Significant Difference In Urodynamic Parameters Research Articles

An analysis of urodynamic parameters in diabetic and nondiabetic women.

Diabetes is highly prevalent worldwide, with an estimated 536 million living with diabetes in 2021, and that number projected to increase to 783 million by 2045. Diabetic bladder dysfunction is thought to affect up to 60%-90% of individuals with diabetes and can significantly impact quality of life. Despite the prevalence of diabetic bladder dysfunction, the exact pathophysiological mechanism, and resulting clinical presentation, remains debated. Our objective was to compare urodynamic parameters between diabetic and nondiabetic women, assessing the impact of various markers of diabetes severity on bladder function. A retrospective chart review was conducted on female patients aged 18 and above who underwent urodynamic studies at a single tertiary care university hospital system from 2014 to 2020. Patients were categorized based on diabetes status, and diabetes severity including duration of disease, hemoglobin A1c levels, insulin dependence, and markers of end-organ dysfunction. Urodynamic variables, including compliance, bladder voided efficiency, bladder contractility index, postvoid residual, maximum flow rate, capacity, voided volume, and detrusor overactivity, were assessed by two independent reviewers. Statistical analyses were performed to assess the impact of diabetes and diabetic severity on urodynamic parameters. A total of 652 female patients were included in the study, of which, 152 (23.3%) had diabetes, with an average duration of diagnosis of 82.3 months. Diabetic women were older and had higher body mass index compared to nondiabetic women. Diabetic retinopathy and neuropathy were present in 18% and 54.6% of diabetic patients, respectively. Significant differences in urodynamic parameters were observed between diabetic and nondiabetic women, with diabetic women showing higher rates of detrusor overactivity (p = 0.01), particularly associated with increasing BMI (p = 0.03). However, classic markers of diabetes severity including duration, as well as markers of end-organ damage, showed mixed associations with urodynamic changes. Despite the prevalence of diabetic bladder dysfunction and its impact on patient quality of life, the exact mechanisms and clinical presentation remain elusive. Our study highlights the significant differences in urodynamic parameters between diabetic and nondiabetic women, emphasizing the need for further research into the relationship between diabetes and diabetic bladder dysfunction.

Comparison of urodynamic results and quality of life between women with interstitial cystitis and overactive bladder

ObjectivesSome symptoms of overactive bladder overlap with those of interstitial cystitis. This study was conducted to compare the urodynamic results and quality of life of patients with the two conditions. Materials and MethodsUrodynamic data were retrospectively analyzed in 55 females with interstitial cystitis and 171 females with overactive bladder between 2012 and 2016. Females with overactive bladder were divided into detrusor overactivity group and non-detursor overactivity group based on urodynamic results. All recruited patients completed validated questionnaires including incontinence impact questionnaire (IIQ-7), urogenital distress inventory (UDI-6), and short form 12 health survey (SF-12). Patient demographics, total scores of questionnaires, and urodynamic results were compared among interstitial cystitis, detrusor overactivity, and non-detrusor overactivity groups. ResultsThe age and body mass index of interstitial cystitis patients were significantly lower than that of overactive bladder patients. The severity of urinary symptoms was higher in interstitial cystitis group than in non-detrusor overactivity group from questionnaire, but similar as detrusor overactivity group. Interstitial cystitis group had lower maximum flow rate, lower residual urine volume, lower maximum cystometric capacity, and higher maximal urethral closure pressure compared with non-detrusor overactivity group. However, there was no significant difference in urodynamic parameters between interstitial cystitis and detrusor overactivity groups. ConclusionInterstitial cystitis and overactive bladder have a negative impact on quality of life, but urodynamic studies are not effective in distinguishing between interstitial cystitis and detrusor overactivity.

