Detrusor Overactivity Incontinence Research Articles

Real-World Use of Intradetrusor Botulinum Toxin Injections: A Population-Based Study from France.

In recent decades, intradetrusor injections of botulinum toxin A (BoNT-A) have been widely applied to treat incontinence in both idiopathic overactive bladder (iOAB) and neurogenic detrusor overactivity incontinence (NDOI). This analysis, based on the French National Hospital Discharge Database (PMSI), aims to describe real-world trends in intradetrusor BoNT-A use between 2014 and 2022. Among 32,864 patients who received at least one intradetrusor BoNT-A injection, 18,320 (55.7%) had conditions coded under iOAB, 13,376 (40.7%) under NDOI, and 1168 (3.6%) under other indications. The overall mean interval between two intradetrusor BoNT-A injections was 9.7 months, ranging from 8.7 months in patients with multiple sclerosis (MS) to 11.5 months in patients with cerebral pathologies. The median number of injections was two (quartile 1-quartile 3, 1-4) in patients with spina bifida, whereas it was five (2-10) in those with MS. Only 31% of patients with iOAB received more than two intradetrusor BoNT-A injections. Regardless of its indication, BoNT-A was well tolerated. Adverse events occurring during or requiring hospitalization included infections (3.8%), hematuria (0.53%), and bleeding episodes necessitating transfusions (0.11%), all recorded within the initial month following BoNT-A injection. Our analysis of the PMSI database highlights a broad spectrum of intradetrusor BoNT-A injection practices.

Concomitant Botulinum Toxin Injections for Neurogenic Detrusor Overactivity and Spasticity-A Retrospective Analysis of Practice and Safety.

As multiple indications for botulinum toxin injections (BTIs) can coexist for neurological patients, there are to date no description of concomitant injections (CIs) to treat both spasticity and neurogenic detrusor overactivity incontinence (NDOI) in patients with spinal cord injuries (SCIs) and multiple sclerosis (MS). We therefore identified patients followed at our institution by health data hub digging, using a specific procedure coding system in use in France, who have been treated at least once with detrusor and skeletal muscle BTIs within the same 1-month period, over the past 5 years (2017-2021). We analyzed 72 patients representing 319 CIs. Fifty (69%) were male, and the patients were mostly SCI (76%) and MS (18%) patients and were treated by a mean number of CIs of 4.4 ± 3.6 [1-14]. The mean cumulative dose was 442.1 ± 98.8 U, and 95% of CIs were performed within a 72 h timeframe. Among all CIs, five patients had symptoms evocative of distant spread but only one had a confirmed pathological jitter in single-fiber EMG. Eleven discontinued CIs for surgical alternatives: enterocystoplasty (five), tenotomy (three), intrathecal baclofen (two) and neurotomy (one). Concomitant BTIs for treating both spasticity and NDOI at the same time appeared safe when performed within a short delay and in compliance with actual knowledge for maximum doses.

Mirabegron in the treament of neurogenic detrusor overactivity incontinence in patients with Parkinson’s disease: Persistence to treatment in a medium-term follow-up

Mirabegron in the treament of neurogenic detrusor overactivity incontinence in patients with Parkinson’s disease: Persistence to treatment in a medium-term follow-up

Efficacy and Safety of AbobotulinumtoxinA in Patients with Neurogenic Detrusor Overactivity Incontinence Performing Regular Clean Intermittent Catheterization: Pooled Results from Two Phase 3 Randomized Studies (CONTENT1 and CONTENT2)

