Fill Cystometry Research Articles

MP74-18 DETRUSOR VOIDING CONTRACTION VELOCITY IS RELEVANT TO PATIENTS WITHOUT BLADDER OUTFLOW OBSTRUCTION

You have accessJournal of UrologyCME1 Apr 2023MP74-18 DETRUSOR VOIDING CONTRACTION VELOCITY IS RELEVANT TO PATIENTS WITHOUT BLADDER OUTFLOW OBSTRUCTION Peter F. W. M. Rosier Peter F. W. M. RosierPeter F. W. M. Rosier More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003348.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Bladder outflow obstruction (BOO) is prevalent in male patients >45 y with LUTS but much less in women. Detrusor voiding contraction underactivity (DVC-DU) is (equally?) prevalent in in both sex. BOO affects DVC through 'compensation'; muscle training, to gain force, which is represented in DVC-detrusor- pressure. DVC-muscle shortening velocity (muscle function Hill equation) is less known/studied and is potentially relevant as an element of DVC-DU. We analysed DVC parameters including contraction velocity in a large cohort of adult men and women without BOO. METHODS: Patients without relevant neurological or anatomical abnormalities, voiding (pressure flow studies PFS) >100 mL and <800 mL with PVR <500 mL, representative, after ICS (quality) standard UDS, for all usual/possible indications, with 7F double lumen water fill cystometry, were included. All known DVC parameters were analysed and DVC-velocity is calculated: (bladder circumference (based on mL) at begin voiding minus circumference at end) / voiding time (tQ>0). All patients had BOO<3 linPURR (ICS- noOBS). 2488 patients were 63.5 y (sd 16.8) men (n1511) 66.3 y (15.1) and women (n977) 59.2 y (18.3). They voided 359 mL with PVR 47 mL; void% 89.3. RESULTS: PFS-voided volumes were not different Void% was slightly lower in men (88.6 vs 90.4). Men's Qmax 12.5 mL/s; pdetQmax 43.3 cm H2O; BOOI 18.1; and Wmax 12.3 W/m2 differed signific. from women Qmax 19.9 mL/s; pdetQmax 25.7 cm H2O; BOOI -14.1; and Wmax 13.0 W/m2. DVC-velocity was 0.37 cm/s in men vs 0.56 cm/s (p.000). 58.4% of men had void%100 62.2% of women. The Figure 1 demonstrates the relevance of DVC-velocity to predict incomplete voiding, in absence of BOO. CONCLUSIONS: Men with LUTS have somewhat higher outflow resistance than women even when they are all within the no BOO -category. Anatomical differences likely the cause. Only a small percentage of all female patients has outflow obstruction (>grade 2) and diagnosing DVC especially in cohorts of female patients (but also in men without BOO) requires a parameter that includes detrusor contraction velocity. Most of the currently available parameters to represent the contraction force or -strength of the DVC include detrusor pressure -with a certain weight- in a mathematical product. If there is no or low grade outflow resistance however, not contraction power (≈pressure), but contraction speed (velocity or (flow)rate) is more important. This is now supported by this analysis showing that, in patients without BOO (<grade3) DVC-velocity, has the highest predictive value to predict incomplete micturition. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1077 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Peter F. W. M. Rosier More articles by this author Expand All Advertisement PDF downloadLoading ...

