Urodynamic Examination Research Articles

TOT does not affect the urethral sphincter innervation: a pilot study

To exclude a neuromuscular denervation damage due to prosthetic mini-invasive surgery using transobturator tape (TOT) by pre and postoperative electromyography (EMG) of the striated urethral sphincter. Seventeen women with SUI were enrolled by urogynecologic and urodynamic examination. Each of them underwent EMG of striated urethral sphincter performed by 25-mm concentric needle that was put in as far as 5 mm inside internal urethral sphincter. Amplitude and duration of EMG potentials were measured during caught, maximal contraction, and at rest. Four months after TOT treatment women underwent EMG. The mean amplitude of EMG potentials does not show significant statistical differences between pre- and post-TOT (P=NS). The duration of potentials, instead, changed between pre and posttreatment only during the maximal contraction test (P ≤ 0.05). TOT prosthesis surgery, avoiding denervation and devascularization of pelvic structures does not produce damage of the urethral sphincter.

Reifensteiner Pouch: Ein vereinfachter Ileum-Kolon-Pouch mit Nabelstoma auf der Basis eines Mainz-Pouch I

Continent urinary diversion after radical cystectomy is the method of choice for suitable patients. For patients, in whom orthotopic bladder replacement with connection to the urethra stump is not possible, different pouches have been developed mostly with anastomosis to the umbilicus. These pouches have to be constructed with regard to three major principles: First, it has to be built as a low-pressure reservoir which does not interfere with high-pressure peaks during filling. Second, a direct transmission of the pressure by reflux from the pouch to the urinary system of the kidney has to be avoided. Finally, a sufficient continence mechanism has to be built to avoid urinary leakage. The standard procedure is the Mainz I pouch. This method is technically challenging and burdened with multiple complications regarding the continence mechanism, which is made by submucous placement of the appendix. Therefore, this operation is mostly performed in specialised centres. In this paper a simplified version of the continent umbilical pouch is, which has been applied in 11 patients. Instead of building the continence mechanism by using the appendix, the continent umbilical pouch acts as a natural valve. To prevent pressure transmission to the upper urinary tract, a part of the terminal ileum is connected proximally, which is built like an ileum conduit. Thereby it is possible to protect the upper urinary tract, as the pressure transmission from the pouch is not reduced by a static antireflux mechanism but by an air-chamber-like-mechanism. By means of the combination of urological standard procedures (like the ileum conduit) and a pouch, which is less challenging to construct, this method is technically simplified and therefore reduces operating time. Stoma stenosis, which had occurred in the first operated patients, was avoidable by a minimal change in technique in the following patients. Other complications that we saw (hernia, mucous tamponades), were not related to the used urinary diversion method. Therefore, this procedure is practical, technically simple and the results for patients are satisfying. This kind of continent pouch with umbilical stoma offers the opportunity for more patients to be operated on with this method. Further observation of the operated patients, possibly with with urodynamic examination, is necessary.

The urodynamic diagnosis of benign prostatic hyperplasia with coexisting overactive bladder