BackgroundFor patients with neurogenic detrusor overactivity incontinence (NDOI), treatment with oral medications is often unsatisfactory. ObjectiveTo assess the efficacy and safety of abobotulinumtoxinA (aboBoNT-A) for NDOI. Design, setting, and participantsTwo randomized, double-blind phase 3 studies (CONTENT1, NCT02660138; CONTENT2, NCT02660359) enrolled patients with NDOI who were regularly performing clean intermittent catheterization (CIC) and were inadequately managed with oral therapy. Pooled results from the first placebo-controlled treatment cycle are reported. InterventionPatients received injections of aboBoNT-A 600 U (n = 162) or 800 U (n = 161) or placebo (n = 162) into the detrusor muscle. Outcome measurements and statistical analysisThe primary endpoint was the mean change from baseline in NDOI episodes per week at week 6. Secondary endpoints reported are the proportion of patients with no NDOI episodes, the volume per void, urodynamic parameters, and quality of life (QoL). Safety was also assessed. Statistical analyses were conducted for the pooled study populations (each aboBoNT-A dose vs placebo). Results and limitationsAt week 6, NDOI episodes per week were significantly reduced in each aboBoNT-A group versus placebo (both p < 0.001) and the volume per void had significantly increased. Approximately one-third of patients in each aboBoNT-A dose group reported no NDOI episodes versus 3% of patients in the placebo group. Reductions in urinary incontinence (UI) were reflected in significantly greater improvements in UI-related QoL in the aboBoNT-A groups versus placebo. Urodynamic parameters (bladder capacity and detrusor pressure) were significantly improved with each aboBoNT-A dose versus placebo. Each aboBoNT-A dose was well tolerated. Symptomatic urinary tract infection was the most frequent treatment-emergent adverse event, with incidence comparable across the aboBoNT-A and placebo groups. The studies were terminated prematurely owing to slow recruitment and were not designed for statistical comparison between the two aboBoNT-A doses. ConclusionsIntradetrusor aboBoNT-A is an effective treatment and alternative option for patients with NDOI who have an inadequate response to oral anticholinergics and are already performing CIC. Patient summaryIn patients with bladder muscle overactivity caused by neurological conditions (multiple sclerosis or spinal cord injury) and resulting in urinary incontinence, abobotulinumtoxinA injections improved their symptoms and bladder function, with no unexpected effects.

P0023 - IncobotulinumtoxinA is not inferior to OnabotulinumtoxinA intradetrusor injections in the treatment of neurogenic detrusor overactivity incontinence: A multicentre, randomized, double-blind, clinical trial

P0023 - IncobotulinumtoxinA is not inferior to OnabotulinumtoxinA intradetrusor injections in the treatment of neurogenic detrusor overactivity incontinence: A multicentre, randomized, double-blind, clinical trial

IncobotulinumtoxinA versus onabotulinumtoxinA intradetrusor injections in patients with neurogenic detrusor overactivity incontinence: a double-blind, randomized, non-inferiority trial.

A randomized, double-blind, non-inferiority clinical study was performed on the efficacy and tolerability of IncobotulinumtoxinA (Incobot/A) vs. OnabotulinumtoxinA (OnabotA) intradetrusor injections in patients with refractory neurogenic detrusor overactivity incontinence performing intermittent catheterization. Sixty-four patients with spinal cord injury (SCI) or multiple sclerosis were randomized to receive 30 intradetrusor injections of Incobot/A or OnabotA 200 U; 28 patients in incobotulinumtoxinA group and 29 in onabotulinumtoxinA group completed the study. Primary outcome measure was the non-inferior variation from baseline in daily urinary incontinence episodes (week 12), with a non-inferiority margin of one episode/day. Secondary outcomes measures were changes in Incontinence- Quality of Life questionnaire, Visual Analog Scale Score (bother of symptoms on Quality of Life), urodynamic parameters, occurrence of adverse effects and related costs (week 12). At week 12, mean value of difference in urinary incontinence episodes/day between the two groups was -0.2 (95% two-sided CI: -1; 0.7); the difference in incontinence episodes/day between the two groups was -0.4 with a higher limit of one-sided 95% CI of 0.2 episodes/day which was much lower than the non-inferiority margin of one episode/day. Total score and subscores of Incontinence- Quality of Life questionnaire, Visual Analog Scale scores and urodynamics did not show differences between the two groups. Adverse effects were similar for both treatments, with urinary tract infection being the most frequent, localised effect. Minor costs were observed following Incobot/A. In patients with refractory neurogenic incontinence due to SCI or multiple sclerosis, incobotulinumtoxinA was not inferior to onabotulinumtoxinA in improving clinical and urodynamic findings in the short-term follow-up, with comparable adverse effects but minor costs.