MP08-20 THE COMPARISON OF ANXIETY LEVELS IN CHILDREN WHO UNDERWENT INVASIVE OR NON-INVASIVE URODYNAMIC STUDIES

You have accessJournal of UrologyCME1 May 2022MP08-20 THE COMPARISON OF ANXIETY LEVELS IN CHILDREN WHO UNDERWENT INVASIVE OR NON-INVASIVE URODYNAMIC STUDIES Cagri Akin Sekerci, Onur Can Ozkan, Yiloren Tanidir, Tufan Tarcan, and Selcuk Yucel Cagri Akin SekerciCagri Akin Sekerci More articles by this author , Onur Can OzkanOnur Can Ozkan More articles by this author , Yiloren TanidirYiloren Tanidir More articles by this author , Tufan TarcanTufan Tarcan More articles by this author , and Selcuk YucelSelcuk Yucel More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002530.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urodynamic studies play an important role in the evaluation of children with lower urinary tract dysfunction. In this study, we aimed to examine the effects of invasive and non-invasive urodynamic studies on the anxiety levels of children with the help of an anxiety scale. METHODS: Children aged 8-17 years who were scheduled for uroflowmetry (UF) or filling cystometry (FC) and who agreed to fill out an anxiety scale were included in the study. It was the first UF or FC of all children. “The Screen for Child Anxiety Related Disorders (SCARED)” form consisting of 41 questions was used in the evaluation. All children included in the study filled the form themselves. The SCARED results of children who underwent UF and FC were compared. RESULTS: A total of 56 children with a mean age of 10.85+/-2.98 years were included in the study. 31 (55.4%) of the children were females and 25 (44.6%) were males. The number of children who had UF was 26 (46.4%; 8.5 (8-14) years), and 30 (53.6%; 11.5 (8-17) years) had FC. The total SCARED scores of the children who underwent UF and FC were 26.5 (5-75) and 27 (2-57), respectively, and there was no statistical difference (p=0.980) (Table 1). A significant difference was found only in "Separation Anxiety Disorder" among sub-score evaluations (p=0.049) (Table 1). In children who underwent filling cystometry, there was no statistical difference in the total SCARED score between those who did and did not do clean intermittent catheterization (28 (3-41); 27 (2-57), respectively) (p=0.860). CONCLUSIONS: The SCARED scores above 25 indicate an anxiety disorder, and interestingly, in this study, both the invasive and noninvasive urodynamic study groups scored over 25. We consider that non-invasive urodynamic tests may cause stress on children as much as invasive ones. Source of Funding: No funding © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e134 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Cagri Akin Sekerci More articles by this author Onur Can Ozkan More articles by this author Yiloren Tanidir More articles by this author Tufan Tarcan More articles by this author Selcuk Yucel More articles by this author Expand All Advertisement PDF DownloadLoading ...

The results of three times repeated filling cystometry and pressure flow studies in children with non-neurogenic lower urinary tract dysfunction.

We previously reported that some urodynamic parameters change with repetitive filling in children with neurogenic lower urinary tract dysfunction (LUTD). In this study, we aimed to search if three-times repeated filling cystometries (FC) and pressure-flow studies (PFS) would change the urodynamics parameters in children with non-neurogenic LUTD. All children with three repeated FC and PFS between June 2017 and December 2018 were included in the study. Urodynamic reports and charts were evaluated retrospectively. The first sensation of bladder filling (FSBF), maximum cystometric capacity (MCC), detrusor pressure at the FSBF (Pdet.first.sens ), maximum detrusor pressure during filling (Pdet.fill.max ), presence of detrusor over activity, compliance, maximum urine flow (Qmax), detrusor pressure at the maximum urine flow (PdetQmax), residual urine and presence of detrusor sphincter dyssynergy (DSD) were compared among three-times repeated urodynamic studies. Forty children were included in the study. 27 (67.5%) were girls and 13 (32.5%) were boys. Median age was 9 (3.4-17) years. Indications were LUTD with low grade vesicoureteral reflux in 19 (47.5%), LUTD refractory to conservative management in 13 (32.5%), urinary tract infection with LUTD in 6 (15%) and secondary enuresis in 2 (5%). Pdet.first.sens , presence of DO, MCC, Qmax, PdetQmax, residual urine, flow pattern, and presence of DSD were comparable in all three repeated tests. The third FC may show decreased filling detrusor pressures and increased compliance with no change on capacity. In children with non-neurogenic LUTD, three-times repeated FC and PFS present comparable results except FSBF, Pdet.fill.max, and compliance at the third test.

Editorial Comment.

No AccessJournal of UrologyPediatric Urology1 Feb 2021Editorial CommentThis article comments on the following:Detrusor Pressures Change with Repeat Filling Cystometry in Myelodysplastic Children with Neurogenic Lower Urinary Tract Dysfunction Elizabeth B. Yerkes Elizabeth B. YerkesElizabeth B. Yerkes Division of Urology, Ann and Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001335.02AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Editorial Comment." The Journal of Urology, 205(2), pp. 584–585

Editorial Comment.

