Factors that influence the incidence of detrusor instability in women

The effect of posture and repetition on urodynamic parameters: A prospective randomized study

Purpose

To evaluate the effect of posture and repetition of filling cystometry on urodynamic parameters.

Materials and Methods

Seventy-one men with benign prostatic hyperplasia participated in a urodynamic study between September 2015 and August 2016 and were randomly assigned to a supine to supine (group SS, n=16), erect to erect (group EE, n=16), supine to erect (group SE, n=19) or erect to supine (group ES, n=20) group. The patients underwent filling cystometry twice. We evaluated the effect of posture and the effect of repetition on filling cystometric parameters. We also evaluated the correlation between overactive bladder (OAB) and detrusor overactivity (DO) and between maximum voided volume (MVV) and maximum cystometric capacity (MCC) for each posture and filling cystometry time.

Results

There was a decrease in bladder sensation and occurrence of DO, and an increase in bladder compliance and MCC in the supine posture group compared to that in the erect posture group. A more significant decrease in bladder sensation and occurrence of DO as well as an increase in MCC was seen during the second filling cystometry than the first one. The supine posture during first filling cystometry showed a better correlation between OAB and DO and between MVV and MCC than erect posture.

Conclusions

There were clear effects of posture and filling cystometry repetition on urodynamic parameters. The supine posture and repeated filling cystometry caused the bladder to be less sensitive and less overactive. The supine posture showed a better correlation to OAB symptoms than erect posture during first filling cystometry.

Validation of a culturally compliant voiding platform for urodynamics in African vesicovaginal fistula patients

INTRODUCTION AND HYPOTHESIS

Most patients in regions where obstetric vesicovaginal fistulas (VVF) are endemic void using a squatting posture. Additionally, many patients continue to have lower urinary tract symptoms (LUTS) following fistula closure. We designed and validated a prototype platform that allows urodynamic studies to be performed in a squatting position and conducted a pilot study to assess uroflowmetry in this patient population.

METHODS

Sixteen patients with persistent LUTS following fistula surgery were recruited. Posture measurements were taken in each patient's natural voiding posture on the ground and were then repeated using the platform. Nine patients with persistent urinary incontinence also underwent uroflowmetry. The data were compared with normal values in different nomograms. Paired t tests were used to determine significant differences in posture. One-way ANOVA was used to determine statistical significance between flow rate values.

RESULTS

Only the heel-to-heel distance (H-H) measure of posture was significantly increased on the platform compared with on the ground. The mean corrected Qmax was 0.89 ± 0.46. Flow rate values were significantly lower than mean normal flow rates obtained from the nomograms. In general, the patients' uroflowmetry patterns were similar to those indicative of impaired detrusor function.

CONCLUSION

A platform for conducting urodynamic studies in a squatting posture was successfully validated in the VVF patient population. The finding of increased H-H on the platform is expected, since the patient must accommodate a large funnel for urine collection. The pilot data suggest that patients with persistent urinary incontinence following VVF closure may also have significant voiding dysfunction.

[Urodynamic testing of the lower urinary tract]

Based on the measurement of simple physiological parameters urodynamic testing can reproduce clinical symptoms in a quantitative way, associates changes in physiological parameters to pathophysiological conditions and helps to establish a diagnosis in numerous lower urinary tract dysfunctions. Furthermore, urodynamic testing allows lower urinary tract dysfunctions to be classified as storage failure, voiding failure or combined storage and voiding failure. Therapeutic decision-making is based on this classification.

Relationship between Proximal Urethrovaginal Space Thickness and Detrusor Overactivity in Women with Stress Urinary Incontinence

Purpose

Detrusor overactivity (DO) cannot be predicted by clinical symptoms. Although it is possible that DO could be related to anatomical structures, scanty data exist about the relations between DO and anatomical structures. The aim of this study was to investigate anatomical differences in DO by measuring the thickness of the urethrovaginal space (UVS) and the urethral length (UL) in women with stress urinary incontinence (SUI).

Materials and Methods

Prospective data were collected from 72 women with SUI who underwent the midurethral sling operation. The subjects were divided into 2 groups according to the presence of DO by preoperative urodynamic study (UDS). UVS thickness was measured by trans-vaginal ultrasound. UL was measured by using a urethral catheter and a ruler. UVS thickness, UL, Q-tip, and urodynamic parameters, such as maximal urethral closure pressure (MUCP) and Valsalva leak point pressure, were compared between the two groups.