Urodynamic profile in the Department of Urology, Cipto Mangunkusumo Hospital Between 2010 and 2015

BACKGROUND This study was aimed to describe urodynamic profiles, the role and advantages of urodynamics for urinary problems detection, and to analyze whether urodynamic examination has been ordered based on accurate indications following guidelines in the Department of Urology Cipto Mangunkusumo Hospital between 2010 and 2015. METHODS Data was retrieved from the patient’s medical records who underwent urodynamic examinations in the Department of Urology Cipto Mangunkusumo Hospital between July 2010 to August 2015. RESULTS 1,091 patients undergone urodynamic procedures in the Department of Urology Cipto Mangunkusumo Hospital. In 553 lower urinary tract symptoms (LUTS) patients, there were 186 (34%) small bladder capacity, 84 (15%) detrusor overactivity (DO), 180 (33%) bladder outlet obstruction (BOO), and 198 (36%) bladder atony patients. In the 317 urinary retention patients, there were 121 (38%) patients with BOO and 2 (1%) patients with a normal voiding phase. In 80 overactive bladder patients, there were 51 (64%) with DO, 17 (21%) with DO incontinence, and 22 (28%) with urodynamic stress incontinence (SI). Among 81 patients with SI problems, there were 63 (78%) urodynamic SI, 9 (11%) DO, and 9 (11%) DO incontinence patients. In 60 (6%) pediatric patients, most LUTS and urinary retention patients were caused by impaired bladder contraction. CONCLUSIONS This study shows the role and superiority of urodynamics in diagnosing patients with voiding disorders, especially if with mixed components in it. Urodynamics played essential roles in detecting urinary problems at Cipto Mangunkusumo Hospital.

When a White Horse is a Horse: Embracing the (Obvious?) Overlap Between Acupuncture and Neuromodulation.

When a White Horse is a Horse: Embracing the (Obvious?) Overlap Between Acupuncture and Neuromodulation.

A re-adjustable sling for female recurrent stress incontinence and intrinsic sphincteric deficiency: Long-term results in 205 patients using the Remeex sling system.

To evaluate the outcomes and complications at long-term follow-up after a Remeex re-adjustable sling for recurrent stress urinary incontinence (rSUI) and intrinsic sphincteric deficiency (ISD) in women. Two hundred thirty women with SUI were evaluated after undergoing a re-adjustable sling operation. Twenty-five patients were lost to follow-up, 205 were classified by Q-tip, urodynamic, and clinical criteria into ISD (109) and rSUI (96). Outcome measures included number of pads, 1 h pad-test, urodynamics and subjective satisfaction index with the procedure. After a mean follow-up of 89 months (26-159), 165 patients were cured of SUI (71.7% in the intention to treat analysis (itt), 80.5% in per protocol analysis (pp)). Forty patients remained incontinent (17.4% in itt, 19.5 in pp). Thirty-one patients (15.1%) had detrusor overactivity (DH) incontinence, 21 (10.2%) with de-novo DH and 10 with previous urodynamic mixed incontinence. Eighty-eight patients required re-adjustment of the sling during the follow-up. The tension was increased in 82 cases due to recurrence of SUI and reduced in six due to outlet obstruction. The overall complications rate was 28.8%, (3.4% clavien III). The Remeex re-adjustable sling provides a good cure rate for rSUI and ISD at long-term follow-up. The complications rate is acceptable since most complications are clavien II. The ability to re-adjust the sling tension during the follow-up allowed us to achieve cure for recurrence after the initial procedure, and to relieve obstruction in every case attempted.

Intradetrusor onabotulinumtoxinA injections for refractory neurogenic detrusor overactivity incontinence: do we need urodynamic investigation for outcome assessment?

To evaluate if urinary continence in patients with refractory neurogenic detrusor overactivity (NDO) incontinence after intradetrusor onabotulinumtoxinA injections is sufficient for appropriate outcome assessment or if urodynamic investigation (UDI) is needed. A consecutive series of 148 patients undergoing intradetrusor onabotulinumtoxinA injections for refractory NDO incontinence were prospectively evaluated. Patients underwent UDI before and at 6 weeks after onabotulinumtoxinA injections. The primary outcome was the prevalence of maximum storage detrusor pressure (Pdetmax storage) of >40 cmH2 O in continent patients at 6 weeks after treatment. The secondary outcomes were treatment effects on other clinical and video-urodynamic variables. At 6 weeks after intradetrusor onabotulinumtoxinA injections, 98 of the 148 patients (66%) with NDO incontinence were continent. Of these patients, 18 (18%, confidence interval 12-27%) had a Pdetmax storage of >40 cmH2 O. Gender, underlying neurological disorder, and high Pdetmax storage before treatment appear to increase the risk of poor urodynamic outcomes. Urinary continence is not sufficient for outcome assessment after intradetrusor onabotulinumtoxinA injections, as high intravesical pressures threatening the upper urinary tract may be missed in a relevant proportion of continent patients. Therefore, we strongly recommend UDI as a routine part of the follow-up.

