Preoperative Detrusor Overactivity Research Articles

Surgical Outcomes and Predictive Factors in Patients With Detrusor Underactivity Undergoing Bladder Outlet Obstruction Surgery.

This study was conducted to evaluate the efficacy of bladder outlet surgery in patients with detrusor underactivity (DU) and to identify factors associated with successful outcomes. We conducted a retrospective review of men diagnosed with DU in urodynamic studies who underwent bladder outlet surgery for lower urinary tract symptoms between May 2018 and April 2023. The International Prostate Symptom Score (IPSS) questionnaire, uroflowmetry (UFM), and multichannel urodynamic studies were administered. Successful treatment outcomes were defined as either an IPSS improvement of at least 50% or the regaining of spontaneous voiding in patients urethral catheterization prior to surgery. The study included 93 male patients. Men diagnosed with significant or equivocal bladder outlet obstruction (BOO) experienced significant postoperative improvements in IPSS (from 20.6 to 6.0 and from 17.4 to 6.5, respectively), maximum urine flow rate (from 5.0 mL/sec to 14.4 mL/sec and from 8.8 mL/sec to 12.2 mL/sec, respectively) and voiding efficiency (from 48.8% to 86.0% and from 61.2% to 85.1%, respectively). However, in the group without obstruction, the improvements in IPSS and UFM results were not significant. The presence of detrusor overactivity (odds ratio [OR], 3.152; P=0.025) and preoperative urinary catheterization (OR, 2.756; P=0.040) were associated with favorable treatment outcomes. Conversely, an unobstructed bladder outlet was identified as a negative prognostic factor. In men with DU accompanied by equivocal or significant BOO, surgical intervention to alleviate the obstruction may enhance the IPSS, quality of life, and UFM results. However, those with DU and an unobstructed bladder outlet face a comparatively high risk of treatment failure. Preoperative detrusor overactivity and urinary catheterization are associated with more favorable surgical outcomes. Consequently, active deobstructive surgery should be considered for patients with DU who are experiencing urinary retention.

Changes of lower urinary tract function after robot-assisted radical prostatectomy: An urodynamic follow-up within 1 year.

This study investigated the changes of lower urinary tract function after robot-assisted radical prostatectomy (RaRP) with 1-year urodynamic follow-up. Clinically localized prostate cancer patients receiving RaRP were prospectively enrolled. We analyzed their clinical symptoms, stress urinary incontinence (SUI) and urge urinary incontinence (UUI) status, and videourodynamic studies (VUDSs) during the postoperative 1st year. In total, 74 patients were enrolled with a mean age of 69.4 ± 8.1 years, a mean total prostate volume of 34.7 ± 15.9 mL, a ≥pT3 stage proportion of 37.8%, and a positive surgical margin rate of 18.9%. The International Prostate Symptom Score significantly reduced from 7.3 ± 6.0 before surgery to 4.1 ± 4.1 at postoperative 1 year. Significantly increased full sensation, reduced detrusor voiding pressure, increased maximal urinary flow rate, and decreased bladder outlet obstruction index were noted at 1-year VUDS follow-up. The changes of VUDS parameters were significantly different between the patients with and without preoperative bladder outlet obstruction. At postoperative 1 year, 8.1% and 6.8% of patients experienced SUI and UUI, respectively. In multivariate analysis, the factors of T stage ≥3, preoperative detrusor overactivity (DO), and positive surgical margin were the independent predictors of immediate SUI and SUI at 3 and 12 months, respectively. During the 1st year after RaRP, patients experienced significant changes of lower urinary tract function demonstrated in VUDS with the improvement in clinical symptoms. Factors of T stage ≥3, preoperative DO, and positive surgical margin were the predictors of postoperative SUI.