No AccessJournal of UrologyPediatric Urology1 Feb 2021Editorial CommentThis article comments on the following:Detrusor Pressures Change with Repeat Filling Cystometry in Myelodysplastic Children with Neurogenic Lower Urinary Tract Dysfunction Kristina D. Suson Kristina D. SusonKristina D. Suson Department of Urology, Children’s Hospital of Michigan, Detroit, Michigan More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001335.01AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Editorial Comment." The Journal of Urology, 205(2), p. 584 Reference 1. : Characteristics and survival of patients with end stage renal disease and spina bifida in the United States renal data system. J Urol 2015; 193: 558. Link, Google Scholar © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsRelated articlesJournal of UrologySep 8, 2020, 12:00:00 AMDetrusor Pressures Change with Repeat Filling Cystometry in Myelodysplastic Children with Neurogenic Lower Urinary Tract Dysfunction Volume 205Issue 2February 2021Page: 584-584 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kristina D. Suson Department of Urology, Children’s Hospital of Michigan, Detroit, Michigan More articles by this author Expand All Advertisement Loading ...

Detrusor Pressures Change with Repeat Filling Cystometry in Myelodysplastic Children with Neurogenic Lower Urinary Tract Dysfunction.

The International Children's Continence Society recommends urodynamics repeated at least twice for the optimal result. We aimed to search if 3 times repeat filling urodynamics in the same session would change the urodynamics parameters in children with neurogenic lower urinary tract dysfunction due to myelodysplasia. We investigated urodynamic reports and charts of 80 consecutive children with neurogenic lower urinary tract dysfunction due to myelodysplasia who underwent 3 repeat, same session filling cystometry studies between June 2017 and December 2018. Maximum detrusor pressure, maximum cystometric capacity, detrusor leak point pressure, compliance, residual urine volume and maximum cystometric capacity/estimated bladder capacity for age ratio were compared among all 3 filling cystometries. The median age was 4.3 years (IQR 5.8). Of the patients 39 (48.75%) were girls and 41 (51.25%) were boys. Primary pathological finding was myelomeningocele in 69 patients (86.3%). Maximum cystometric capacity, compliance, residual urine and maximum cystometric capacity/estimated bladder capacity for age were found comparable in 3 repeat cystometries. However, maximum detrusor pressure at first filling was higher compared to others (second, p=0.015, and third, p=0.002). Detrusor leak point pressure at the first filling was also higher compared to the third (p <0.001). Detrusor overactivity was persistent in all 3 fillings in 85% of patients (68 of 80). Of the patients 68 (85%) remained in the same risk group according to detrusor leak point pressure (cutoff 40 cmH2O). Maximum cystometric capacity and detrusor overactivity are comparable in 3 repeat cystometries but detrusor pressures significantly decrease in the repeat fillings. In our practice we plan our management according to the most worrisome urodynamics parameters for a safer proactive approach.

Detrusor pressure in cystometry compared to physiological filling in patients with a reflex urinary bladder after spinal cord injury

The maximum detrusor pressure and the duration of detrusor contractions in 10-50 ml/min fill cystometry were compared to the corresponding measurements during 12 hours of physiological filling, in 18 patients with a reflex urinary bladder after spinal cord injury. In four consecutive cystometries with 10 min intervals the intraindividual variation of the maximum detrusor pressure and the duration of detrusor contractions were similar to the variation during physiological filling. The mean pressure values in cystometries of each patient correlated well with the mean values in registration during physiological filling. In cystometry, there was no significant difference between mean values in 50 ml/min filling compared to 10 ml/min filling nor between mean values in first and second cystometries compared to third and fourth cystometries. Thus, mean values from a series of 10 ml/min or 50 ml/min fill cystometries appear to be as useful as registrations during physiological filling to describe the mean maximum detrusor pressure and the mean duration of contractions in a patient with a spinal reflex bladder.

Clinical significance of intravesical prostatic protrusion in the management of benign prostatic enlargement: a systematic review and critical analysis of current evidence.

