ICS teaching module: Ambulatory urodynamic monitoring.

AIM: To present the ICS Teaching Module on ambulatory urodynamics monitoring (AUM). METHODS: This teaching module has been developed by the ICS Urodynamics Committee to assist ICS members in their routine clinical practice. A detailed literature search on studies published on the clinical role of AUM as well as expert opinions have been considered. A slide set on AUM has been developed, approved by all members of the ICS Urodynamics Committee and is available to the ICS membership on the ICS website. The final approved teaching module has been presented at the ICS Annual Scientific Meeting in Brazil 2014. RESULTS: The scientific evidence on the clinical role of AUM in patients with lower urinary tract symptoms is summarized. The catheters and recording systems used, the patient preparation for the test, the technique, the instructions to the patient, the analysis, interpretation, and quality control assessment of AUM trace as well as the contraindications for AUM are described. CONCLUSIONS: The clinical role of AUM is still controversial. The scientific evidence on the usefulness of AUM is still limited but the ICS Urodynamics Committee recommends its use as a second line diagnostic tool when office laboratory urodynamics have failed to achieve a diagnosis. AUM has been showed to be more sensitive than laboratory urodynamics in diagnosing detrusor overactivity but the level of evidence for this measurement is not high. This manuscript summarizes the evidence and provides practice recommendations on AUM for teaching purposes in the framework of an ICS teaching module. Neurourol. Urodynam. 36:364-367, 2017. © 2015 Wiley Periodicals, Inc.

Are the measurements of water-filled and air-charged catheters the same in urodynamics?

INTRODUCTION AND HYPOTHESIS: The aim of our study was to compare air-charged and water-filled catheters simultaneously in the measurement of the intravesical, abdominal and detrusor pressure during urodynamic investigations. METHODS: Consecutive women with lower urinary tract symptoms, referred for urodynamics were prospectively studied. Readings of intravesical pressure (p(ves)), abdominal pressure (p(abd)) and detrusor pressure (p(det)), recorded by both the air-charged and water-filled catheters, were displayed simultaneously and compared at the end of filling, on standing, on sitting prior to voiding and at the maximum involuntary detrusor contraction. The signals (pressures) recorded by both types of catheter were compared using the Bland-Altman plot and paired samples t test. RESULTS: Twenty women with a mean age of 49 (range 36-72) were recruited. One patient with normal urodynamics was excluded in view of the poor quality trace. At each of the four comparison points, the air-charged catheters consistently produced higher mean pressures than the water-filled catheters. There were wide variations in the difference between the readings produced by the two types of catheter. CONCLUSIONS: Pressures measured using air-charged catheters are not comparable with water-filled catheters and are therefore not interchangeable. Caution must be used when comparing urodynamic parameters using air-charged and water-filled catheters.

Antimuscarinic effects on current perception threshold: a prospective placebo control study.

AIMS: To evaluate the effect of Tolterodine on urethral and bladder afferent nerves in women with detrusor overactivity (DO) in comparison to placebo, by studying the changes in the current perception threshold (CPT). METHODS: Women with overactive bladder symptoms and idiopathic DO were recruited and randomized in a double-blind manner between placebo and tolterodine extended release. All women underwent CPT testing of the bladder and urethra using a Neurometer constant current stimulator. CPT values were determined at three frequencies, including 2,000 Hz (corresponding to Aß-fibers), 250 Hz (corresponding to Aδ-fibers), and 5 Hz (corresponding to C fibers) before and 7 days on treatment. CPT values before and on treatment were compared using a Wilcoxon Signed Rank test. RESULTS: Twenty women (mean age 46 years) were studied. There was no statistical difference between the two groups in terms of age, ethnicity, severity of symptoms and pre-treatment CPT values. Only in the tolterodine group there was a significantly increased CPT value at 5 and 250 Hz upon both urethral and bladder stimulation after 1 week of treatment. When compared with placebo, women taking tolterodine had significantly increased Bladder CPT values at 5 Hz (P-value <0.05). The electrical stimulation with 5 Hz was described as urgency. CONCLUSIONS: This is a randomized placebo control study evaluating the effect of antimuscarinics on sensory nerve function in women with DO. Our results support the animal studies that antimuscarinics have an effect on sensory function.

Women's perspective of botulinum toxin treatment for overactive bladder symptoms.