Results

Of 72 women, 23 patients had DO (31.9%). The proximal UVS was significantly thinner (p<0.001) and the MUCP was significantly lower (p=0.008) in women with DO. According to the receiver operating characteristic (ROC) curve based DO prediction, the best cutoff value for UVS thickness was 0.84 cm (area under the ROC curve 0.763).

Conclusions

In this study, the proximal UVS was significantly thinner and the MUCP was significantly lower in patients with DO. A proximal UVS thickness of less than 0.84 cm was shown to be a predictive parameter for the development of DO on preoperative UDS. A large-scale prospective study is needed to validate these results.

Changes in urodynamic parameters after tolterodine treatment for female overactive bladder syndrome with or without voiding dysfunction

AIM

To investigate changes in urodynamic parameters after tolterodine treatment for female overactive bladder syndrome, especially in patients with voiding dysfunction.

METHODS

Between January and December 2006, 44 patients were enrolled for six months of treatment with tolterodine. Pre-treatment and post-treatment urodynamic studies were scheduled for the enrolled patients.

RESULTS

Among the remaining 33 patients (11 dropped out), bladder capacity (P < 0.001) and post-void residual urine (P = 0.009) increased, and functional urethral length (P = 0.049) and pad weight test (P = 0.03) decreased after treatment. Besides this, detrusor pressure at maximal urine flow, functional urethral length, maximal urethral pressure and maximal urethral closure pressure were less affected by tolterodine in patients with voiding dysfunction, compared to those without voiding dysfunction.

CONCLUSIONS

Tolterodine treatment increased bladder capacity and decreased urine leakage; however, some urodynamic parameters in patients with voiding dysfunction were less affected by tolterodine treatment.

Does the patient's position influence the detection of detrusor overactivity?

AIMS

The demonstration of preoperative detrusor overactivity (DO) with associated overactive bladder symptoms (OAB) is known to have an adverse effect on surgery performed for stress incontinence or for prostatic obstruction. The purpose of this review is to examine the best position, when filling the bladder during urodynamics, to demonstrate detrusor overactivity and reproduce the OAB symptoms, when the demonstration of DO might be important.

MATERIALS AND METHODS

MEDLINE and PUBMED literature searches were performed, spanning the period from 1956 to August 2005 using the keywords "detrusor overactivity" or "detrusor instability" combined with "posture or position or standing or sitting" and "urodynamics." Other studies were identified by reviewing secondary references in the original citations.

RESULTS

Sixteen studies looked at the effect of position on the detection rate of DO. There is good consistency between the studies analyzed. All but two [Ramsden et al., Br J Urol 49:633-9, 1977; Choe et al., J Urol 161:1541-4, 1999] showed a clear effect, with an increase in DO when the patient is filled in the vertical position or is asked to sit or stand, with a full bladder, after being filled supine. Performing the urodynamics (UDS) in the supine position would have missed a large proportion of DO diagnoses ranging from 33% to 100%.

CONCLUSIONS

This review confirms that the patient's position is a significant variable during urodynamics and that supine cystometry will fail to detect a significant percentage of patients with DO. We suggest that all patients should be filled sitting or standing, unless physically disabled. It seems desirable for the International Continence Society (ICS) to extend its "Good urodynamic practice guideline" [Schafer et al., Neurourol Urodyn 21:261-74, 2002] to cover this important issue.

Tension-free vaginal tape, suprapubic arc sling, and transobturator tape in the treatment of mixed urinary incontinence in women