Filling cystometry and pressure flow studies (PFS) are the most widespread used invasive urodynamic techniques in the assessment of male LUTS. However, these techniques are time- and cost-intensive. Intravesical prostatic protrusion (IPP) has been proposed as non-invasive method used to diagnose bladder outlet obstruction (BOO) in men with male lower urinary tract symptoms (LUTS). The purpose of the present review is to analyze the diagnostic and therapeutic relevance of IPP. A comprehensive systematic MEDLINE search was performed for English language reports published before June 2016 using the term "intravesical prostatic protrusion." We identified 28 eligible original articles. Determination of IPP seems as useful method to predict BOO. The area under the curve of IPP for the prediction of BOO was found to range from 0.708 (95% CI: 0.615-0.791) to 0.858 (95% CI: 0.809-0.908). IPP seems to have a predictive role in a successful trial without catheter following acute urinary retention. The percentage of successful TWOC in patients with IPP>10 mm was reported at 13% and 18%, respectively, compared to a approximately 80% chance of successful trial in patients with IPP<10 mm. The impact of IPP on postoperative outcomes following surgery for benign prostatic enlargement seems controversial. The heterogeneity of the current studies, the potential intra-observer variability and the potential learning curve need to be taken into account. Analysis of IPP may be regarded as potential non-invasive alternative to standard PFS in the assessment of BOO. Patients with IPP>10 mm should be counseled regarding the high chance of need for surgical treatment following acute urinary retention.

A Chronic, Conscious Large Animal Platform to Quantify Therapeutic Effects of Sacral Neuromodulation on Bladder Function

Sacral neuromodulation is a Food and Drug Administration approved therapy for urinary urge incontinence, urgency-frequency and fecal incontinence. Most preclinical studies have used anesthetized preparations in small animals. To expand the testing capabilities of sacral neuromodulation stimulation parameters and novel concepts we created a large animal model in fully conscious sheep. Six adult female sheep were tested weekly using 10 trials of single fill cystometry, similar to clinical urodynamics. Maximal bladder capacity was measured without (trials 1 to 5) and with (trials 6 to 10) sacral neuromodulation. A mixed effects regression model was used to analyze the effect of sacral neuromodulation on bladder capacity. Acute sacral neuromodulation significantly increased bladder capacity in conscious female sheep from 75.2 to 118.7 ml, an almost 60% increase. This was not simply an effect of repeat cystometric trials since testing without sacral neuromodulation was not associated with an increase in bladder capacity. These data demonstrate the effects of acute sacral neuromodulation on bladder capacity in the conscious sheep. This model represents a useful testing platform for novel sacral neuromodulation concepts such as alternate methods and parameters of therapy delivery.

Autonomic dysreflexia during bowel evacuation procedures and bladder filling in subjects with spinal cord injury.

Randomized, controlled clinical trial. Bladder and bowel management may cause serious autonomic dysreflexia (AD) in subjects with high spinal cord injury (SCI). We aimed at investigating autonomic responses to digital rectal evacuation (DE), transanal irrigation (TAI) with 500 ml and filling cystometry (FC) in SCI. Aarhus University Hospital, Denmark. Eight subjects with SCI (AIS A) at or above T6 (high SCI) and a previous history of AD were compared with three subjects with SCI (AIS A) between T10 and L2 (low SCI). In randomized order, DE, TAI and FC were performed. AD was defined as an acute rise in systolic blood pressure (sBP) of ⩾30 mm Hg above baseline. Blood levels of norepinephrine and epinephrine were determined before and shortly after the procedures. During all three procedures, AD occurred in all patients with high SCI but not in those with low SCI. In high SCI subjects, DE increased median sBP from 127 (range: 86-154) to 188 (range: 140-206) mm Hg (P<0.02), TAI from 126 (range: 91-146) to 163 (range: 130-188) mm Hg (P<0.02) and FC from 125 (range: 106-149) to 200 (range: 179-220) mm Hg (P<0.01). The sBP increase was lower during TAI than during DE (P<0.05) or FC (P<0.02). In high SCI subjects, the blood levels of norepinephrine, but not those of epinephrine, increased significantly during all three stimuli (all P<0.05). Bowel and bladder management caused AD in high SCI. The response is less severe during TAI than during FC or DE.

PD11-12 PREDICTING A SUCCESSFUL OUTCOME WITH SACRAL NEUROMODULATION TESTING: ARE URODYNAMIC PARAMETERS DURING FILLING CYSTOMETRY PROGNOSTIC?