INTRODUCTION AND HYPOTHESIS: This study aimed to evaluate the women's' views and expectations about outcomes and complications of botulinum toxin treatment for overactive bladder (OAB) symptoms. METHODS: Consecutive women with OAB symptoms and detrusor overactivity were requested to fill out a multiple choice questionnaire to assess whether they would consider botulinum and what outcomes as well as complications they would find acceptable to undergo this treatment. RESULTS: Two hundred sixty-one women, mean age of 58 (range, 38-78) years, were studied. Two hundred twenty-four were treatment-naive women (group A), while 37 were no responders to anticholinergics (group B). Only 49.6% of women in group A and 54% in group B would accept botulinum toxin. No significant differences were found between treatment-naive women and non-responders to anticholinergics (p > 0.05). CONCLUSIONS: Acceptance of botulinum toxin treatment involves a complex interaction of efficacy and possible complications. The balance of these factors changes the acceptability of the treatment.

Bladder sensations during filling cystometry are different according to urodynamic diagnosis.

PURPOSE: To determine the position and character of bladder filling sensations in women undergoing urodynamic investigations. MATERIALS AND METHODS: Women with lower urinary tract symptoms referred to urodynamic clinics of two tertiary referral teaching hospitals were prospectively studied. During filling cystometry the women were asked to describe the bladder sensations at the first sensation of bladder filling, first desire to void, strong desire to void, maximum bladder capacity and if the woman felt urgency. Women were also asked to define the time that the voiding could be delayed and to indicate the position of each sensation on a body map. Women were classified into four groups according to urodynamic diagnosis: detrusor overactivity (DO), urodynamic stress incontinence (USI), co-existing DO and USI (mixed) and inconclusive urodynamics; the latter was excluded from the study. Bladder sensations were compared between these groups using Chi squared and Kruskall-Wallis tests. RESULTS: Eighty-two women were studied. Women with DO and mixed urodynamic diagnosis predominantly described the bladder sensations as being perineal or vaginal in origin, whereas those with USI felt the sensations suprapubically. The character of bladder sensation was not significantly different between the diagnostic groups and the intensity increased with larger bladder volume. The duration that women could delay voiding was significantly different between different urodynamic groups. CONCLUSIONS: Bladder sensations experienced during cystometry are different in position and duration in relation to urodynamic diagnoses. This indicates that uniform descriptions of sensations during filling cystometry might not be appropriate to different urodynamic diagnoses.

Do women with pure stress urinary incontinence need urodynamics?

OBJECTIVES: To evaluate the value of performing urodynamic investigations in the assessment of women with a history of pure stress urinary incontinence (SUI). METHODS: Consecutive women with lower urinary tract symptoms were studied retrospectively. Urinary symptoms were determined from the frequency-volume chart and symptom section of the King's Health Questionnaire. Only women with pure SUI symptoms were included. RESULTS: A total of 3428 women aged 24-81 years were studied. Only 308 women (8.9%) could be classified as having pure SUI from the questionnaire. Of these, 241 of women (78.2%) had urodynamic stress incontinence, 23 women (7.5%) had detrusor overactivity, 9 women (2.9%) had mixed urodynamic diagnosis, and 35 women (11.4%) had inconclusive urodynamics. Postvoid residual volumes greater than 100 mL were noted in 24 (7.8%) women. CONCLUSIONS: Our results show that urodynamic investigations provide useful information in the assessment of women with a history of pure SUI, because as many as 20% of them might not need surgery as the first line of treatment.

Is ultrasound estimation of bladder weight a useful tool in the assessment of patients with lower urinary tract symptoms?

INTRODUCTION AND HYPOTHESIS: The aim of this study was to assess the relationship between ultrasound estimation of bladder weight (UEBW), symptoms and urodynamic diagnosis. METHODS: Women with lower urinary tract symptoms underwent urodynamics studies and measurement of UEBW at a fixed bladder volume. RESULTS: Women with overactive bladder symptoms had a median UEBW of 48.3 g (95% CI 44-52), with stress urinary incontinence a median UEBW of 35.1 g (95% CI 30-41) and with mixed urinary incontinence a median UEBW of 40.0 g (95% CI 37-43) (p<0.001). Women with detrusor overactivity had a median UEBW of 48.0 g (95% CI 46-51), with urodynamic stress incontinence a median UEBW of 30 g (95% CI 29-31) and detrusor overactivity and urodynamic stress incontinence a median UEBW of 37.3 g (95% CI 33-41) (p<0.001). CONCLUSIONS: UEBW is higher in women with overactive bladder and detrusor overactivity. UEBW may be a useful tool in women with lower urinary tract symptoms.