To investigate the urodynamic features in patients of benign prostatic hyperplasia (BPH) with coexisting overactive bladder (OAB). Clinical data of 235 patients with symptomatic BPH who underwent urodynamic examination during January 2009 to May 2010 were retrospectively analyzed. Patients were divided into group of pure BPH, BPH with detrusor overactivity (DO), BPH with coexisting OAB without DO and BPH with coexisting OAB with DO. The difference of age, International Prostate Symptom Score (IPSS), transrectal ultrasound (TRUS)-volume, maximum flow rate, residual urine volume, bladder volume of first sensation, bladder volume of strong sensation, bladder outlet obstruction index (BOOI) and the prevalence of decreased detrusor contractility were compared between these groups. The urodynamic characteristics of DO between group of BPH with DO and group of BPH coexisting OAB and DO were analyzed. A total of 219 cases were included in the final analysis, with mean age of (66 ± 8) years, mean TRUS-volume was (35 ± 24) ml, mean maximum flow rate was (11 ± 6) ml/s. Of the 219 patients, 93 patients (42.5%) had pure BPH, 11 patients (5.0%) had BPH with DO, 52 patients (23.7%) had BPH coexisting OAB without DO, 63 patients (28.8%) had BPH coexisting OAB and DO. Comparing to group of BPH (n = 104), patients with BPH and OAB (n = 115) were older, had higher IPSS, bigger TRUS-volume, less bladder volume of first sensation and strong sensation, higher BOOI and higher prevalence of decreased detrusor contractility. Comparing to group of BPH with coexisting OAB without DO patients, patients of BPH with coexisting OAB and DO had higher IPSS score (19 ± 12 vs 17 ± 10), bigger TRUS-volume [(51 ± 33) ml vs (43 ± 27) ml], higher BOOI (49 ± 18 vs 37 ± 14). Comparing to patients pure BPH, patients of BPH with DO had less bladder volume of first sensation and bladder volume of strong sensation [(82 ± 41) ml vs (118 ± 35) ml;(335 ± 67) ml vs (419 ± 53) ml]. Comparing to group of BPH with DO, patients of BPH with coexisting OAB and DO had higher maximum DO pressure [(45 ± 36) cmH2O vs (39 ± 30) cmH2O (1 cmH2O = 0.098 kPa)] and longer DO time [(7 ± 4) s vs (6 ± 4) s]. The urodynamic features in patients with BPH differ greatly and these information should be helpful in making choice of treatment and in predicting treatment outcomes.

The value of sacral skin lesions in predicting occult spinal dysraphism in children with voiding dysfunction and normal neurological examination

ObjectiveThe role of magnetic resonance imaging (MRI) in detecting occult spinal dysraphism (OSD) in children with voiding dysfunction and a normal neurological examination is still under debate. The aim of this study was to assess the correlation of sacral skin lesions with OSD detected on MRI, in a population of children with resistant lower urinary tract symptoms (LUTS). Patients and methodsA total of 114 children over 5 years of age with urinary tract infection (UTI) and/or LUTS and normal neurological examination were enrolled. All children underwent sacral neurological examination, urine analysis and cultures, renal/bladder ultrasound, voiding cystourethrogram and urodynamic examination. After a treatment period of 6 months, the patients were re-evaluated and spinal MRI was performed in 61 with ongoing LUTS or UTI. ResultsNineteen of 61 children (31%) had cutaneous stigmas. MRI detected spinal abnormality in 2/42 children with a normal sacral examination in comparison to 7/19 children with an abnormal sacral finding (Chi-squared test, P < 0.005). The sensitivity and specificity of an abnormal sacral finding in predicting MRI abnormality were 0.76 and 0.77, respectively. Urodynamic parameters did not predict an abnormal spinal MRI. ConclusionsAbnormal sacral findings, but not urodynamic studies, are strong predictors of OSD. A normal sacral examination does not rule out OSD.

ELECTROMYOGRAPHY OF THE URETHRAL SPHINCTER IN SUI

The study values, through electromyography (emg), the stripped urethral sphyncter activity in women with stress incontinence (USI). 10 women with USI and 5 healthy women -control group- underwent urogynecologic examination, urodynamic examination and urethral electromyography examination. The endurance and extension of tension were took in the consideration. 9 women with USI had EGM showing denervation/renervation nervous damage, supported by potential&amp;rsquo;s wideness and length higher than control group (&amp;gt;300&amp;mu;V), either during relax or cough, and the trace&amp;rsquo;s absence of the interference with voluntary contraction. Only one woman with USI showed an EGM compatible with myogen damage: values &amp;lt;100 &amp;mu;V in all traces and negative anamnesis for risk factors. The Authors emphasize the role of EMG as a particular exam to study in deep the causes of urinary incontinence helpful to identify basic disorders of USI.

Influence of urodynamic factors on urinary retention in patients with cervical carcinoma after radical hysterectomy

