Predictability of urodynamic findings based on the urogenital distress inventory-6 questionnaire

Abstract

Objectives. The Urogenital Distress Inventory (UDI-6) is a validated 6-item questionnaire that assesses lower urinary tract symptoms, including incontinence, in women. Similar indexes developed in men to evaluate symptoms of benign prostatic hyperplasia have failed to show a relationship with urodynamic (UD) parameters indicating bladder outlet obstruction (BOO). In this study, we sought to determine whether UDI-6 responses could predict information obtained during UD evaluations. Methods. All women referred to our clinic with lower urinary tract complaints who completed a UDI-6 questionnaire and subsequently underwent UD evaluation were included (n = 128). UD findings used for analysis included Valsalva leak point pressure (VLPP), maximum flow rate (Qmax), and detrusor pressure at Qmax (PdetQmax). BOO was defined as Qmax of 15 mL/s or less and PdetQmax of greater than 20 cm H 2O; detrusor overactivity (DO) was defined as any rise in detrusor pressure associated with urge during filling. Results. The most common chief complaints were incontinence (mixed, 26.6%; stress, 20.3%; and urge, 13.3%), urgency/frequency (14.1%), and symptomatic prolapse (10.1%). There was a moderate correlation between a positive response to question 3 (stress urinary incontinence [SUI]) and leakage with strain or cough during UD evaluation (correlation coefficient = 0.51). In fact, most patients answering that SUI was moderately or greatly bothersome were found to have stress-induced leakage during the UD evaluation (82%), which differed significantly from those who reported no bother (Fisher’s exact test, P = 0.0006). Severity of leakage assessed by VLPP, however, did not correlate with the severity assessed by any question. With regard to BOO in women, most patients who answered that incomplete emptying was their most bothersome symptom had BOO (61%), and most women with a different main complaint were unobstructed (73%, P <0.002). Finally, 30 of 36 women who answered that leakage related to urgency was moderately or greatly bothersome were found to have DO, which was significantly different than the incidence of DO in women who did not report this complaint (correlation coefficient = 0.38, P <0.001). Conclusions. Unlike similar indexes used to assess lower urinary tract symptoms in men, specific items from the UDI-6 may provide predictive information regarding UD findings in women, particularly with regard to SUI, BOO, and DO. However, if VLPP is considered vital to planning treatment, UD studies will still be required, since no question could estimate the severity of incontinence as determined by serial VLPP measurement.