Predictors of cure and overactive bladder syndrome after a mid-urethral sling procedure in women with stress urinary incontinence

ObjectivesTo determine predictive factors for the cure of stress urinary incontinence (SUI) or persisting or de novo overactive bladder syndrome (OAB) after a mid-urethral sling procedure (MUS) for women with SUI, especially for menopausal women. Study designAll women who had consecutively received MUS for SUI between January 2008 and July 2019 in a tertiary referral center were reviewed. Main outcome measuresMultivariable Cox proportional hazards model or logistic regression analysis was used to assess the predictors of cure and persisting or de novo OAB after MUS. ResultsA total of 385 women had undergone MUS, of whom 265 (68.8%) were menopausal. The multivariable Cox proportional hazards model revealed that age (hazard ratio = 1.04), and preoperative detrusor overactivity (hazard ratio = 2.26) were independent predictors of persisting/recurrent SUI. Among the 216 women with preoperative OAB, 109 (50.5%) experienced resolution of their OAB after MUS; and among 169 women without preoperative OAB, twenty-five (14.8%) women developed de novo OAB after MUS (p < 0.0001). Preoperative OAB (hazard ratio = 3.97), small voided volume (hazard ratio = 0.83), and preoperative detrusor overactivity (hazard ratio = 1.62) were predictors of postoperative OAB. In addition, six (1.6%) women had mesh extrusion. Parity (odds ratio = 2.08) was the sole predictor of mesh extrusion. Menopause (hazard ratio = 1.69) was a predictor of postoperative OAB in the univariate analysis. However, menopause was not a predictor of cure or OAB in the multivariable analysis. ConclusionsAge and preoperative detrusor overactivity were independent predictors of persisting/recurrent SUI. In addition, preoperative OAB, small voided volume, and preoperative detrusor overactivity were predictors of postoperative OAB. These findings could serve as a guide for preoperative consultation for MUS.

De novo OAB After ATOMS: An Underestimated Problem or a Rare Side Effect?

Background: The urinary incontinence system ATOMS (A.M.I., Austria) generates suburethral compression through its sphincter cushion. To what extent the ATOMS may lead to overactive bladder (OAB) symptoms or which risk factors for these symptoms exist remain unknown to date. We report on our multicentre evaluation on the prevalence, status, and therapy of OAB after ATOMS.Methods: Between 10/09 and 01/17, a total of 361 patients received an ATOMS device in Vienna and Halle. A prerequisite for surgery was persistent male stress urinary incontinence lasting at least 6 months after the primary intervention, as well as the failure of conservative treatment. Patients with a preoperative untreated anastomotic stricture or detrusor overactivity were excluded. In addition to continence and voiding parameters, patient's age, BMI, comorbidities, and pre-treatment strategies of the underlying disease and urinary incontinence were examined. If de novo OAB was present, urodynamics were used for further clarification. Statistical analysis was performed with GraphPad Prism 7® (GraphPad Software, Inc., La Jolla, USA), p < 0.05 considered significant.Results: OAB presented 18 patients (4.9%). Regarding the degree of urinary incontinence as well as uroflowmetry, residual volume and comorbidities, patients with an OAB showed no differences compared to patients without an OAB (p < 0.05). Only previous radiotherapy or urinary incontinence surgery and urethral stricture interventions resulted in statistically significant differences based on the bivariate analysis (p = 0.030, p = 0.006, p = 0.007). The consecutive postoperative urodynamics revealed a sensory OAB in 17 patients and a low-compliance bladder in a patient with newly diagnosed insulin-dependent type II diabetes mellitus. OAB was treated with a standard dose of antimuscarinic drugs and for the low-compliance bladder with botulinum toxin type A.Conclusion: OAB symptoms can occur after ATOMS implantation, but are rare and have no clear correlation to the incontinence device but rather are due to urinary incontinence-related underlying diseases and previous treatments.

Effect of urodynamic preoperative detrusor overactivity on the outcomes of transurethral surgery in patients with male bladder outlet obstruction: a systematic review and meta-analysis.