We evaluated the outcome at least 6 months after tension-free vaginal tape (TVT), suprapubic arc (SPARC) sling, or transobturator tape (TOT) procedure in women with mixed urinary incontinence and identified factors predicting the outcome in these patients. A total of 144 women, 29 to 77 years old (mean age 57.3), were included in the study; TVT (n = 72), SPARC (n = 22), and TOT (n = 50). The mean follow-up time was 10.9 months (range 6 to 52). There were no significant differences in the three groups in terms of the cure rate for stress urinary incontinence (SUI; TVT, 95.8%; SPARC, 90.0%; TOT, 94.0%; P = 0.625) and urinary incontinence (UUI; TVT, 81.9%; SPARC, 86.4%; TOT, 82.0%; P = 0.965). In the multivariate model, there is no influencing factor for treatment failure of SUI, while maximum urethral closure pressure (MUCP) and the diagnosis of uninhibited detrusor contraction during cystometry were independent risk factors for treatment failure of UUI. Decreasing MUCP was associated with an increased likelihood of treatment failure of UUI [odds ratio (OR), 0.974; 95% confidence interval (CI), 0.950-0.998; P = 0.034]. In the same model, uninhibited detrusor contraction was associated with 3.4-fold risk of treatment failure of UUI (OR, 3.351; 95% CI, 1.031-10.887; P = 0.044). Our findings suggest that low MUCP and the presence of uninhibited detrusor contraction during cystometry should be considered to be at high risk of treatment failure of UUI after surgery in these patients.

Clinical and urodynamic features according to subjective symptom severity in female urinary incontinence

AIMS

The aim of this study was to determine the relationship between subjective symptom severity and clinical or urodynamic parameters and to compare these parameters according to subjective symptom severity.

METHODS

A total of 268 female patients with grade II (n = 94) and grade III (n = 174) according to the Ingelman-Sundberg scale were included in the study. Mean patient age was 55.9 years (range 28-80). Of 268 patients, 196 women (73.1%) complained of stress urinary incontinence (SUI) and 72 (26.9%) reported additional symptoms of urge urinary incontinence (UUI). Fifty-four (20.1%) women previously had hysterectomies and 12 (4.5%) underwent surgery for UI.

RESULTS

Patients with severe incontinence (grade III) are older, have longer duration of symptoms, concomitant urgency or UUI, and low maximal urethral closure pressure and low Valsalva leak point pressure (VLPP). No difference in other characteristics including pad test loss and urethral mobility was observed in the two groups. In the multivariate logistic regression analysis, a longer duration of symptoms was associated with an increased likelihood of severe symptoms (P = 0.025). Patients with mixed incontinence were at five-fold increased risk of severe symptoms compared with those with SUI only (P = 0.011). In the same model, increasing VLPP was associated with a decreased likelihood of severe symptoms (P = 0.037).

CONCLUSIONS

Longer symptom duration, mixed incontinence and low VLPP have independent effects on the severity of incontinence. Our findings suggest that incontinent patients with sphincteric impairment or urge component may have and increased probability of severe symptoms.

Overactive Bladder: A Better Understanding of Pathophysiology, Diagnosis and Management

PURPOSE

We reviewed current information regarding the updated definitions, prevalence, etiologies, disease burden, and management of OAB from a number of perspectives, including professional impact and patient quality of life.

MATERIALS AND METHODS

Published literature and current treatment concepts were reviewed regarding the understanding and management of OAB.

RESULTS

OAB is a symptom syndrome including urinary urgency with or without urinary incontinence, usually with frequency and nocturia. Approximately 17% of the adult population experience OAB. There are evolving theories regarding its pathophysiology and the mechanism of action of the most commonly prescribed pharmacological therapy (antimuscarinic agents). Treatment primarily revolves around improving quality of life.

CONCLUSIONS

Behavioral therapy combined with pharmacological therapy often will bring about acceptable outcomes for patients with OAB. Modalities such as botulinum toxin injections, neuromodulation, and various surgical interventions also are showing encouraging results in more refractory patients.

Tension-free vaginal tape procedure for urinary incontinence with low Valsalva leak point pressure

PURPOSE

We evaluated the outcome of the tension-free vaginal tape (TVT) procedure for stress urinary incontinence with low Valsalva leak point pressure (VLPP) and identified factors predicting the outcome.

MATERIALS AND METHODS

A total of 221 women 29 to 80 years old (mean age 55.2) were included in the study. The TVT procedure was performed mostly using local anesthesia. Mean followup was 10.5 months (range 6 to 52). Patients were divided into 61 with low (less than 60 cm H2O) and 160 with higher (60 cm H2O or greater) VLPP. Cure of incontinence was defined as an absent subjective complaint of leakage and absent objective leakage on stress testing.

RESULTS

The overall cure rate was significantly lower in patients with low vs higher VLPP (82.0% vs 93.1%, p = 0.013). In women with low VLPP multivariate analysis indicated that urge symptoms and low maximal urethral closure pressure were independent factors for treatment failure (OR 15.12, 95% CI 1.90 to 120.61, p = 0.010 and OR 0.92, 95% CI 0.86 to 0.99, p = 0.018, respectively).