Urodynamic characteristics might be variable in bladder pain syndrome/interstitial cystitis patients with different non-bladder co-morbid conditions

BackgroundThe aim of the study was to identify the impact of non-bladder co-morbid conditions on the urodynamic characteristics of patients with bladder pain syndrome/interstitial cystitis. MethodsPatients with bladder pain syndrome/interstitial cystitis completed the screening questionnaires for chronic fatigue syndrome, irritable bowel syndrome, fibromyalgia, temporo-mandibular disorders, multiple chemical sensitivities, tension/migraine headache, and localized myofascial pain disorder. They underwent either conventional pressure-flow urodynamic studies or video-urodynamic studies. Urodynamic variables were compared between patients with and those without co-morbid conditions. ResultsOf 111 patients (16 males and 95 females) with bladder pain syndrome/interstitial cystitis, 87 (78.4%) had at least one co-morbid condition (62% males vs 82% females, p = 0.005). Those with concomitant irritable bowel syndrome were younger and had urodynamic characteristics of smaller catheter-free voided volume, lower catheter-free average flow rate, smaller bladder volume on the first desire to void, and more prevalent dysfunctional voiding than those without irritable bowel syndrome. Patients with concomitant localized myofascial pain disorder also had larger bladder volume at the first desire to void and lower pressure at maximum flow than those without co-morbid myofascial pain disorder. There were no significant differences in urodynamic parameters between bladder pain syndrome/interstitial cystitis patients with and those without other co-morbidities. ConclusionBladder pain syndrome/interstitial cystitis patients, especially females, are more likely to have non-bladder co-morbidities, especially tension/migraine headache and localized myofascial pain. Bladder pain syndrome/interstitial cystitis Patients with co-morbid irritable bowel syndrome are younger and more likely to have abnormal urodynamic findings.

Detrusor pressures in urodynamic studies during voiding in women.

To investigate detrusor pressure during voiding in women using urodynamic studies (UDS). The study group comprised 57 women with non-neurogenic lower urinary tract symptoms. All patients underwent UDS between January 2010 and December 2014. UDS included filling cystometry, pressure flow study (PFS), uroflowmetry for the maximum flow rate (Qmax) and mean flow rate, and postvoid residuals. Existence of voluntary detrusor contraction was defined as a continuous and smooth increase in detrusor pressure (Pdet) after the instruction to micturate in the PFS. The bladder contractility index (BCI) was calculated as Pdet at Qmax + 5×Qmax. Statistical analyses were performed using the Mann-Whitney U test and p < 0.05 was considered statistically significant. The PFS showed that 23 patients had detrusor contraction (Pdet+ group) and 34 patients had no detrusor contraction (Pdet- group) during voiding. There were no significant differences in urodynamic parameters between the Pdet+ and Pdet- groups except in Pdet at Qmax and BCI. In the Pdet- group, 21 patients showed an increase in abdominal pressure during voiding (Pabd+ group), while the other 13 patients did not (Pabd- group). There were no differences in any of the urodynamic parameters between the Pabd+ and Pabd- groups. Based on UDS, an increase in detrusor or abdominal pressure may not be necessary in micturition in women. The present study suggests that relaxation of pelvic floor muscles including normal urethral function are important for micturition in women.

Differences in Urodynamic Parameters Between Women With Interstitial Cystitis and/or Bladder Pain Syndrome and Severe Overactive Bladder

To identify differences in urodynamic parameters between female outpatients with interstitial cystitis (IC) and/or bladder pain syndrome (BPS) and severe overactive bladder (OAB). This cross-sectional study included 24 and 28 consecutive IC/BPS and severe OAB female patients, respectively. IC/BPS was defined based on the American Urological Association guideline, and severe OAB was defined based on baseline symptoms recorded in a voiding diary. Before treatment, symptom assessment using questionnaires and a 3-day voiding diary, as well as laboratory tests, were performed at the initial visit. The patients' baseline characteristics and urodynamic parameters were compared between the IC/BPS and severe OAB groups. The IC/BPS group showed fewer episodes of urge incontinence and shorter duration of symptoms than the severe OAB group (P = .019, P = .017, respectively). Volumes at first sense, normal desire, strong desire, and maximal capacity during filling cystometry (MBC) were significantly higher in the severe OAB group than in the IC/BPS group (P <.001, P <.001, P = .006, P <.001, respectively). The IC/BPS and severe OAB groups showed significant differences in urodynamic parameters in terms of MBC and the volume discrepancy between MBC and maximal voided volume (P <.001, both). The receiver operating characteristic curve also showed an area under the curve of 0.760 and 0.783 for MBC and volume discrepancy, respectively (both P <.001). Data from our study suggest that combined with other clinical findings, urodynamic studies could provide useful information to differentiate between a diagnosis of IC/BPS or severe OAB.