To investigate the effect of urodynamic detrusor overactivity (DO) on the outcomes of transurethral surgery in patients with male bladder outlet obstruction (BOO). We systematically searched the PubMed, Embase, and Cochrane Library databases for articles published between January 1989 and June 2017. All results of eligible studies were synthesized. Nine articles met the eligibility criteria. These studies included a total of 932 patients with a median number of 92 patients per study (range 40-190). Of the nine studies, the conventional transurethral prostatectomy was adopted in four studies, photoselective vaporization of prostate in three studies, and other surgical modalities in two studies. In patients with DO positive, the pooled mean difference (MD) was not significant for a better or poorer improvement in the International Prostate Symptom Score [pooled MD, - 0.27; 95% confidence interval (CI), - 1.75 to 1.22; studies, 9; participants, 827], quality-of-life score (pooled MD, - 0.14; 95% CI, - 0.46 to 0.18; studies, 7; participants, 734), maximal flow rate (pooled MD, 0.79; 95% CI, - 1.57 to 3.14; studies, 8; participants, 781), and post-void residual volume (pooled MD, 2.81; 95% CI, - 4.70 to 10.32; studies, 6; participants, 509) compared to patients with DO negative. Some comparisons showed between-study heterogeneity despite the strict criteria of the eligible studies. However, there was no clear evidence of publication bias in the funnel plots. Our meta-analysis results demonstrated that preoperative urodynamic DO has no diagnostic role in the prediction of surgical outcomes in patients with male BOO.

Mixed urinary incontinence: A prospective study on the effect of trans-obturator mid-urethral sling

ObjectivesIt is hypothesized that urethral dysfunction is central in mixed urinary incontinence (MUI) in women, since urine entering the proximal urethra under increased intra-abdominal pressure provokes a urethro-detrusorial reflex and involuntary detrusor contraction. Mid-urethral slings have been proposed as a solution. Our primary objective was to evaluate the long-term subjective and objective outcomes on continence and other urinary symptoms of a trans-obturator mid-urethral sling (TOT) procedure. Our secondary objectives were to determine its impact on quality of life (QoL), and to investigate which factors influence outcomes. Study designThis is a single-centre prospective study on a consecutive series of 86 women who underwent TOT for MUI as defined by ICS/IUGA. Since the definition of MUI that we used is symptom-based, we included patients both with and without associated detrusor overactivity. All patients underwent placement of Monarc® Subfascial Hammocks. Statistical analysisWe used the McNemar chi-square test, the paired t-test and Fisher’s exact test. A logistic regression model and odds ratios were used to assess age, parity, body mass index, menopausal status, preoperative detrusor over-activity, and detrusor pressure at maximum flow as possible factors for treatment failure. Only those that were statistically significant in the univariate analysis were included in the multivariate analysis. ResultsWith a mean follow-up of 59 months, SUI was cured objectively in 83.7% of patients and subjectively in 87.2%. Three patients underwent further anti-incontinence surgery. The continence rates were 74.4% for urgency urinary incontinence (UUI) and 66.3% for SUI-UUI. The patient-reported success rate was 87.2% (‘much better’ or ‘very much better’ on Patient Global Impression of Improvement scale). There were statistically significant improvements in all domains except general health. The univariate analysis found no significant risk factor for persistence of SUI. Median age >60 years and menopause were predictive for persistence of UUI. Median and mean age >60 years were predictive of persistence of overall incontinence. In the multivariate model, all variables lost their statistical significance. ConclusionOur study demonstrates TOT surgery can be performed for patients with MUI following unsuccessful conservative therapy. We also demonstrate that menopause and age >60 are risk factors for failure. This should be considered when counselling preoperatively.

Does the diagnosis of detrusor overactivity affect the long-term prognosis of patients treated with a retropubic midurethral sling?