CONCLUSIONS

The cure rate after the TVT procedure is lower in women with VLPP less than 60 cm H2O compared to those with higher VLPP. Our findings suggest that women with urge symptoms and low maximal urethral closure pressure should be considered to be at high risk for failure after the TVT procedure.

TENSION-FREE VAGINAL TAPE PROCEDURE FOR THE TREATMENT OF MIXED URINARY INCONTINENCE: SIGNIFICANCE OF MAXIMAL URETHRAL CLOSURE PRESSURE

PURPOSE

We investigated factors predicting persistent urge incontinence after the tension-free vaginal tape procedure in patients with mixed urinary incontinence.

MATERIALS AND METHODS

Between March 1999 and May 2003 female patients with complaints of urinary incontinence were evaluated according to our protocol. After the tension-free vaginal tape procedure patients were followed at 1, 6 and 12 months, and yearly thereafter. A total of 274 women (stress urinary incontinence in 201 and mixed urinary incontinence in 73) with followup at least greater than 6 months were included in the study. The cure of stress induced incontinence after the procedure was defined as an absent subjective complaint of leakage and objective leakage on stress testing. All other cases were considered failures.

RESULTS

There was no significant difference in the cure rate for stress induced incontinence between patients with stress and mixed urinary incontinence. However, 12 of 73 patients (16.4%) with mixed urinary incontinence had persistent urge incontinence. Thus, the overall cure rate was significantly higher in the stress incontinence group than in the mixed incontinence group (95.5% vs 78.1%, p <0.001). On multivariate analysis maximal urethral closure pressure was associated with a 0.9-fold risk of persistent urge incontinence after the procedure in patients with mixed urinary incontinence (OR 0.94, 95% CI 0.88 to 0.99, p = 0.030).

CONCLUSIONS

Our findings suggest that low maximal urethral closure pressure may be associated with persistent urge incontinence after the tension-free vaginal tape procedure in patients with mixed urinary incontinence.

Are urodynamic tests useful tools for the initial conservative management of non-neurogenic urinary incontinence? A review of the literature

OBJECTIVES

To summarise the evidence for the role of urodynamic tests in the diagnosis and classification of urinary incontinence.

METHODS

Reference lists in relevant papers were reviewed and MEDLINE searches conducted.

RESULTS

The mean sensitivity (specificity) of clinical history versus urodynamic tests was 0.82 (0.57) for stress incontinence, 0.69 (0.60) for urge incontinence/overactive bladder, and 0.51 (0.66) for patients with mixed incontinence. The proportion of women with a clinical diagnosis of urinary incontinence but with normal findings from urodynamic tests ranged from 3 to 8%. Overall sensitivity of urodynamic tests was about 85-90% in the diagnosis of urodynamic stress incontinence, but generally lower following diagnosis of urge and mixed incontinence. No relationship emerged between urodynamic test results and response to medical treatment.

CONCLUSIONS

This literature review shows that the sensitivity of clinical history versus urodynamic tests was 0.82, 0.69 and 0.51 respectively for stress, urge and mixed urinary incontinence. It also suggests that urodynamic diagnosis does not predict response to treatment. These data add to the ongoing 'urodynamics or no urodynamics' debate in the evaluation of urinary incontinence and show that urodynamic testing may not be helpful for patients receiving initial non-invasive therapy. These data are in line with the conclusions of the 1st and 2nd International Consultations on incontinence.

An assessment of the surgical outcome and urodynamic effects of the pubovaginal sling for stress incontinence and the associated urge syndrome

PURPOSE

We assessed the urodynamic changes after pubovaginal sling procedure for stress incontinence, particularly in regard to the associated symptoms of urgency, frequency, nocturia and urge incontinence, known as the urge syndrome.

MATERIALS AND METHODS

A total of 85 women with proved stress incontinence underwent a pubovaginal sling procedure using rectus fascia between 1992 and August 1996. Of the women 41 (48%) had undergone previous anti-incontinence surgery and 59 (69%) had the associated urge syndrome. There was at least some degree of hypermobility in 51 cases and type III stress incontinence was diagnosed in 34. Patients were assessed with a questionnaire and video urodynamics preoperatively and 3 months postoperatively. Preoperative and postoperative ambulatory studies were performed in 25 cases.