To study the effect of urodynamic factors on the urinary retention of the patients with cervical cancer received radical hysterectomy. Seventy-two patients with cervical cancer International Federation of Gynecology and Obstetrics (FIGO) stage Ib1 to IIa hospitalized in Fujian Provincial Maternity and Child Health Hospital between June 2006 and August 2009, who were not found any abnormal representation of urodynamics before the operation, were divided into the group with urinary retention and the group without urinary retention based on whether urinary retention after the operation. All patients were detected by urodynamic examination following radical hysterectomy. Data obtained from urodynamic examination were analysed by logistic regression to evaluate the influence of urodynamic factors on the urinary retention postoperation. Twenty-one patients out of all were found with urinary retention after the operation, the incidence rate of urinary retention was 29%. The first sensation after operation in both groups were increased significantly than those before operation [(171 ± 61) ml vs. (126 ± 28) ml, (134 ± 39) ml vs. (119 ± 17) ml, all P < 0.05], while the maximum volume [(337 ± 66) and (300 ± 66) ml, respectively], the compliance [(31 ± 25) and (29 ± 18) ml/cm H2O (1 cm H2O = 0.098 kPa), respectively], the maximum flow rate [(10 ± 4) and (12 ± 5) ml/s, respectively] and the pressure at the maximum flow rate [(27 ± 9) and (32 ± 8) cm H2O, respectively] were decreased obviously after radical hysterectomy in both the group with urinary retention and the group without urinary retention (all P < 0.05), compared with the corresponding value before the operation. The urodynamic changes in urinary retention group was much more severe than those in group without urinary retention (P < 0.05). The single factor analysis results showed that bladder destusor dysfunction (OR = 8.20, 95%CI: 2.62-25.66, P < 0.01) and lack of sensation (OR = 6.90, 95%CI: 1.95-24.43, P < 0.01) were relevant to the urinary retention post-operation. While there were not relationship was found between low compliance bladder (OR = 1.99, 95%CI: 0.70-5.63, P = 0.195), detrusor overactivity (OR = 2.51, 95%CI: 0.73-8.67, P = 0.144), bladder outlet obstruction (OR = 3.77, 95%CI: 0.76-18.57, P = 0.104) or dyssynergia of urethral external sphincter (OR = 2.67, 95%CI: 0.49-14.45, P = 0.255) and urinary retention following the operation. There were an antagonistic effects (OR = 7.60, 95%CI: 1.43-40.39, P = 0.017) of detrusor overactivity and bladder destrusor dysfunction on urinary retention. The multiple factors analysis results revealed that bladder destusor dysfunction (OR = 7.01, P < 0.01) and lack of sensation (OR = 5.45, P = 0.018)were the independent risk factors influencing on the urinary retention post-operation. There are obvious urodynamic change in cervical cancer patients following radical hysterectomy. Bladder destrusor dysfunction and lack of sensation are the independent urodynamic risk factors influencing on urinary retention following radical hysterectomy, while detrusor over activity may be a protective effect on bladder destrusor dysfunction post-operation in some degree. Urodynamic test is important for analysis and treatment of urinary retention following radical hysterectomy.

Clinical study of resiniferatoxin on neurogenic bladder

To understand the effect of resiniferatoxin on neurogenic bladder by intravesical filling. Twenty-four male spinal cord injury patients with an obviously low cystometric capacity, 2 incomplete cervical cord injury, 5 complete thoracic cord injury, 4 incomplete thoracic cord injury, 5 incomplete lumbar cord injury and 8 complete lumbar cord injury were examined. The age range was 24 - 58 years old and the course of disease 1 - 6 years. There were 0.0063 mg/4 ml RTX in each bottle, it was dissolved in 50 ml physiologic saline and was infused into bladder slowly, kept 30 min, then was discharged by intermittent catheterization (IC). During the process, the patients were requested to fill a micturition chart and conduct urodynamic examination before and after the infusion. We regulated that it was utility when the amount of increased maximal cystometric capacity (MCC) exceeded or was 100 ml, otherwise it was invalid. The urodynamic examination before intravesical filling and 1 week after intravesical filling showed that the average MCC were (210 ± 23) ml and (360 ± 30) ml respectively, the average bladder compliance were (17 ± 3) ml/cm H2O and (24 ± 5) ml/cm H2O, there were statistic difference between them (both P < 0.01). The overall effective rate was 62.5%. It lasted 1 - 4 months. Resiniferatoxin is effective to increase the cystometric capacity and booster the bladder compliance.