Multiscale Entropy Analysis of Surface Electromyographic Signals from the Urethral Sphincter as a Prognostic Indicator for Surgical Candidates with Primary Bladder Neck Obstruction

To explore information hidden in the electromyographic (EMG) signals of the urethral sphincter that may be of prognostic significance for patients with primary bladder neck obstruction (PBNO), 41 patients with voiding difficulty were divided into four groups: 1) patients with primary bladder neck obstruction (PBNO) with successful (Group 1, n = 14) and 2) unsuccessful (Group 2, n = 8) surgical outcomes, 3) patients with detrusor overactivity (Group 3, n = 7), and 4) patients with detrusor-external sphincter dyssynergia (Group 4, n = 12). All patients underwent baseline urodynamic studies (preoperative for Group 1 and Group 2) for comparison. The results demonstrated that, despite no significant difference in urodynamic parameters between Group 1 and Group 2, the large-scale multiscale entropy (MSE) of preoperative EMG (i.e., MSELS(EMG)) of Group 1 was significantly higher than that of Group 2 without notable difference between Group 1 and Group 3 (i.e., patients with normal sphincter function). Moreover, the MSELS(EMG) and small-scale MSE of preoperative EMG (i.e., MSESS(EMG)) of Group 2 were notably higher than those of Group 4 (i.e., patients with abnormal sphincter function), while both MSELS(EMG) and MSESS(EMG) of Group 3 were notably higher than those of Group 2. In conclusion, using MSE analysis for assessing preoperative urethral sphincter EMG signals successfully distinguished between PBNO patients with subsequent successful surgery from those with surgical failure possibly due to subtle functional impairment of the urethral sphincter that cannot be detected by routine urodynamic studies. The results, therefore, highlight the potential clinical significance of this analytical tool in guiding urologists regarding their choice of medical versus surgical treatment for this patient population.

Effect of the Chinese traditional prescription Suo Quan Wan on TRPV1 expression in the bladder of rats with bladder outlet obstruction.

BackgroundSuo Quan Wan (SQW) is a Chinese traditional prescription that has been used in clinical treatment of lower urinary tract symptoms for centuries. However, scientific basis of SQW efficacy and mechanism is still needed. This study investigated the effect of SQW on bladder function and transient receptor potential vanilloid 1 (TRPV1) expression in the bladder of rats with bladder outlet obstruction (BOO). The induced changes in bladder function in overactive bladder (OAB) rat model were observed following different periods of outlet obstruction to obtain an appropriate rat model.MethodsThis study was carried out in two parts. In the first part, female Sprague–Dawley rats received sham operations or partial BOO operations. Two, four, and six weeks later, the OAB model groups and control were subjected to urodynamic tests to measure differences in bladder functions. Once the appropriate rat model was obtained, the second part of the experiment was performed. The rat model was recreated and treated with SQW. Urodynamic assessment was conducted, and the bladders of the rats were then removed. Immunofluorescence staining, real-time PCR, and Western blot were performed to localize and quantify the expression of TRPV1 in the bladder.ResultsResults of the first part indicated that at 2 and 4 weeks, the OAB model group exhibited significant differences in urodynamic parameters, including bladder pressure, maximum voiding pressure, and maximum bladder capacity, compared with the sham group. At 4 and 6 weeks, the OAB model group exhibited significant differences in residual volume (RV) and non-voiding contraction frequency. Six-week OAB model group showed much more RV but less voiding efficiency when compared with 6-week sham group or 2—and 4-week OAB model group. Rats that underwent BOO exhibited similarities with the compensated state before four weeks and may have entered decompensated state at six weeks. Studies conducted with 4-week OAB model were appropriate.In part two of the experiment, unstable bladder in the OAB model group recovered bladder stability after SQW treatment, accompanied by improved bladder hypertrophy, as well as corrected urodynamic parameters. Expression of TRPV1 mRNA and proteins in the bladder was significantly greater in the OAB model group than that in the control group, which subsequently decreased significantly with SQW treatment in BOO-induced rats.ConclusionsSQW can modulate the expression of TRPV1 in accordance with the recovery of bladder function.Electronic supplementary materialThe online version of this article (doi:10.1186/s12906-015-0898-7) contains supplementary material, which is available to authorized users.