RESULTS

Of the 85 patients 83 (97%) were symptomatically cured of stress incontinence. The urge syndrome resolved in 32 patients (69%), almost all of whom had a closed bladder neck at rest. Overall bladder neck incompetence at rest decreased from 57 to 18% (p<0.001). Of 27 patients with the persistent urge syndrome postoperatively 9 (41%) had an open bladder neck at rest compared to 4 of 50 (8%) without urge incontinence (p<0.01). Despite symptomatic control of stress incontinence in 83 patients (97%), only 66 were satisfied with the surgical result, mainly because of the persistent urge syndrome in 27. Despite care to avoid obstruction overall, there were statistically significant obstructive changes in detrusor pressure at maximum flow rate, maximum flow rate and residual urine volumes.

CONCLUSIONS

The pubovaginal sling is effective in curing genuine stress incontinence and, when correctly placed at the right tension, the associated urge syndrome also can be managed, usually by achieving bladder neck closure at rest. However, despite careful maneuvers, obstruction occasionally persists.

Simple urodynamic evaluation of incontinent elderly female nursing home patients. A descriptive analysis

We present a descriptive analysis of the functional, mental, and urodynamic status of a population of incontinent elderly female nursing home patients. One hundred fifty-five intermediate care female patients with a mean age of 85.5 years were identified as being incontinent of urine at least once daily. After urologic evaluation, each patient was classified into one of four categories: incontinence with normal cystometrogram 68 (44%), detrusor instability (DI) 52 (34%), stress incontinence (SI) 27 (17%), or overflow incontinence (OI) 7 (4%). Thirteen weeks later, patients were again studied using simple water cystometry. At follow-up evaluation, 45 patients (33%) had urodynamic findings which differed from the initial evaluation. Of these women, 10 with DI, 12 with SI, and 2 with OI were found to have normal cystometric parameters at the time of follow-up study, while 19 (14%) who initially had normal cystometric findings had evidence of DI (11) or SI (3). Strong correlation between urinary incontinence in patients with normal cystometric findings and moderate to severe cognitive impairment was present. Simple urodynamic evaluation did identify patients with SI and OI who might benefit from specific therapy. Urodynamic evaluation of incontinent elderly female nursing home patients is indicated and may provide direction for planning treatment strategies.

Urinary incontinence in community-dwelling women: clinical, urodynamic, and severity characteristics

Descriptive data on 145 community-dwelling older women with urinary incontinence are presented. Assessment included history, physical and functional examinations, and urodynamic and severity evaluations. Patients were 67 +/- 8 years old, mentally and functionally intact, predominantly white, and of middle-to-upper socioeconomic strata. Specific urodynamic criteria were used to establish the diagnosis of sphincteric incompetence and detrusor instability. Fifteen (10%) did not fulfill either criteria, 90 (62%) had sphincteric incompetence, 17 (12%) had detrusor instability, and 23 (16%) had both. Detrusor and urethral function variables showed some impairment in all patients. Impairment was least in subjects without demonstrable diagnosis and worst in those with both disorders (p less than 0.01). The findings suggest that detrusor and urethral functions are impaired in all incontinent women and that the degree of impairment varies. The impairment seems worse when both urodynamic diagnoses are demonstrable. The data support the pathophysiologic association of urethral and detrusor dysfunctions.

Simple versus multichannel cystometry in the evaluation of bladder function in an incontinent geriatric population

Bladder capacity and stability were determined among 171 incontinent geriatric patients (mean age 80 years) with 2 techniques: a simple procedure for cystometry involving incremental bladder filling by gravity and a continuous water filling multichannel cystometrogram. Bladder capacities measured by both methods in 164 patients were correlated significantly by simple linear regression (r equals 0.75, p equals 0.0001) and they were not significantly different by paired t tests (t equals 1.20, p equals 0.23). Of the patients 110 (64 per cent) had detrusor motor instability or hyperreflexia on the multichannel cystometrogram, and simple cystometry had a sensitivity of 75 per cent, specificity of 79 per cent and positive predictive value of 85 per cent for this finding. The simple procedure was practical, well tolerated and helped to provide information for management decisions that would have been difficult to obtain from many of these geriatric patients without a formal and more complex urodynamic evaluation. When performed with other simple tests of lower urinary tract function and interpreted in conjunction with a few straightforward clinical criteria, simple cystometry can be helpful to assess bladder function among incontinent geriatric patients in settings in which formal urodynamics are either unavailable or impractical.