Quality of life and urodyanmic characteristics in nonparalytic spinal cord dysfunction patients with neurogenic underactive bladder

Objective To investigate the change of quality of life and urodynamics after the enterocystoplasty combined with clean intermittent self-catheterisation (CISC) in nonparalytic spinal cord dysfunction (NSCD) patients with neurogenic underactive bladder by the Medical Outcomes study 36-item short-form general health survey (SF-36). Methods The quality of life of 72 NSCD patients with NUB were measured by SF-36 questionnaire, who had been taken enterocystoplasty combined with CISC or only CISC according to urodynamic results. In total, 58(81% ) patients were successfully followed for one year by SF-36 questionnaire and urodynamic examination, including 30 men (mean age 27±5 year) and 28 women (mean age 26±4 year). The normal volunteers without lower urinary tract symptom were set as control group, including 20 men (mean age 28 ± 4 year) and 20 women (mean age 29±4 year). Results At the follow-up, physical role, vitality and social function of men and women were 55±14 and 45±15, 76±19 and 74±15, 52±19 and 59±13 respectively, significantly higher than those before the treatment (35 ± 10 and 32 ±11, 27 ± 18 and 33 ± 17, 40 ±12 and 34 ±15). The bladder compliance and maximum cystometric capacity were (320 ± 44 ) ml and ( 338 ±50)ml,(55±15)cm H2O and (60±17)cm H2O respectively, also significantly higher than those before the treatment (131±30ml and 140±35ml,5±3 cm H2O and 6±4 cm H2O). However, detrusor leakage point pressures were (6±2)cm H2O and (6±3)cm H2O respectively, significantly lower than those before the treatment (28 ±9 cm H2 O and 25 ± 6 cm H2O). Except for physical function and bodily pain, the all domains of quality of life in both men and women patients were significantly lower than those in control group. Only 17 % of men and 7 % of women believed their health is better than that one year ago. There was no significant difference in the remission rate between men and women (89% vs 76%) in the patients with RUUTD before treatment. Conclusions It is suggested that urodynamic parameters are significantly improved. Many domains of quality of life were not improved and the reduced quality of life still occurred in NSCD patients with NUB using enterocystoplasty and CISC. Key words: Spinal disearse; Bladder, neurogenic; Urodynamics

Chronic prostatitis presenting with dysfunctional voiding and effects of pelvic floor biofeedback treatment

To investigate the features of chronic prostatitis presenting with dysfunctional voiding (DV) and the effects of pelvic floor biofeedback (PFB). The study included 21 patients, diagnosed by having symptoms for > or =3 months, including urinary frequency and urgency, voiding difficulty, upper abdominal or perineal discomfort, and with a score of > or =1 on the first and second part of the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI). Patients with bacterial prostatitis, urethritis, interstitial cystitis, urethral stricture and neurogenic bladder were excluded. All patients had a urodynamic examination, to assess the uroflow curve, maximum urinary flow rate (Q(max)), maximum detrusor pressure during the storage phase (P(det.max)), maximum urethral pressure (MUP) and the maximum urethral closure pressure (MUCP) were recorded. PFB was carried out in patients with non-neurogenic detrusor sphincter dyssynergia, and the effects evaluated after 10 weeks. Before and after PFB treatment the mean (sd) Q(max), P(det.max), MUP, MUCP were 8.2 (4.1) vs 15.1 (7.3) mL/s, 125.1 (75.3) vs 86.3 (54.2) cmH(2)O, 124.3 (23.3) vs 65.4 (23.0) cmH(2)O and 101.5 (43.6) vs 43.5 (16.7) cmH(2)O, all significantly different (P < 0.05). The respective differences in the pain, urination and life impact subdomain scores, and total scores, of the NIH-CPSI were 4.0 (2.0) vs 2.2 (1.7), 7.9 (2.1) vs 2.2 (1.9), 9.6 (2.7) vs 2.9 (2.6) and 21.7 (4.8) vs 8.4 (4.6), and all differences were significant (P < 0.05). There might be DV in patients with chronic prostatitis and lower urinary tract symptoms. Urodynamics showed a low Q(max) and increasing intravesical pressure and, in some patients, increasing urethral pressure. Urodynamics could be used to help in the diagnosis, and to select the most appropriate treatment. PFB had satisfactory short-term effects on these patients.

