Urethral dilatation: Is there any benefit over cystoscopy and distension? A randomized trial in women with overactive bladder symptoms

Abstract

To evaluate the effect of urethral dilatation (UD) on urgency symptoms in women with overactive bladder (OAB) and voiding dysfunction. Women with OAB symptoms and a maximum flow rate of less than 15 ml/sec on a volume voided of 200 ml were eligible for entry to the trial. Fifty women with OAB symptoms and a maximum flow rate of less than 15 ml/sec on a volume voided of over 200 ml were randomized to undergo UD plus cystoscopy or cystoscopy alone. All subjects underwent filling and voiding cystometry pre-operatively and at 6 weeks' post-operatively. Subjective outcomes were assessed using the Urgency Perception Scale (UPS) and King's Health Questionnaire at baseline, 6 weeks and 6 months. The primary outcome measure was cure of urgency, defined using the UPS. Urgency was cured in 10/22 (45%) patients in the UD group and 5/28 (18%) in the non-UD group at 6 weeks (Odds ratio 3.8, 95% confidence interval 1.1-13.8, P = 0.03). Cystometric flow data were available for all patients pre- and post-UD. UD was associated with a significant increase in the flow rate centile from 1.66 to 8.54 (P = 0.01). At 6 months there was no benefit from UD with 4/22 in the UD group cured of urgency and 4/28 in the non-UD group cured (Odds ratio 1.3, 95% confidence interval 0.3-6.1, P = 0.50). UD confers a significant short-term benefit in cure of urgency over cystoscopy alone, but there is no significant benefit in symptom relief in the long term.