The value of bladder filling in the clinical detection of urine loss and selection of patients for urodynamic testing

Bladder filling was used to enhance the clinical detection of urine loss in 37 women who attended a general gynaecological outpatient clinic with lower urinary tract symptoms and incontinence. Videocystourethrography was performed subsequently in all women, and the clinical and fluoroscopic detection of urine loss compared. The two methods of detecting urine loss agreed in all but four women with very slight genuine stress urinary incontinence, two being detected by one but not by the other of the two tests. In only 5 of 25 patients was incontinence demonstrable clinically without bladder filling, and in only 13 of 25 was it demonstrable in the supine position. These proportions were 5 of 21 and 10 of 21, respectively, for those with genuine stress incontinence, with or without coexistent detrusor instability. Bladder filling provoked uncontrollable voiding in five women, two had detrusor instability on cystometry, and two had low peak urinary flow rates on uroflowmetry. The significance of these findings is discussed in the context of selecting patients for urodynamic testing.

Clinical versus urodynamic diagnosis in an incontinent geriatric female population

The clinical presentation of incontinence was compared to diagnoses based on urological and urodynamic evaluation in 135 elderly women assessed consecutively in an outpatient clinic. Most patients (64 per cent) presented with mixed symptoms: 16 per cent presented with pure stress and 16 per cent with pure urge incontinence. After evaluation 46 per cent of the patients had stress incontinence with a stable bladder, 27 per cent had detrusor instability or hyperreflexia without sphincter weakness and 19 per cent had mixed urodynamic abnormalities. Presenting symptoms were predictive of urodynamic diagnosis in 64 per cent of the patients with pure stress incontinence and 55 per cent with pure urge incontinence. In general, symptoms in our patient population were less predictive of urodynamic findings than in previously reported series of younger incontinent women but they were more predictive than in other series of elderly women. Predictive values for some urodynamic findings were enhanced by combining a symptom with certain physical findings. Implications of these data for the evaluation and treatment of incontinence in the geriatric population are discussed.

Cystometry: unstable bladder and urinary tract infection

In order to study the effect of urinary infections upon the incidence of bladder instability during cystometric evaluation, 15 women underwent cystometry during the course of significant bacteriuria (10(5) organisms/ml) and again 2 weeks after treatment. The pre-treatment incidence of bladder instability (53%) dropped by 50% following treatment of the infection but other cystometric measurements remained unchanged. Urinary tract infections must be treated adequately before treating bladder instability.

Perineal electromyographic patterns in urge incontinence

The EMG patterns of anal sphincter and periurethral striated musculature were analyzed in 55 women with urge incontinence during cystometry. Six had a sensory urge and 49 a motor urge incontinence. In 18 cases the unstable bladder contractions were accompanied by an intense EMG activation and in 31 cases by a decrease of perineal activity. During bladder filling a progressive decline of activity was found in 9 cases and an irregular EMG pattern and urethral pressure in 18 cases. Five patients had abnormal EMG action potentials while 16 out of 39 patients had an abnormal evoked sphincter reaction. Although the EMG of the perineal muscles during bladder filling is often abnormal in women with urge incontinence, it does not give any additional information on the causes of the urethral and bladder instability.

Bladder training and terodiline in females with idiopathic urge incontinence and stable detrusor function

Twenty consecutive female patients with urge incontinence and stable detrusor function on provocative rapid fill CO2-cystometry were treated as out-patients with a bladder training programme and with terodiline/placebo in a double-blind cross-over design. Frequency and incontinence episodes decreased significantly, while first sensation and cystometric bladder capacity increased. Both objectively and subjectively terodiline was significantly better than placebo with 50% (95% confidence limits 18-82) more patients improved on terodiline than on placebo. Thirty percent of the patients (95% confidence limits 12-54) relapsed after withdrawal of terodiline. At 3 months follow-up the remaining 70% were satisfied with the outcome of the training programme. Side effects were mild and reversible. Serum creatinine and alkaline phosphatase increased slightly on terodiline and the diastolic blood pressure was probably also increased by terodiline. In conclusion, female patients with idiopathic urge incontinence and stable detrusor function did respond to treatment as do female patients with urge incontinence and proven instability.