Prospective Study Comparing the Suprapubic Arc (Sparc) Procedure and the Transobturator (Monarc) Procedure for Treating Female Stress Urinary Incontinence

In a comparative trial we evaluated the efficacy and safety of the suprapubic arch (Sparc) and transobturator (Monarc) procedures for the treatment of female stress urinary incontinence (SUI). Between November 2003 and May 2004, 46 women with SUI who underwent the Sparc procedure and 42 women who underwent the Monarc procedure were analyzed. The preoperative evaluation included history taking, physical examination, voiding diary, stress and 1-h pad tests and a comprehensive urodynamic examination. Postoperative evaluation included a stress test, 1-h pad test, and uroflowmetry with postvoid residuals. After 1 year of follow up, the rates of cure and satisfaction were 93.5 and 93.0%, respectively, in the Sparc group. The rates of cure and satisfaction were 95.2 and 85.7%, respectively, in the Monarc group. After 2 years of follow up, the rates of cure (93.5 vs 92.9%) and satisfaction (84.8 vs 83.3%) were similar between the two groups. No bladder injury occurred in the Monarc group. Bladder injury occurred in 6.5% (n = 3) of the patients in the Sparc group. Vaginal wall perforation occurred in 4.8% (n = 2) of the patients in the Monarc group (P > 0.05). Late complications included de novo urge symptoms (8.7 vs 11.9%) and voiding dysfunction (10.9 vs 9.5%). The transobturator Monarc procedure appears to be as efficient and safe as the retropubic Sparc procedure for the treatment of SUI.

Répercussions cliniques et urodynamiques du traitement de l’incontinence urinaire d’effort par bandelettes sous-urétrales transobturatrice

Analyse changes in voiding patterns after the treatment of female urodynamic stress incontinence (USI) with suburethral transobturator tape (TOT).Prospective study of 50 women with pure stress urinary incontinence treated between March 2004 and February 2006; mean age was 53+/-13 (34-87); parity was 2+/-0.75; mean follow-up was of 15 months (7-43). Each patient did a complete urodynamic examination and filled in two questionnaires (MHU and Contilife), before and three months after surgery.Cure rate was 94% (47/50). Three of 50 patients remained incontinent after surgery (6%). No peroperative complications occurred. Analysis of questionnaires showed that two clinical symptoms predominated postoperatively: dysuria (14%; n=7) and urgency (6%; n=3). Urodynamic profiles showed the following: a decrease in maximum flow rate from 23.6 to 18.9 ml/s (p<0.01), and an increase in urethral resistance from 0.12 to 0.23 (p<0.01). The number of patients with at least two Massey Abrams criteria defining obstruction rose from six to 19, while only seven patients had symptomatic dysuria. Quality of life improved significantly, from 2.32 to 4.63 (p<0.05).TOT is a safe, effective procedure with few complications. While urodynamic data show some obstruction, this has little impact upon clinical results or mid-term complications; it only mildly affects voiding and does not compromise patient satisfaction.

Risk factors of recurrence after transurethral resection of the prostate due to benign prostate hyperplasia

To review the clinic data of benign prostate hyperplasia (BPH) cases, and to find the risk factors of recurrence in post transurethral resection of the prostate (TURP) patients. From November 2002 to November 2007, 1471 cases were reviewed, including 41 patients of recurrence after TURP. Record the data include onset age, course of disease, age of surgery, LUTS, PSA, blood serum creatinine, size of the prostate in transabdomen ultrasonography, data of urodynamic examination, weight of resected tissue, persistence time of the resection, length of stay, score of inflammation of the pathologic sample, experience of the operator, routine blood examination, routine urine examination and so on. Statistical analysis was performed using univariate and multivariate unconditional Logistic regression analysis for evaluation of the data. In the univariate analysis, onset age (t = 2.292, P = 0.086), PVR (t = 2.181, P = 0.03), size of the prostate in transabdomen ultrasonography (t = -1.987, P = 0.047), experience of the operator (Z = 10.13, P = 0.0015) and the symptom that bladder does not feel completely empty right after urinating (chi(2) = 9.240, P = 0.002) had statistical significance. In the multivariate unconditional Logistic regression analysis, Odds ratio (OR) of the factors were investigated, the symptom that bladder does not feel completely empty right after urinating (OR = 0.557), the score for inflammation (OR = 0.905) and experience of the operator (OR = 0.393) had statistical significance. The risk factors for elevating the incidence of post-TURP recurrence are the lower score for inflammation, younger onset age, having the symptom that bladder does not feel completely empty right after urinating, bigger size of prostate in transabdomen ultrasonography, lower post void residual urine volume and poor experience of the operator.