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Incontinence Evaluation1 Apr 2014PD11-12 PREDICTING A SUCCESSFUL OUTCOME WITH SACRAL NEUROMODULATION TESTING: ARE URODYNAMIC PARAMETERS DURING FILLING CYSTOMETRY PROGNOSTIC? Julie Jenks, Eskinder Solomon, Mahreen Pakzad, Rizwan Hamid, Tamsin Greenwell, Julian Shah, and Jeremy Ockrim Julie JenksJulie Jenks More articles by this author , Eskinder SolomonEskinder Solomon More articles by this author , Mahreen PakzadMahreen Pakzad More articles by this author , Rizwan HamidRizwan Hamid More articles by this author , Tamsin GreenwellTamsin Greenwell More articles by this author , Julian ShahJulian Shah More articles by this author , and Jeremy OckrimJeremy Ockrim More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.545AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Sacral neuromodulation (SNM) is an effective treatment modality for medically refractory overactive bladder (OAB). Standard selection criteria are based on frequency-volume charts, pad weight (objective) assessments, and patient reported (subjective) outcomes. Little is reported of the utility of urodynamic study in selecting patients for SNM therapy. We assessed whether the urodynamic parameters during filling cystometry correlated with successful outcome from first stage SNM testing. METHODS All OAB patients were screened prior to first stage testing with urodynamics to confirm (idiopathic) detrusor overactivity (IDO). The mean voided volumes, peak amplitude of IDO contraction, compliance and end fill pressure was recorded. Primary outcomes were assessed using frequency-volume charts, pad testing and ICIQ/EQ5D questionnaires. Success was considered if patients achieved >50% improvement in urinary symptoms. Conversion to a permanent SNM implant was undertaken according to response. The predictive value of the four parameters was assessed using binary logistic regression analysis. RESULTS 177 consecutive IDO patients had first stage SNM evaluation between 2010 and 2013. The mean voided volume for patients with successful response was 184 (147-223) mls and for those with failed response 171 (128-214) mls, peak DO pressure was 41.0 (29-52) cmH20 compared to 40 (28-52) cmH20, compliance pressure 12 (7-16) cmH20 compared to 49 (3-95) cmH20, and end fill pressure 25 (19-30) cmH20 compared to 24 (14-33) cmH20. Logistic regression analysis did not demonstrate any significant relationship between peak detrusor pressure and outcome (B = -0.005, 0.001, 0.026, 0.016 respectively) (Figure 1). Figure 1: Box plots representing the distribution of mean void volume, peak DO, compliance and end-fill pressures with first stage SNM testing. Box borders illustrate the upper, median and lower quartiles; whiskers depict the 99% interval. Extreme (star) and mild (circle) outliers are also shown. CONCLUSIONS There was no correlation between any urodynamic parameter and successful SNM outcome. SNM is an option for all IDO patients, regardless of their dynamic bladder function on filling cystometry. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e291 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Julie Jenks More articles by this author Eskinder Solomon More articles by this author Mahreen Pakzad More articles by this author Rizwan Hamid More articles by this author Tamsin Greenwell More articles by this author Julian Shah More articles by this author Jeremy Ockrim More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Functional Brainstem Changes in Response to Bladder Function Alteration Elicited by Surgical Reduction in Bladder Capacity: A Functional Magnetic Resonance Imaging Study