There are few long-term studies on the midurethral sling (MUS) procedure in patients with preoperative detrusor overactivity (DO) and there is debate regarding the usefulness of preoperative cystometry. This study was designed to provide long-term efficacy and safety data for the Advantage MUS and to compare the outcomes in patients with pure urodynamic stress incontinence (USI) with the outcomes in patients with mixed USI and DO. This was a retrospective consecutive case series study of 100 patients with USI (USI-only group) matched to a consecutive group of a further 100 patients with preoperative USI and DO (mixed group) treated with a retropubic MUS. Outcomes were assessed using the King's Health Questionnaire and Patient Global Impression of Improvement questionnaire. After a mean follow up of 6years more patients in the USI-only group described themselves as "very much better" or "much better" (86% USI-only group vs. 57% mixed group; p = 0.007). Quality of life was improved at 6years from baseline in both groups. Patients in the mixed group were more likely to complain of urgency (69% vs. 42%; p = 0.0007) which was more likely to be severe (34% vs. 10%; p = 0.004). A repeat MUS procedure was needed in 1% of patients and 0.6% needed surgical removal of the MUS for persistent troublesome pain. This study suggests that the preoperative diagnosis of DO affects the long-term patient-perceived outcome of the MUS procedure. However, most patients have significant long-term improvement in quality of life.

Is benign prostatic obstruction surgery indicated for improving overactive bladder symptoms in men with lower urinary tract symptoms?

Lower urinary tract symptoms (LUTS) in men are highly prevalent, and include both storage and voiding symptoms in many cases. The effect of benign prostatic obstruction (BPO) relief on storage symptoms remains unclear. The present review summarizes data about the relation between overactive bladder (OAB), voiding symptoms, and urodynamic characteristics in men with LUTS. Pathomechanisms of OAB in a context of BPO are reviewed. Rates of persistent bladder dysfunction after BPO relief are described along with predictive factors of persisting OAB. OAB is a common clinical feature in a population of male LUTS, often concomitant with voiding symptoms. Although detrusor overactivity is found in some patients with OAB and BPO, there is no absolute correspondence between clinical symptoms and urodynamic findings. In the context of BPO, OAB pathophysiology implicates nitric oxide pathway, bladder ischemia, ageing of the urinary tract, and calcium-activated potassium channels activity. BPO relief can be followed in the medium term by persistence of OAB symptoms, and preoperative detrusor overactivity has been identified as the main predictive factor. However, preoperative urodynamics remain only indicated in specific cases, when it could directly influence clinical decision-making. Antimuscarinics may be the treatment of choice for persistent symptoms after surgery, but there is no firm recommendation in this clinical setting.

Prediction of Mid-Urethral Sling Failure with Clinical Findings and Urodynamics.

Mid-urethral slings (MUS) become a standard, minimally invasive surgery to treat urinary stress incontinence. Our aim is to investigate the contribution of preoperative urodynamics to mid-urethral slings success and determine predictors for choosing mid-urethral sling route. Women with stress urinary incontinence and who desired surgical correction of their incontinence were included in the study. The selection of the procedure was according to an algorithm used in an institution. Urodynamic and baseline factors that may be associated with surgery failure were analyzed. A total of 159 patients in the tension free transvaginal tape (TVT) group and 83 patients in the transobturator tape (TOT) group were included in the present study. Urodynamic findings of subjects who were considered MUS failure were not significantly different from those women who were continent after 1 year of surgery. Detrusor overactivity was present on urodynamics in 23 of 37 women (62.2%) with MUS failure, 81 of 205 women (39.7%) with no stress test positivity with the cough stress test (P < 0.05). A vaginal hysterectomy had been performed on 13 of 37 (35.1%) subjects with MUS failure 1 year after operation, and 20 of 205 subjects (9.8%) in the stress urinary incontinence (SUI) continent group (P < 0.001). Preoperative detrusor overactivity (DO) was the only urodynamic finding that negatively affected the success of surgery in both TOT and TVT groups. Our study demonstrated an increased risk of surgery failure for those who underwent a concurrent hysterectomy for pelvic organ prolapse.