A novel urodynamic model for lower urinary tract assessment in awake rats

To develop a urodynamic model incorporating external urethral sphincter (EUS) electromyography (EMG) in awake rats. Bladder catheters and EUS EMG electrodes were implanted in female Sprague Dawley rats. Assessments were performed in awake, lightly restrained rats on postoperative day 12-14. Measurements were repeated in the same rat on day 16 under urethane anaesthesia. Urodynamics and EUS EMG were performed simultaneously. In addition, serum creatinine and bladder histology was assessed. No significant differences in urodynamic parameters were found between bladder catheter only vs bladder catheter and EUS EMG electrode groups. Urethane anaesthesia evoked prominent changes in both urodynamic parameters and EUS EMG. Serum creatinine was within the normal limits in all rats. Bladder weight and bladder wall thickness were significantly increased in both the bladder catheter only and the bladder catheter and EUS EMG group compared with controls. Our novel urodynamic model allows repetitive measurements of both bladder and EUS function at different time points in the same rat under fully awake conditions and opens promising avenues to investigate lower urinary tract dysfunction in a translational approach.

Predicting Refractory Detrusor Overactivity: Are There any Clues at Diagnosis

Approximately one-third of patients diagnosed with detrusor overactivity (DO) will be refractory to treatment with antimuscarinic drugs. In this study, we examined baseline clinical details and history of urinary tract infection (UTI), urodynamics parameters, urinary pH and ATP in voided urodynamic fluid for any prognostic factors that would allow prediction of the refractory state at the time of diagnosis. At follow-up (2 to 5 years), patients were characterised as responders or non-responders based on a &gt;50% decrease in urge leaks and voids per 24 hours. Of the 61 patients who met the inclusion criteria, follow-up revealed that 25% of these did not respond to antimuscarinic therapy. There were no significant differences in urodynamic parameters in responders compared to non-responders. Patients with a greater number of leaks/week at baseline and a history of UTI were more likely to be non-responsive to antimuscarinic therapy. There was no difference in urinary pH or ATP concentration in voided urodynamic fluid in the two groups. The results indicate that severity of leakage at baseline history and a history of recurrent UTI appears to be poor prognostic features in patients with DO. These may be associated with the development of the ‘refractory’ state.

Prospective randomized trial of 100u vs 200u botox in the treatment of idiopathic overactive bladder

Aim:To evaluate the clinical outcomes of two different doses of BTX-A in patients with refractory idiopathic overactive bladder.Patients and Methods:Thirty nine patients with refractory idiopathic overactive bladder from 1/1/2008 till 30/3/2009 were evaluated in a tertiary care hospital. Patients were evaluated using urodynamic studies, voiding diary, UDI-6 and IIQ-7 questionnaires prior to being prospectively randomized (alternate randomization) to the BTX-A applications and three months after treatment. Voiding diary and residual volume were followed two weeks later. All patients received intradetrusorial injections of BTX-A (Botox, Allergan, Irvine, CA) of 100u or 200u under cystoscopic control on an outpatient basis. The primary endpoint was assessed for the improvement of urodynamic parameters and adverse events at three months after the initial treatment. Secondary end points included urinary frequency, urgency and UUI episodes as assessed by voiding diary and QoL.Results:Eleven patients were enrolled to each arm of the study. There were no significant differences in demographic characteristics between the two groups. Urodynamic assessment at the end of the third month showed significant improvement in urodynamic variables in both groups. There was no statistically significant difference in urodynamic parameters and in the voiding diary between the two groups. QOL was significantly improved in both groups with no statistically significant difference between the different doses. Only three patients developed acute urinary retention.Conclusion:BTX-A at 100u and 200u appears to improve symptoms, urodynamic parameters and QoL with no statistical significance between the two groups.