Our previous results revealed a positive correlation between bladder dysfunction and cortical arousals in children with enuresis. This finding implied an interrelationship between bladder dysfunction and brainstem dysfunction. Thus, we used an animal model to characterize brainstem functional changes in response to altered bladder function. Adult male New Zealand rabbits weighing 3.0 to 3.5 kg underwent surgical bladder volume reduction (12) or sham operation (12). We performed conventional fill cystometry and brainstem functional magnetic resonance imaging in each group 4 weeks postoperatively. During scanning bladder stimulation was provided by bladder filling up to 70% of maximum capacity. We then compared brainstem activation area(s). Results revealed voiding dysfunction in animals with altered bladder function. Bladder function was markedly altered in the reduced bladder volume vs the sham operated group, mainly as significantly increased maximum voiding detrusor pressure (mean ± 1 SD 24.4 ± 7.0 vs 0.16.5 ± 7.2 cm water, p <0.05) and markedly decreased cystometric bladder volume (mean 35.3 ± 8.2 vs 71.6 ± 12.9 ml, p <0.05). Functional magnetic resonance imaging results revealed activation of 2 brainstem regions, including in 1) the ventrolateral periaqueductal gray and 2) the dorsolateral pons, in response to bladder distention. Activation in the ventrolateral periaqueductal gray was significantly decreased in the reduced bladder vs the sham operated group with a corresponding decrease in signal size (25% vs 83.3%, signal size 0.7 ± 1.4 vs 3.3 ± 2.1 mm(2)). There was no significant difference in activation of the dorsolateral pons between the groups (83.3% vs 91.7%, signal size 3.7 ± 2.4 vs 0.4.7 ± 3.0 mm(2)). Functional derangement in brainstem micturition centers can be evoked by bladder dysfunction. In response to bladder dysfunction the ventrolateral periaqueductal gray shows deactivation during bladder distention, suggesting that it has an important role in bladder dysfunction biofeedback.

Comparison of Continuous and Intermittent Filling Cystometry in Patients with Spinal Cord Injury

Comparison of Continuous and Intermittent Filling Cystometry in Patients with Spinal Cord Injury

Proof of principle: The effect of antimuscarinics on bladder filling sensations in healthy subjects—A placebo controlled double blind investigation using 4 and 8 mg tolterodine extended release

There is evidence that antimuscarinic drugs have depressant influence not only on bladder muscle activity, but also on bladder sensations. The aim of this study was to evaluate the effect of a single dose tolterodine extended release (ER) 4 and 8 mg on bladder sensations during filling cystometry. After approval of the local ethics committee, 30 healthy female subjects (23.7 +/- 2.3 years) were included and randomly assigned to three groups: (A) placebo, (B) tolterodine ER 4 mg, and (C) tolterodine ER 8 mg in a double blind manner. Measurements were performed at baseline and 4 hr postmedication in each group, consisting of: (1) Filling cystometry with 25 ml/min at which subjects had to indicate first sensation of filling (FSF), first desire to void (FDV), and strong desire to void (SDV). (2) Uroflowmetry and ultrasound control for residual urine. In the placebo group, filling volumes at FDV and SDV decreased significantly posttreatment. This effect could not be observed for the tolterodine 8 mg group and only at SDV in the 4 mg group. No significant difference between groups was found regarding uroflowmetry parameters and postvoid residual volume. No increase of filling volumes in healthy subjects could be observed with tolterodine. However, the results suggest that tolterodine is able to alleviate irritation caused by repeated catheterization and cystometry. There was no significant influence of tolterodine ER 4 or 8 mg on voiding function.

Natural Fill Urodynamics and Conventional Cystometrogram in Infants With Neurogenic Bladder

We compared findings from natural fill urodynamics and conventional cystometrogram in infants with neurogenic bladder. We retrospectively analyzed data from 19 infants undergoing 24-hour natural fill urodynamics and cystometrogram. The infants concurrently underwent ultrasound. Voided volume, detrusor overactivity, area under the curve (per minute) and baseline detrusor pressure obtained at natural fill urodynamics were compared to cystometric capacity, detrusor overactivity, leak point pressures and bladder compliance obtained at cystometrogram. Voided volumes during natural fill urodynamics were significantly less than cystometric capacity volumes (p <0.001). Natural fill urodynamics revealed more detrusor overactivity than did cystometrogram. Four infants with leak point pressures greater than 40 cm H2O had detrusor overactivity at natural fill urodynamics. Five patients with leak point pressure less than 40 cm H2O had no detrusor overactivity at natural fill urodynamics or cystometrogram. Four of 5 infants with decreased bladder compliance had baseline detrusor pressure greater than 10 cm H2O and detrusor overactivity. Urodynamic parameters obtained at natural fill urodynamics may be associated with cornerstone parameters such as leak point pressure and bladder compliance obtained at cystometrogram.