2272 PREOPERATIVE DETRUSOR OVERACTIVITY IS A PREDICTOR OF EARLY URINARY INCONTINENCE AFTER ROBOT-ASSISTED LAPAROSCOPIC PROSTATECTOMY

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Urodynamics Testing1 Apr 20132272 PREOPERATIVE DETRUSOR OVERACTIVITY IS A PREDICTOR OF EARLY URINARY INCONTINENCE AFTER ROBOT-ASSISTED LAPAROSCOPIC PROSTATECTOMY Akihiro Yanagiuchi, Hideaki Miyake, Kazushi Tanaka, and Masato Fujisawa Akihiro YanagiuchiAkihiro Yanagiuchi Kobe, Japan More articles by this author , Hideaki MiyakeHideaki Miyake Kobe, Japan More articles by this author , Kazushi TanakaKazushi Tanaka Kobe, Japan More articles by this author , and Masato FujisawaMasato Fujisawa Kobe, Japan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2201AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To investigate changes in the bladder and urethral function and to detect preoperative parameters have an impact on early urinary incontinence after robot-assisted laparoscopic prostatectomy (RALP). METHODS This study included 60 consecutive patients who underwent RALP for clinically localized prostate cancer. Urodynamic study (UDS), including filling cystometry, pressure flow study, electromyogram of external urethral sphincter and urethral pressure profile, were performed in the patients before and 3 months after RALP. In this series, continence was defined as free for pad against urinary incontinence. International prostate symptom score (I-PSS), QOL index, and OABSS were also examined before and at 1 and 3 months after RALP. RESULTS All Patients included in this series could void spontaneously before RALP. On UDS, maximum cystometric capacity (MCC) and bladder compliance after RALP were significantly reduced than those before RALP. The degree of obstructive symptoms was markedly improved postoperatively, resulting in the significant decrease in maximum detrusor pressure 3 months after surgery; however, detrusor contractility was significantly deteriorated postoperatively. Furthermore, maximum urethral closure pressure (MUCP) and functional length (FL) after RALP were significantly decreased compared with those before RALP. In patients with postoperative incontinence, preoperative MUCP and FL were significantly lower than those in patients without incontinence. On multivariable analysis, detrusor overactivity was preoperative independent predictor of stress incontinence at 1M after RALP. CONCLUSIONS These findings suggest that both bladder contraction and external urethral sphincter function were not sufficiently recovered 3 months after RALP, and preoperative detrusor overactivity is a predictor of early stress incontinence after RALP. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e931-e932 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Akihiro Yanagiuchi Kobe, Japan More articles by this author Hideaki Miyake Kobe, Japan More articles by this author Kazushi Tanaka Kobe, Japan More articles by this author Masato Fujisawa Kobe, Japan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Quantification of changes in detrusor function and pressure‐flow parameters after radical prostatectomy: Relation to postoperative continence status and the impact of intensity of pelvic floor muscle exercises

We aim to quantify changes in detrusor function and pressure-flow parameters after radical retropubic prostatectomy (RRP) and to determine the impact of the level of intensity of pelvic floor muscle exercises (PFME) on these changes. We also tried to identify preoperative urodynamic factors, predictive of postoperative continence status. Sixty-six patients were included in the study. An urodynamic examination was performed before surgery and 26 weeks after catheter removal. All patients were instructed in PFME. However the intensity of PFME varied between instructions based on an information folder only (F-PFME) and intensive guidance by a physiotherapist, in addition to the folder (PG-PFME). In 66 men pre- as well as postoperative urodynamic studies were available for analysis. Overall, Q(max) increased, p(det.Qmax) and the urethral resistance factor URA decreased significantly after surgery. At baseline, detrusor overactivity (DOA) was found in 34% and 5.3% of the men who were still incontinent 6 months postoperatively and those who regained continence, respectively (P = 0.015). Postoperatively, Q(max) was significantly higher (P = 0.04) and URA significantly lower (P = 0.047) in the physiotherapist-guided group. No prognostic standard urodynamic factors for post-RP incontinence (PRPI) were identified. In univariate analysis, preoperative DOA is associated with a higher risk of remaining incontinent after surgery. However, in multivariate analysis, urodynamic parameters predictive of PRPI could not be identified. Therefore, standard preoperative filling cystometry and pressure-flow studies seem to have no role as preoperative predictors of PRPI in patients with localized prostate cancer. More intensive PFME might have a lowering effect on bladder outflow resistance after RRP.