MP63-18 DO SYMPTOMS CORRELATE WITH URODYNAMIC FINDINGS FOR MEN WITH POST-PROSTATECTOMY INCONTINENCE?

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Incontinence: Evaluation (Urodynamic Testing)1 Apr 2017MP63-18 DO SYMPTOMS CORRELATE WITH URODYNAMIC FINDINGS FOR MEN WITH POST-PROSTATECTOMY INCONTINENCE? Joseph LaBossiere and Sender Herschorn Joseph LaBossiereJoseph LaBossiere More articles by this author and Sender HerschornSender Herschorn More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1970AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Persistent bothersome urinary incontinence occurs in up to 10-15% of men after radical prostatectomy (RP). Urodynamics (UDS) are often utilized in the assessment of men with post-prostatectomy incontinence (PPI). Our objective is to determine how well patient symptoms correlate with UDS in men with PPI. METHODS Retrospective review of a cohort of 496 men referred to our institution with PPI over a 20-year period. All patients with a history of RP were included in the study. All patients had a standardized history as well as the original multichannel UDS and interpretation. RESULTS 496 patients with an average age of 64 were reviewed accounting for 513 studies. UDS were performed on average 3 years after RP. On history, 471 (91%) patients complained of stress urinary incontinence (SUI), 249 (48%) urgency urinary incontinence (UUI) and 207 (40%) had mixed urinary incontinence (MUI). 264 (52%) of patients had only SUI and 42 (8%) only UUI symptoms. 356 of the 471 patients with a history of SUI symptoms had SUI on UDS for a positive predictive value (PPV) of 75%. Negative predictive value (NPV) for SUI symptoms was 78%. 6% of men complaining of SUI symptoms on history had only detrusor overactivity incontinence (DOI) on UDS, and 18% of men with SUI symptoms demonstrated no incontinence on UDS. 108 of the 249 patients with symptoms of UUI had DOI on UDS for a PPV of 43%. NPV for UUI symptoms was 85%. Of the 42 men complaining only of UUI symptoms, 14% had only SUI, 50% had only DOI and 17% had both SUI and DOI on UDS. 19% of men with only UUI symptoms demonstrated no incontinence on UDS. 77% of patients with MUI symptoms had SUI on UDS. CONCLUSIONS 91% of men in this study with PPI presented with some element of SUI symptoms on history. SUI symptoms on history accurately predicts SUI on UDS and rarely identifies only DOI. These data question the routine use of UDS in the workup of men presenting with SUI symptoms after RP prior to treatment. Men complaining only of UUI symptoms on history also predicts for DOI on UDS. UDS may be helpful in this patient group to further guide treatment decisions if initial treatment fails and to rule out SUI. Most men with MUI symptoms will have SUI identified on UDS. © 2017FiguresReferencesRelatedDetailsCited byViers B, VanDyke M, Pagliara T, Shakir N, Scott J and Morey A (2017) Improving Male Sling Selectivity and Outcomes—A Potential Role for Physical Demonstration of Stress Urinary Incontinence Severity?Urology Practice, VOL. 5, NO. 6, (458-465), Online publication date: 1-Nov-2018. Volume 197Issue 4SApril 2017Page: e842-e843 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Joseph LaBossiere More articles by this author Sender Herschorn More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP27-03 PREDICTION OF URGE URINARY INCONTINENCE (UUI) AFTER HOLMIUM LASER ENUCLEATION OF PROSTATE (HOLEP): REVISITING THE URODYNAMIC DETRUSOR OVERACTIVITY (DO)

