compared with OAB-dry.

Methods

Between September 2007 and September 2013, the medical records of 623 women with OAB who completed a 3-day bladder diary and underwent urodynamic studies in a medical center were retrospectively reviewed. OAB-wet was diagnosed in patients who complained of at least one episode of urgency incontinence in the previous month; otherwise, OAB-dry was diagnosed. Multivariable logistic regression analysis was used to predict the presence of OAB-wet.

Results

Age (odds ratio [OR], 1.05; P<0.001), maximal flow rate (Qmax) (OR,1.06; P<0.001), voided volume (OR, 0.996; P=0.001), detrusor pressure at maximal flow rate (PdetQmax) (OR, 1.02; P=0.003), urgency episodes (OR, 1.04; P<0.001) and urodynamic stress incontinence (OR,1.78; P=0.01) were independent predictors for the presence of OAB-wet vs. OAB-dry. If we use bladder contractility index as a variable for multivariable logistic regression analysis, bladder contractility index (OR, 1.012; P<0.001) become an independent predictor for OAB-wet.

Conclusions

A smaller bladder capacity and more frequent urgency episodes were predictors of OAB-wet, and the above findings indicate that OAB-wet and OAB-dry might be a continuum of OAB. Old age, high Qmax, high PdetQmax and urodynamic stress incontinence were also predictors for OAB-wet, and the above results reveal that OAB-wet and OAB-dry have partially different clinical and urodynamic features. Further studies might be performed to elucidate whether different treatment strategies between OAB-dry and OAB-wet can improve treatment efficacy.