Heart rate variability: An objective measure of autonomic activity and bladder sensations during urodynamics

There are still controversies regarding the reproducibility of cystometric data and no objective measurement of bladder sensations is currently available. Additionally, very little information exists about autonomic activity during standard filling cystometry (FC). The aim of this study was to evaluate the use of heart rate variability (HRV) analysis as a reliable monitor of the autonomic nervous system and objective measure for bladder sensations during FC. In a volunteer sample of healthy female subjects a standard FC at 25 ml/min was performed, using an 8 Fr microtip catheter with integrated pressure transducers. During FC, subjects had to indicate first sensation of filling (FSF), first desire to void (FDV) and strong desire to void (SDV). A 3-lead electrocardiogram was continuously recorded. After 5 h all measurements were repeated. Power spectrum analysis was used to analyse HRV, to obtain low frequency (LF) and high frequency (HF) parameters, from which the LF/HF ratio was derived. 12 subjects with a mean age of 23.3 +/- 2.3 years could be included. 11 of 12 subjects completed both measurement sessions. One subjects had to be excluded, due to irritating urethral discomfort following catheterisation. The LF/HF ratio showed a reproducible activation pattern in the healthy subjects with a stable sympathovagal balance until FDV. Before SDV was indicated, the sympathovagal balance started to shift towards sympathetic activation and caused a significant increase in LF/HF. HRV analysis seems to be a useful indicator for the general activation pattern of the sympathovagal balance during FC, correlating the intensity of the bladder filling sensation to stress and sympathetic activation.

1526: Can Bladder Sensation During Repeated Filling Cystometry be Objectively and Reproducibly Measured?

1526: Can Bladder Sensation During Repeated Filling Cystometry be Objectively and Reproducibly Measured?

1527: Can Detrusor Overactivity Affects Bladder Sensation During Repeated Filling Cystometry?

1527: Can Detrusor Overactivity Affects Bladder Sensation During Repeated Filling Cystometry?

Variability of Detrusor Overactivity on Repeated Filling Cystometry in Men With Urge Symptoms: Comparison With Spinal Cord Injury Patients

Variability of Detrusor Overactivity on Repeated Filling Cystometry in Men With Urge Symptoms: Comparison With Spinal Cord Injury Patients

Bladder function associated with posterior urethral valves after primary valve ablation or proximal urinary diversion in children and adolescents.

We retrospectively reviewed 2 series of patients with posterior urethral valves treated initially with valve ablation preceded by bilateral cutaneous ureterostomies or valve ablation alone to evaluate and compare bladder function behavior of each treatment group. From 1970 to 1983, 19 males 22 days to 21 months old with posterior urethral valves were treated with 1 of 2 initial surgical approaches, including upper tract diversion, delayed undiversion and ablation in 11 (group 1), and primary valve ablation only in 8 (group 2). Median patient age at the time of cutaneous urinary diversion and primary valve ablation for groups 1 and 2 was 7 and 9 months, respectively. Median duration of bladder defunctionalization was 48 months. All patients were evaluated urodynamically after initial ablation or re-functionalization of the bladder using standard rapid fill cystometry. Median patient age for groups 1 and 2 was 14 and 9.5 years, respectively, at the time of urodynamic testing 16 and 12.6 years, respectively, at followup. Urodynamic assessment revealed detrusor instability in 5 group 1 patients but in only group 2 1 patient. Group 2 patients had significantly lower median end filling pressure (4 versus 15 cm. water, p <0.03) and higher maximum bladder capacity (1.4 versus 0.8, p <0.005) than those in group 1. Group 1 patients had lower compliance than those in group 2 (median 15 versus 82 cm. water, p <0.05). Further analysis showed no difference between groups 1 and 2 in overall median voiding detrusor pressure at maximum flow (51 versus 52.6 cm. water, respectively). Cystometric detrusor under activity patterns were noted in 5 group 1 and 2 group 2 patients. Residual urine volumes were 17%, 31%, 19% and 8% of bladder capacity, respectively, in 2 group 1 and 2 group 2 patients. At final followup 5 group 1 and 2 group 2 patients had renal function deterioration. Two other group 1 patients and group 2 had progression to end stage renal failure. A higher ureteral reimplantation rate was noted in group 1 (63%) than group 2 (6%). This retrospective study revealed that long-term bladder function of patients with posterior urethral valves treated with temporary supravesical diversion is affected more adversely than those treated with valve ablation alone.