Urodynamic examination in diagnosis of female bladder outlet obstruction

Urodynamic examination in diagnosis of female bladder outlet obstruction

Comparison of TOA and TOT for Treating Female Stress Urinary Incontinence: Short-Term Outcomes

PurposeThe transobturator adjustable tape (TOA) sling operation is a new procedure that allows for the adjustment of tension after surgical intervention, thus permitting correction of postoperative incontinence or obstruction. The aim of this study was to compare the efficacy and safety of TOA with that of the transobturator tape (TOT) procedure.Materials and MethodsBetween 2008 and 2009, women with stress urinary incontinence (SUI) underwent TOT (n=63) or TOA (n=40). The preoperative evaluation included history taking, physical examination, voiding diary, stress and 1-hour pad tests, and a comprehensive urodynamic examination. Postoperative evaluation was performed at the 1-week and 3-month postoperative follow-up visits.ResultsThe overall cure rate was 90.0% for the TOA group and 85.7% for the TOT group. The rate of satisfaction was higher in the TOA group than in the TOT group (95.0% vs. 85.6%). Four patients in the TOA group needed reduced tension as the result of urinary obstruction. The tension of the mesh was tightened in 1 patient because of a certain degree of continuing incontinence. The residual urine volume was significantly lower in the TOA group than in the TOT group (7.8 ml vs. 43 ml, p=0.01).ConclusionsTOA allowed postoperative readjustment for a number of days after surgical intervention, which allowed for good short-term treatment outcomes. These data suggest that better subjective and objective results and residual urine volume can be obtained in the TOA group than those achieved with the traditional non-adjustable mesh and without significant postoperative complications.

Long-Term Results of Bulking Agent Injection for Persistent Incontinence in Cases of Neurogenic Bladder Dysfunction

We evaluated the effectiveness of bladder neck injection as a supplementary treatment for persistent low pressure incontinence after unsatisfactory fascial sling procedures in patients with neurogenic lower urinary tract dysfunction. A total of 89 patients with neurogenic lower urinary tract dysfunction underwent fascial sling procedures between 1992 and 2005. Because of unsatisfactory results, 27 patients received endoscopic injection of a bulking agent. All patients included in the study underwent urodynamic examination after the sling procedure, which revealed persistent low pressure transurethral leakage of urine. We retrospectively analyzed the endoscopic approach used to administer the bladder neck injection, method of postoperative catheterization and number of injections given. Efficacy of bladder neck injection was graded by the patient and the urologist. After a median followup of 8 years (range 2.5 to 14) only 2 patients (7%) were continent after having received a single injection of bulking agent. A total of 12 patients (44%) were given a second injection and 8 (30%) were given a third injection but these subsequent injections did not result in continence. Of the patients 16 (59%) eventually underwent bladder neck surgery, 2 (7%) were dry and 8 (30%) accepted the inconvenience. Two patients underwent ileocystoplasty and 1 patient underwent botulinum A toxin (Botox(R)) injection due to decreased bladder capacity and poor bladder compliance. Neither the endoscopic approach nor the method of postoperative catheterization affected the success rate. Bladder neck injection after failure of primary sling procedures has limited value in patients with neurogenic lower urinary tract dysfunction. Repeat bladder neck injection yields no additional benefits.

Examen urodynamique et incontinence urinaire féminine non neurologique

Female urinary incontinence raises various physiopathological mechanisms which can be investigated by urodynamics. The aim of this work is to specify the validity and the relevance of the various urodynamic parameters used in clinical practice. A bibliographical research was realized on the basis of Medline data from original articles dealing with the incontinence in the absence of genital prolapse. Urodynamic examination has to contain uroflowmetry, post void residual, filling cystometry with detrusor pressure measurements during micturition, urethral pressure profile with maximal urethral closure pressure (MUCP) and Valsalva leak point pressure (VLPP). A urodynamic examination is not necessary before conservative treatment of urinary incontinence in the female. A complete urodynamic examination is recommended before any decision of surgical correction of urinary incontinence and in case of surgical failure.