Concomitant tension‐free vaginal tape for urinary incontinence during laparoscopic hysterectomy

To evaluate the effectiveness and safety of placing tension-free vaginal tape (TVT) during a laparoscopically assisted vaginal hysterectomy (LAVH) in women with stress urinary incontinence and coexistent benign gynaecological disease. Retrospective clinical study (Canadian Task Force classification II-2). Thirty patients diagnosed with genuine stress incontinence and benign gynaecological disease were studied. All the patients underwent LAVH and concomitant TVT procedure. There was no significant difference in urodynamic parameters before and after surgery. All patients were followed postoperatively for a mean duration of 24.6 +/- 11.5 months (range 12-40). The cure rate of stress urinary incontinence was 96.7%. Concomitant placement of tension-free vaginal tape during a laparoscopically assisted vaginal hysterectomy proved to be an efficacious and safe procedure for women with benign gynaecological disease and coexistent stress urinary incontinence.

Estrogen Receptor Subtypes and Afferent Signaling in the Bladder

The influence of estrogen on bladder function has been the subject of several experimental and clinical studies. In addition to the well-known estrogen receptor (ER)alpha, recently the ER subtype ERbeta was discovered. We investigated potential changes in bladder function in mice lacking either 1 or both receptor subtypes compared with WT mice. Female mice lacking genes for ERalpha (ERKO), ERbeta (BERKO) or both and their WT littermates were used for the study. Continuous cystometry in awake animals was performed before and after intravesical administration of capsaicin. In addition, in vitro responses to electrical field stimulation before and after incubation with scopolamine and alpha,beta-methylene adenosine triphosphate, and to carbachol were investigated. Control cystometry revealed no significant difference in urodynamic parameters among all strains. After capsaicin instillation the micturition interval and volume decreased, and micturition pressure increased in WT, ERbeta and 2 gene mice, while no changes were seen in ERKO mice. In vitro contractility was similar in all groups. Incubation with scopolamine and alpha,beta-methylene adenosine triphosphate led to significant decreases in the response to electrical field stimulation. There was no difference in the response to carbachol among the groups. The lack of ERalpha and/or ERbeta had little effect on in vitro contractility or on continuous cystometry in awake animals. The lack of response to capsaicin instillation in ERKO suggests that ER subtypes are important for vanilloid receptor function and mechano-afferent signaling.

The Impact of Urodynamic Parameters on the Upper Tracts of Spinal Cord Injured Men Who Void Reflexly

Few studies have evaluated which urodynamic parameters impact the upper urinary tracts in men with complete spinal cord injuries (SCI) who void reflexly. Previous studies focused primarily on voiding pressures. This study investigated the effects of bladder wall compliance, opening pressure, maximum detrusor voiding pressure, duration of the uninhibited contraction, cystometric bladder capacity and post-void residual on vesicoureteral reflux and stasis of the upper tracts. Urodynamic studies, cystograms and renal scans of 84 consecutive men with complete SCI who void reflexly were evaluated. Of the 84 patients (168 renal units), 71 men (142 renal units) had normal uppertracts, four patients (four renal units) had vesicoureteral reflux and nine patients (15 renal units - 12 bilateral, three unilateral) had upper urinary tract stasis. There was no statistical difference between those with reflux and those without reflux with regards to any urodynamic parameter evaluated. When comparing those with and without upper urinary tract stasis, the only statistically significant difference in urodynamic parameters was the duration of bladder contraction. The mean duration of the uninhibited contraction in the non-stasis group was 113.7 seconds ±84 seconds (1.9 minutes ± 1.4 minutes). The mean duration of the uninhibited contraction in the stasis group was 236.4 seconds! 139.1 seconds (3.9 minutes ±2.3 minutes, p=0.0098). In summary, the duration of bladder contraction, which reflects both detrusor and sphincter function, was found to be an important variable in those with upper tract stasis. This should be considered when evaluating and treating men with complete SCI who void reflexly. (J Spinal Cord Med 1998;21:15-20)