232 The effect of TURP on improvement of irritative symptoms in BPH patients with preoperative detrusor overactivity

232 The effect of TURP on improvement of irritative symptoms in BPH patients with preoperative detrusor overactivity

Predictors for overactive bladder symptoms after pelvic organ prolapse surgery

To review the predictors for overactive bladder (OAB) symptoms after pelvic organ prolapse (POP) surgery. In general, an improvement on OAB can be expected after POP surgery. There are few studies which study the predictors of OAB after POP surgery and most studies had a different perspective. Some studies made conclusions on the basis of multivariate analysis, in which all relevant factors were taken into account. On the basis of these studies, it seems that various factors influence the results on OAB symptoms after POP surgery. Predictors for improvement gave a confusing and sometimes contradicting results. The role of preoperative detrusor overactivity is unclear, improvement as well as persistence of OAB was found. Further, the detrusor opening pressure and maximum flow rate seem to play a role. The absence of bothersome OAB preoperatively was a further predictor for absence of postoperative symptoms. Further, it was found that the individual OAB symptoms had different predictors. All together, the results of the various studies are inconclusive. It is therefore at present essentially still impossible to reliably predict the presence of OAB after POP surgery. More research is necessary on the predictors for OAB after POP surgery.

Long-Term Outcome of Transobturator Tension-Free Vaginal Tape: Efficacy and Risk Factors for Surgical Failure

To assess the 5-year efficacy of the inside-out transobturator tension-free vaginal tape (TVT-O) for the treatment of stress urinary incontinence (SUI) and to explore possible predictors for long-term failure. Sixty-five consecutive patients who underwent TVT-O were prospectively enrolled. Patients who required concomitant anterior or apical pelvic organ prolapse repair or both and those with urodynamic occult SUI were excluded. Postoperatively, patients were scheduled for evaluation at 1, 3, 6, and 12 months and annually thereafter. Surgical failure was defined as positive stress test, daily episodes of SUI, and negative global satisfaction. Preoperative and interim clinical and urodynamic predictors for long-term failure were analyzed from a computerized database. Sixty-one patients (mean age at surgery 56.6±10.2 years) completed 5 years of follow-up. Of these, 11 (18%) patients were classified as surgical failure, 5 (8%) as improved, and 45 (74%) as cured. Any SUI (100% vs. 10%, p=0.001), daily SUI (100% vs. 0%, p=0.001), overactive bladder (OAB) (100% vs. 48%, p=0.001), and the use of antimuscarinic drugs (64% vs. 26%, p=0.03) were found to be significantly more common among failure cases. Preoperative detrusor overactivity (odds ratio [OR] 7.6, 95% confidence interval [CI] 1.7-32.9), interim 1-year OAB (OR 20.5, 95% CI 1.9-215.4), and interim 1-year SUI (OR 26.4, 95% CI 1.5-475.2) were found to be significant independent risk factors for long-term surgical failure. An 18% rate of surgical failure was observed 5 years after TVT-O. Larger studies with longer follow-up periods may facilitate the identification of risk factors for failure and, thus, enable better preoperative consultation.

