Handwashing in the cystometric evaluation of detrusor instability

Abstract

AbstractAmbulatory community living women were evaluated for complaints of urinary incontinence. Diagnostic testing included a detailed history and physical examination, urinalysis, full bladder stress testing, and urodynamic studies consisting of uroflometry, urethropro‐filometry, and provocative water cystometry. Provocative maneuvers included coughing, heel bouncing, and handwashing. Uninhibited contractions were detected during cystometry in 34 of the 112 patients who completed diagnostic testing. The majority (74%) of the 34 patients with detrusor instability demonstrated evidence of uninhibited contractions during the filling phase of cystometry; coughing elicited contractions in 20%, heel bounces in 9%, and handwashing in 68% of patients, respectively. Of the nine patients with detrusor instability who did not have contractions during filling, all nine demonstrated bladder contractions after handwashing, whereas coughing and heel bouncing each elicited contractions in one patient apiece. In 66 patients who had evidence of stress‐related urine loss during the cystometric study, all but one lost urine with coughing but only 14% after handwashing. These findings suggest handwashing may be a sensitive and specific stimulus for detection of detrusor instability during cystometric testing.