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology II1 Apr 2017MP27-03 PREDICTION OF URGE URINARY INCONTINENCE (UUI) AFTER HOLMIUM LASER ENUCLEATION OF PROSTATE (HOLEP): REVISITING THE URODYNAMIC DETRUSOR OVERACTIVITY (DO) Myong Kim, Tai Young Ahn, and Myung-Soo Choo Myong KimMyong Kim More articles by this author , Tai Young AhnTai Young Ahn More articles by this author , and Myung-Soo ChooMyung-Soo Choo More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.795AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Recent recommendation of international continence society (ICS, 2002) suggested the qualification of urodynamic DO as according to their pattern (phasic or terminal) or causes (neurogenic or idiopathic). However, quantification of DO has not been suggested. It is well known that there are some discordances between urodynamic DO and actual storage symptoms such as UUI. We assessed whether the quantification of urodynamic DO can improve the prediction of post-operative UUI following the HoLEP in patients with benign prostatic hyperplasia. METHODS We prospectively measured the filling volume at DO (Vol_DO), detrusor pressure at DO (PdetDO), and presence or absence of DO incontinence, in addition to the ICS recommendations for urodynamic study (UDS) in 105 patients who underwent HoLEP between May 2010 and September 2015. RESULTS Mean age (±SD) and prostate volume were 71.1 (±7.0) years and 63.7 (±24.2) mL. Of the 105 patients, 10 (9.5%) patients experienced the UUI at post-operative 3 months. The UUI-positive group demonstrated higher international prostate symptom score (IPSS)-storage (11.4 vs. 7.5, p=0.004) than the UUI-negative group. However, other parameters such as age, prostate size, preoperative uroflometry findings, IPSS-emptying, and IPSS-QoL were not significantly different between two groups (p range, 0.062-0.797). On UDS findings, UUI-positive group showed higher PdetDO than UUI-negative group (100.4 vs. 54.7 cmH2O, p=0.008). However, rates of DO presence and DO_vol were not significantly different between two groups (p-value, 0.423 and 0.788). DO incontinence is more frequent in UUI-positive group than in UUI-negative group, but failed to reach the statistical significance (80.0 vs. 52.6%, p=0.098). Spline curve analysis results suggested the optimal cut-off value of PdetDO for increased risk of UUI as 108.0 cmH2O (Figure). Our multivariate analysis revealed that pre-operative IPSS-storage (OR=1.696, p=0.036) and PdetDO (≥108.0 cmH2O; OR=15.546, p=0.044) were independent predictive factors for UUI after HoLEP. CONCLUSIONS Quantification of urodynamic DO improved the prediction of UUI after HoLEP © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e328-e329 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Myong Kim More articles by this author Tai Young Ahn More articles by this author Myung-Soo Choo More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Correlation of bladder wall thickness and treatment success in types of urinary incontinence

The aim of the study was to investigate the correlation between mean bladder wall thickness (BWT) and treatment success in patients diagnosed with urinary incontinence, based on urodynamic test results. In this prospective study, patient urinary incontinence type was identified using urodynamic tests. Patients (N = 125) were categorized into three groups: urodynamic stress incontinence (SUI), detrusor over-activity (DO) and mixed urinary incontinence. Measurements from the bladder dome, anterior wall and trigone were averaged to calculate BWT. Student's t test and Mann-Whitney U test were used to compare pre-treatment BWT. Receiver operating characteristic (ROC) curve analysis was used to determine optimal cut-off values for BWT to predict treatment success. Mean pre-treatment BWT significantly differed between success and non-success groups for each urinary incontinence type (p value for the SUI, DO and MUI groups was 0.043, 0.001 and 0.002 respectively). Using ROC curves to anticipate the treatment success, a threshold was calculated for mean pre-treatment BWT; 5.05mm for SUI (sensitivity 74%, specificity 66%, positive predictive value [PPV] 85%, negative predictive value [NPV] 50%), 4.98mm for DO (sensitivity 73%, specificity 92%, PPV 95%, NPV 63%) and 5.31mm for mixed type (sensitivity 88%, specificity 73%, PPV 79%, NPV 85%). The study results suggest a significant relationship between the pre-treatment BWT and the success of urinary incontinence treatment. The mean BWT may be used as a benchmark in assessing the responsiveness to treatment of urinary incontinence types.

1113 Intradetrusor onabotulinumtoxinA injections for refractory neurogenic detrusor overactivity incontinence: Do we need urodynamic investigation for outcome assessment?

1113 Intradetrusor onabotulinumtoxinA injections for refractory neurogenic detrusor overactivity incontinence: Do we need urodynamic investigation for outcome assessment?