Treatment of mixed urinary incontinence

IntroductionMixed urinary incontinence (MUI) is a prevalent condition and imposes a significant impact on a woman's quality of life. Treatment is often challenging, as a single modality may be inadequate for alleviating both the urge and stress component.Materials and methodsA MEDLINE search was conducted regarding English-language literature pertaining to the pathophysiology, diagnosis of, and treatment for MUI. Non-English language articles were considered if they could be translated into English using GOOGLE translator.ResultsThe identification of an ideal single treatment has also been made more challenging by the poor characterization of the pathophysiology of MUI. Behavioral and lifestyle modification, as well as pelvic floor muscle therapy, should be considered first-line options for all women with MUI. Treatment of the urge component with anti-muscarinics is effective; however the stress component is likely to persist after therapy. Anti-incontinence surgery may have a positive impact on both the stress and urge components of MUI, with emerging evidence suggesting that transobturator MUS may be associated with lower rates of de novo and persistent urge component compared to other procedures. The presence of concomitant, preoperative detrusor overactivity has not been consistently associated with postoperative outcomes.ConclusionsThe optimum treatment of MUI may often require multiple treatment modalities. While surgery may have a positive impact on both the urge and stress component, its implementation should be approached with caution and patients should be carefully selected. Detailed informed consent in women with MUI cannot be overstated.

Predictors of improved overactive bladder symptoms after transvaginal mesh repair for the treatment of pelvic organ prolapse

The aim of this study was to identify the predictors of improved overactive bladder (OAB) symptoms after transvaginal mesh repair. Eighty women with pelvic organ prolapse (POP) stage II to IV reporting OAB symptoms were scheduled for transvaginal mesh procedures. Preoperative and postoperative assessments included a bladder diary, urodynamics, and a personal interview about urinary symptoms. Sixty-three (78.8%) women experienced improvement of OAB symptoms (Improvement group), and 17 (21.2%) women remained unchanged or worsened (Persistence group) postoperatively. A univariate analysis of patients' characteristics showed no difference between two groups regarding parity, diabetes, hypertension, prolapse status, preoperative urodynamic parameters, and urinary symptoms (P > 0.05). However, the age (P = 0.042) and preoperative detrusor overactivity (DO) (P = 0.03) were two significant predictors of postoperative OAB improvement. Women with POP may experience improvement of their OAB symptoms after transvaginal mesh repair. Both age and DO were two predictors in our univariate analysis, and the latter was the only significant predictor of symptom relief after adjusting age factor.

Association Between Detrusor Overactivity and Postoperative Outcomes in Patients Undergoing Male Bone Anchored Perineal Sling

In this study we determined if there was an association between the presence of preoperative detrusor overactivity and patient outcomes after bone anchored perineal sling. A total of 85 men underwent a male perineal sling procedure for urodynamically proven stress urinary incontinence. Preoperative history and physical examination were performed, and patients completed self-assessment questionnaires. Based on urodynamics patients were divided into 2 groups of those with and those without detrusor overactivity. Questionnaires including the Patient Global Impression of Improvement Scale were readministered postoperatively. Success was defined by the Patient Global Impression of Improvement as very much better or much better. Failure was defined by the responses of a little better, no change, a little worse or much worse. Successes and failures were compared to the presence of detrusor overactivity. Preoperative parameters, preoperative and postoperative questionnaire scores, and postoperative pad and anticholinergic use were compared between the 2 groups. A total of 72 patients were included in the analysis, and of these 22 (30.6%) had detrusor overactivity and 50 (69.4%) did not. All patients completed the Patient Global Impression of Improvement. There was no statistical difference in the number of cases classified as successes or failures in the 2 groups (p = 0.4213). A significantly higher percentage of patients with detrusor overactivity required postoperative anticholinergics. There was no statistical difference in the number of patients using pads postoperatively. Preoperative detrusor overactivity was not associated with worse postoperative outcomes. Men with urodynamic stress urinary incontinence and detrusor overactivity may be considered for a male sling procedure. However, they may require postoperative anticholinergics and should be counseled accordingly.