UP-2.196: A Long-Term Observation on Technique Remoulding and Accessory Modification for Gaining Precise High Quality Results in Urodynamic Examination

UP-2.196: A Long-Term Observation on Technique Remoulding and Accessory Modification for Gaining Precise High Quality Results in Urodynamic Examination

Prospective assessment of overactive bladder symptoms in women who have undergone transvaginal surgery for advanced vaginal wall prolapse: A preliminary report

To evaluate the changes in symptoms of overactive bladder (OAB) on the advanced cystocele after restoration of prolapse using the Perigee system. This prospective clinical study recorded 16 women for the Perigee procedure due to advanced cystocele with OAB symptoms. Prolapse assessment was measured according to the pelvic organ prolapse quantization system. Complete urodynamic examination was performed before and six months after the operation. Subjects were also asked to fill in a questionnaire before and after the operation for a quantitative assay of OAB symptoms. Additional pelvic reconstructive surgeries including the Apogee procedure, retropubic tension-free vaginal tape and posterior colporrhaphy with tension-free vaginal tape were performed concurrently on 10 patients. Eleven cases were available for data analysis. Results showed significant improvement at points Aa and Ba after the operation. The Perigee procedure could restore the advanced cystocele adequately, with points Aa and Ba almost back to their normal physiological and anatomical positions. However, urodynamics showed two subjects with motor urgency and one with sensory urgency having objective improvement in urge sensation. Questionnaire results of postoperative subjective symptoms revealed a significant improvement with respect to coping, concern and sleep as compared to preoperative symptoms. This preliminary report reveals that the Perigee procedure is an efficient and effective surgical approach for the treatment of anterior vaginal wall prolapse. It can also improve the subjective symptoms of OAB.

Reproducibility of same session repeated cystometry and pressure‐flow studies in women with symptoms of urinary incontinence

The aim of this study was to determine the reproducibility of same session repeated urodynamic measurements in women with symptoms of urinary incontinence. Women presenting with symptoms of urinary incontinence underwent standardized urodynamic examination, which consisted of free uroflowmetry and two filling cystometries and pressure-flow studies. Intra-class Correlation Coefficient (ICC) and McNemar tests were used to describe the same session reproducibility. Two evaluable urodynamic tests were available in 152 patients. Overall, reproducibility of the urodynamic parameters were good to excellent (ICC range: 0.72-0.93), except for the bladder volume at first sensation of bladder filling (ICC = 0.46) and the maximum Watt's factor (ICC = 0.68). The bladder volume at first sensation and the maximum cystometric capacity were systematically higher in the second run (mean difference (95% CI) = -45 (-73; -37) and -3 (-15; 10), respectively). Reproducibility of the diagnosis stress urinary incontinence and/or detrusor overactivity were good to excellent (median ICC = 0.76, P = 0.68 and P = 1.00, respectively). Reproducibility of the volume and amplitude at involuntary detrusor contractions, however, were only poor (ICC = 0.18 and 0.25, respectively). The reproducibility of same session repeated urodynamic measurements in women with symptoms of urinary incontinence was good to excellent. Our results provide the scientific support for guidelines that recommend the omission of repeated filling cystometries and pressure-flow studies in cases where the first test confirms the pathology expected.

Does Optimizing Bladder Management Equal Optimizing Quality of Life? Correlation Between Health-related Quality of Life and Urodynamic Parameters in Patients With Spinal Cord Lesions

To analyze the influence of bladder management on patient well-being by correlating the objective urodynamic results of bladder treatment with the perceived quality of life in patients with spinal cord lesions. In a prospective study, 41 consecutive patients with neurogenic lower urinary tract dysfunction due to a spinal cord lesion who were performing intermittent self-catheterization underwent urodynamic examination and answered the German version of the Qualiveen (Coloplast A/S, Humlebaek, Denmark) questionnaire. The urodynamic results were classified as either treatment success or failure. The results of the Qualiveen questionnaire were correlated with these results. The Qualiveen scales concerning fears and feelings were significantly worse in patients with suboptimal bladder function compared with those patients with treatment success. The results of our study have demonstrated that a treatment regimen leading to favorable urodynamic data and continence correlates with better quality of life.