The outcome of intravesical onabotulinum toxin injections for salvage therapy of refractory detrusor overactivity following augmentation enterocystoplasty

Objective: The objective of this article is to assess the effect of intravesical onabotulinum toxin A (OBTX-A) injections in patients with persistent/refractory symptomatic detrusor overactivity (DO) and urge urinary incontinence (UUI) following previous augmentation enterocystoplasty. Patients and methods: We conducted a retrospective review of all patients with previous augmentation enterocystoplasty having intravesical OBTX-A for persistent/refractory DO and UUI. Information on demographics, original diagnosis, date and technique of enterocystoplasty, dose of OBTX-A and symptomatic outcomes was recorded. Results: Fifteen patients (three men) with mean age 42 years were studied. Eight out of 15 (53%) reported complete continence or significant improvement, while the remaining seven (47%) noticed no difference in their symptoms. Urodynamics were repeated in these seven patients and persistent DO was confirmed. Four out of five (80%) NDO patients who received 300 U of OBTX-A reported a favourable outcome, whereas a favourable response was noted in only four out of 10 IDO (40%) when smaller amounts of OBTX-A (100 U or 200 U) were used. Conclusions: Intravesical OBTX-A injections completely resolved or significantly improved persistent/recurrent symptoms of DO in 53% of patients with a previous augmentation enterocystoplasty. The success rate was higher for those receiving the higher dose of 300 U and/or those with NDO.

Risk factors and functional abnormalities associated with adult onset secondary nocturnal enuresis in women

The study aims to evaluate bothersome lower urinary tract symptoms (LUTS), risk factors, and associated functional abnormalities in women reporting adult onset secondary nocturnal enuresis (SNE), to help understand factors associated with SNE. 12,795 women (age >18) attending a tertiary referral centre underwent a comprehensive standardized evaluation including urodynamic testing in accordance with the International Continence Society recommendations. Records of all patients reporting bedwetting while asleep were evaluated under various categories. Multiple logistic regression was used to identify statistically significant risk factors and urodynamic findings associated with SNE. The prevalence of SNE in women undergoing urodynamic testing for bothersome LUTS was 14.4% (1,838). High BMI (OR = 1.47, P < 0.001), cigarette smoking (OR = 2, P < 0.001), antidepressant usage (OR = 1.8, P < 0.001), neurological conditions (OR = 2.12, P < 0.001), and previous hysterectomy (OR = 1.19, P = 0.03) were significantly associated with SNE. Women with SNE significantly complained of overactive bladder (OAB) symptoms (OR = 1.65, P < 0.001) and slightly higher mean nocturia episodes (OR = 1.38, P < 0.0001). Low maximum urethral closure pressure (MUCP) (OR = 1.34, P < 0.0001) and detrusor overactivity incontinence (DOI) (OR = 1.75, P < 0.0001) were significantly associated with SNE. There was no significant association with the symptom of stress urinary incontinence (P = 0.264), urodynamic stress incontinence (P = 0.454) or detrusor overactivity (P = 0.231). Women with adult SNE usually present with OAB symptoms. SNE is associated with high BMI, cigarette smoking, antidepressant use, and neurological conditions. DOI and a low MUCP are possible pathophysiological mechanisms in SNE. Neurourol. Urodynam. 36:188-191, 2017. © 2015 Wiley Periodicals, Inc.

The Functional Effects of Cigarette Smoking in Women on the Lower Urinary Tract

The aim of the study was to evaluate the urodynamic findings in women who smoke cigarettes, with bothersome lower urinary tract symptoms, to help develop an understanding of potential impact of smoking on the lower urinary tract function. Methods: A database of 11,678 women who underwent urodynamic testing in a tertiary referral centre in the United Kingdom, from January 1991 to December 2009 was retrospectively analysed. All women reporting cigarette smoking were included in the study group. Urodynamic testing and interpretation of results were done in accordance with the recommendations of the International Continence Society. Results: Overall, 2,476 (21.2%) women reported smoking cigarettes. Overactive bladder symptoms (OAB) were more common in smokers (OR 1.14, p = 0.006). Female smokers significantly complained of secondary nocturnal enuresis (OR 2.26, p < 0.001) and coital incontinence (CI; OR 1.14, p < 0.001). Detrusor overactivity (DO; OR 1.42, p < 0.001) and detrusor overactivity incontinence (DOI; OR 1.42, p < 0.001) were the most significant urodynamic findings. Smoking was not shown to be significantly associated with SUI (OR 1.08, p = 0.213) or urodynamic stress incontinence (OR 0.86, p = 0.001). Conclusion: Cigarette smoking is associated with OAB, secondary nocturnal enuresis and CI. DO and DOI are the most significant urodynamic findings.

Urodynamics for incontinence after midurethral sling removal.