Risk Factors Affecting Cure After Mid-urethral Tape Procedure for Female Urodynamic Stress Incontinence: Comparison of Retropubic and Transobturator Routes

To identify the risk factors affecting cure after the tension-free vaginal tape procedure (TVT) or transobturator tape procedure (TOT). A total of 121 women with urodynamically proved stress incontinence underwent TVT (n = 61) or TOT (n = 60). We analyzed all data with univariate and multivariate logistic regression analyses. Univariate analysis revealed that a larger postvoid residual urine volume, greater pad weight test, and lower maximal flow rate were associated with a greater risk of failure to be cured after TVT. A lower maximal urethral closure pressure (MUCP) was associated with a greater risk of failure after the TOT procedure. With additional analysis, we found that a MUCP of <or=40 cm H(2)O (odds ratio [OR] 9.21, P = .004) was associated with a significantly greater risk of failure to be cured after the TOT procedure but not a MUCP of <o=50 cm H(2)O (OR 2.24, P = .21). Multivariate analysis revealed that preoperative detrusor overactivity was an independent risk factor affecting cure after TVT (OR 113.1, 95% confidence interval 1.84-6592.77, P = .02) or TOT (OR 23.7, 95% confidence interval 1.63-344.53, P = .02), and MUCP <o=40 cm H(2)O (OR 8.34, 95% confidence interval 1.52-45.65, P = .01) was another risk factor for TOT. The risk factors affecting cure after mid-urethral tape procedures were preoperative detrusor overactivity for TVT and TOT and MUCP <o=40 cm H(2)O for TOT.

Mixed incontinence: Do we have the urge to improve the stress?

Mixed urinary incontinence (MUI) may impose a significant negative impact on a woman’s quality of life. Treatment is often challenging, as a single modality, such as oral medications, behavioral modification, or pelvic floor physiotherapy, may be inadequate for alleviating both the urge and stress components. Historically, surgical intervention for MUI has been approached with trepidation, owing to a concern about postoperative worsening of the urge component. Identifying an ideal single treatment also has been made more challenging by the poor characterization of the pathophysiology of MUI. Fortunately, surgical options, such as colposuspensions, bladder neck slings, and midurethral slings, appear to have similarly effective rates of MUI resolution in women. The durability of symptom resolution is being evaluated, as long-term outcomes of the midurethral slings continue to emerge. The presence of concomitant, preoperative detrusor overactivity has not been consistently associated with postoperative outcomes.

Does the patient's position influence the detection of detrusor overactivity?

The demonstration of preoperative detrusor overactivity (DO) with associated overactive bladder symptoms (OAB) is known to have an adverse effect on surgery performed for stress incontinence or for prostatic obstruction. The purpose of this review is to examine the best position, when filling the bladder during urodynamics, to demonstrate detrusor overactivity and reproduce the OAB symptoms, when the demonstration of DO might be important. MEDLINE and PUBMED literature searches were performed, spanning the period from 1956 to August 2005 using the keywords "detrusor overactivity" or "detrusor instability" combined with "posture or position or standing or sitting" and "urodynamics." Other studies were identified by reviewing secondary references in the original citations. Sixteen studies looked at the effect of position on the detection rate of DO. There is good consistency between the studies analyzed. All but two [Ramsden et al., Br J Urol 49:633-9, 1977; Choe et al., J Urol 161:1541-4, 1999] showed a clear effect, with an increase in DO when the patient is filled in the vertical position or is asked to sit or stand, with a full bladder, after being filled supine. Performing the urodynamics (UDS) in the supine position would have missed a large proportion of DO diagnoses ranging from 33% to 100%. This review confirms that the patient's position is a significant variable during urodynamics and that supine cystometry will fail to detect a significant percentage of patients with DO. We suggest that all patients should be filled sitting or standing, unless physically disabled. It seems desirable for the International Continence Society (ICS) to extend its "Good urodynamic practice guideline" [Schafer et al., Neurourol Urodyn 21:261-74, 2002] to cover this important issue.