We reviewed the role of urodynamics (UDS) in the management of women with incontinence following mid-urethral sling removal (MUSR). Following IRB approval, women from a longitudinal database who had persistent or recurrent urinary incontinence (UI) after MUSR, desired further therapy, and subsequently underwent UDS were reviewed. Women with neurogenic bladder, obstructive symptoms without UI, urethra-vaginal fistula, anterior compartment prolapse >Stage 2, or those who had concomitant autologous sling surgery at the time of MUSR were excluded. Interval time between MUSR and UDS, UDS findings, and UI management after UDS were recorded. From 2006 to 2013, 71 of 246 women had UDS after MUSR for persistent or recurrent UI. For the 54 women in the final analysis, mean time between tape removal and UDS was 12.4 months (range: 4-65). UDS demonstrated incontinence in 78% of patients: stress urinary incontinence (SUI) in 19 (35%), detrusor overactivity incontinence (DOI) in 6 (11%), and mixed urinary incontinence (MUI) in 17 (32%). On pressure-flow studies, the following voiding patterns were demonstrated: normal voiding (39), valsalva voiding (6), obstruction (2), underactive detrusor (1), no voiding records (6). UDS storage and emptying data were used in subsequent symptom-based patient counseling for treatment planning. Urethral bulking agent was the most commonly chosen management (43%). Our current guidelines for UDS in women after incontinence procedures and MUSR are currently based on a low level of evidence. This study reinforces the role of UDS to guide therapy for UI after MUSR. Neurourol. Urodynam. 35:939-943, 2016. © 2015 Wiley Periodicals, Inc.

Urodynamic study in women with pure stress urinary incontinence

ObjectiveTo describe the results of urodynamic study in women with pure stress urinary incontinence symptoms, including the characteristics of the overactive detrusor. No other clinical assessments were taken into account. Materials and methodsA retrospective study in women with urinary incontinence consecutively evaluated by urodynamic study. From a total of 710 women, only 108 (15%) with pure stress urinary incontinence symptoms were selected. Women with prior urinary incontinence surgery, pelvic organ prolapse (stage ≥iii), pelvic radiotherapy, using medication active on the lower urinary tract and neurological diseases were excluded. Infusion rate was 70ml/min. Detrusor overactivity was induced only by cough. A standardized cough stress test with progressive cough intensity was carried out. ResultsReference urodynamic values for stress incontinent women are described. Urodynamic stress incontinence was observed in 79 women (73.1%), detrusor overactivity in 4 (3.7%) and mixed urodynamic diagnosis in 15 (13.8%). Test was inconclusive in 10 patients (9.2%). Two women had detrusor overactivity incontinence (1.9%). One patient had detrusor overactivity induced by cough without urodynamic stress incontinence (0.9%). There was an association between detrusor overactivity and nocturia ≥2 (p=0.002; odds ratio: 3.74; 95% confidence interval: 1.22–11.39). One woman had a bladder outlet obstruction (0.9%). ConclusionsIn women with pure stress urinary incontinence, without knowing the outcome of other clinical assessments, urodynamic study can provide useful information to define the proper therapy.

Estudio urodinámico en mujeres con síntomas de incontinencia urinaria de esfuerzo pura

ObjectiveTo describe the results of urodynamic study in women with pure stress urinary incontinence symptoms, including the characteristics of the overactive detrusor. No other clinical assessments were taken into account. Material and methodsA retrospective study in women with urinary incontinence consecutively evaluated by urodynamic study. From a total of 710 women, only 108 (15%) with pure stress urinary incontinence symptoms were selected. Women with prior urinary incontinence surgery, pelvic organ prolapse (stage≥iii), pelvic radiotherapy, using medication active on the lower urinary tract and neurological diseases were excluded. Infusion rate was 70ml/min. Detrusor overactivity was induced only by cough. A standardized cough stress test with progressive cough intensity was carried out. ResultsReference urodynamic values for stress incontinent women are described. Urodynamic stress incontinence was observed in 79 women (73.1%), detrusor overactivity in 4 (3.7%) and mixed urodynamic diagnosis in 15 (13.8%). Test was inconclusive in 10 patients (9.2%). Two women had detrusor overactivity incontinence (1.9%). One patient had detrusor overactivity induced by cough without urodynamic stress incontinence (0.9%). There was an association between detrusor overactivity and nocturia≥2 (P=.002; odds ratio: 3.74; 95% confidence interval: 1.22-11.39). One woman had a bladder outlet obstruction (0.9%). ConclusionsIn women with pure stress urinary incontinence, without knowing the outcome of other clinical assessments, urodynamic study can provide useful information to define the proper therapy.