Objective differences between overactive bladder patients with and without urodynamically proven detrusor overactivity

Current optimal pharmacologic therapies for overactive bladder

INTRODUCTION

Overactive bladder (OAB) is a common syndrome in adults. Current pharmacologic treatment includes antimuscarinic agents and β-3 adrenoceptor agonists. For non-responders to oral medication, intravesical injection of botulinum toxin A (BoNT-A) is an effective option. However, these treatments have potential adverse events and should be cautiously selected for appropriate patients. This review presents the recently published results of clinical trials and studies for patients with OAB and the underlying pathophysiology of OAB. Appropriate medical therapy based on pathophysiology of OAB is also presented.

AREAS COVERED

Literature search from Pubmed from 2001 to 2023 including clinical background, pharmacology, and clinical studies for OAB medications.

EXPERT OPINION

Treatment of OAB syndrome with any antimuscarinic or β-3 adrenoceptor agonist is feasible as a first-line approach. For patients with suboptimal therapeutic effect to full-dose antimuscarinics or mirabegron, combination with both drugs can improve efficacy. Intravesical BoNT-A 100-U injection provides therapeutic effects for refractory OAB. Patients who are refractory to initial pharmacotherapies should be investigated for the underlying pathophysiology; then an appropriate medication can be added, such as an α1-blocker or anti-inflammatory agents. Patient education about behavioral modification and therapies should always be provided with oral medication or BoNT-A injection for OAB patients.

Correlation between overactive bladder and detrusor overactivity: a retrospective study

INTRODUCTION

The primary objective of this study is to determine the prevalence of overactive bladder (OAB) and detrusor overactivity (DO) in female patients who were referred for urodynamic study (UDS) because of lower urinary tract symptoms (LUTS). The secondary objective is to determine the subjective and objective differences between female OAB patients with and without DO.

MATERIALS AND METHODS

All female patients who underwent UDS for LUTS between June 2016 and September 2019 were retrospectively reviewed. Personal history, medical history, physical examination, and validated questionnaires were collected. One-hour pad test and multichannel urodynamic study was performed. All statistical analyses were conducted by SAS 9.4. P-value < 0.05 was considered statistically significant.

RESULTS

A total of 4184 female patients underwent UDS because of LUTS between June 2016 and September 2019; 1524 patients were analyzed for OAB or DO. The occurrence of OAB was 36.4%. The overall incidence of DO in OAB patients was 15.5%; 9.5% of all patients had DO findings on UDS, and 4.6% were incidental findings. There were significant differences among mean age, parity, ICIQ-UI SF, OABSS, POPDI-6, and all UDS parameters (except for maximal urethral pressure and pressure transmission ratio) between patients with and without DO. In patients with DO, there were no significant differences among age, parity, and BMI with or without OAB symptoms. However, there were significant differences among mean OABSS, ICIQ-UI SF, UDI-6, POPDI-6, IIQ-7, and pad test.

CONCLUSIONS

Patients with DO are associated with older age, increased parity, greater urine leakage, and worse storage and micturition functions on UDS. Combinations of subjective and objective measurements are better predictive models for OAB patients.

Problems with enuresis management-A personal view

Much has happened since the end of the era when enuresis was blamed on the parents or the children themselves. Still, there are large gaps in our knowledge and large parts of modern enuresis management guidelines are (still) not based on firm evidence. In this review I will question the following commonly made assumptions regarding enuresis evaluation and treatment: •It is important to subdivide enuresis according to the presence of daytime symptoms•Voiding charts are crucial in the primary evaluation of the enuretic child•All children with enuresis need to be screened for behavioral or psychiatric issues•Concomittant daytime incontinence needs to be successfully treated before addressing the enuresis•Concomittant constipation needs to be successfully treated before addressing the enuresis•Urotherapy is a first-line treatment against enuresis In this review I will argue that much of what we do with these children is based more on experience and well-meant but poorly supported assumptions than on evidence. Some advice and therapies are probably ineffective whereas for other treatments we lack reliable predictors of treatment response. More research is obviously needed, but awaiting new results enuresis management could be substantially simplified.

Health-related quality of life among Chinese primary care patients with different lower urinary tract symptoms: a latent class analysis

PURPOSE

No previous study has used a data-driven approach to explore symptom subclasses among patients with lower urinary tract symptoms (LUTS). The objectives of this study were to use latent class analysis (LCA) to identify distinct classes of LUTS among primary care patients and to assess the class differences in health-related quality of life (HRQOL).

METHODS

In this cross-sectional study, 500 patients were randomly recruited, and 18 symptoms according to the International Continence Society 2002 criteria were assessed. Classes were identified by LCA. Patient HRQOL was measured using the 12-item Short Form Health Survey (version 2), the modified Incontinence Impact Questionnaire-Short Form and the HRQOL item from the International Prostate Symptom Score.

RESULTS

Six distinct LUTS classes were identified: "asymptomatic" (26.0%), "mild symptoms" (22.6%), "moderate multiple symptoms" (17.0%), "urgency symptoms" (13.8%), "urinary incontinence" (12.0%) and "severe multiple symptoms" (8.6%). Multinomial regression analysis found differences in the gender distribution and prevalence of heart diseases across classes, and multiple linear regression found that patients with "severe multiple symptoms" and "urinary incontinence" had the poorest HRQOL.

CONCLUSION

Almost three quarters of the primary care patients in this study were suffering from varying degrees of LUTS. The poor HRQOL in "severe multiple symptoms" and "urinary incontinence" implies that patients in these classes require additional attention and treatments.

Recurrent urinary tract infection in women and overactive bladder - Is there a relationship?

Overactive bladder (OAB) in women has similar symptomatology with other common urologic diseases such as recurrent urinary tract infection (UTI). Recent evidence showed that chronic low-grade bacterial bladder colonization might exacerbate OAB symptoms and could be the etiology of recurrent UTI. The high prevalence of lower urinary tract dysfunction is associated with OAB. Women with urgency urinary incontinence refractory to antimuscarinic therapy had more bacteria and a more diverse urinary microbiome. The bacterial reside in the superficial urothelial cells to form intracellular bacterial community and outbreak when the host innate immunity is low. Women with recurrent UTI are found to have highly prevalent voiding dysfunction and detrusor overactivity. These functional abnormalities will further damage the urothelial barrier integrity and create vulnerable to uropathogen invasion. The defective urinary microbiota is less common in women with recurrent UTI, suggesting that the normal flora in the urine might inhibit uropathogen growth and invasion. The defective urothelial barrier function, deficient basal proliferation, and deficient maturation might be owing to chronic suburothelial inflammation, resulting in activation of sensory nerves (causing OAB) and failure elimination of intracellular bacterial communities (causing recurrent UTI). Precision diagnosis and multidisciplinary treatment of the underlying pathophysiology of OAB and recurrent UTI is necessary.

The association between frailty and detrusor overactivity in older adults

OBJECTIVE

To explore the relationship between frailty, age, and detrusor overactivity (DO) in older adults presenting to an academic urology practice.

MATERIALS AND METHODS

This study uses the University of California, San Francisco Geriatric Urology Database to examine all adults ages ≥65 years who underwent urodynamic testing from December 2015 to April 2019. All subjects had a timed up and go test (TUGT) as a measure of frailty and were categorized as fast (≤10 seconds), intermediate (11-14 seconds), or slow (≥15 seconds), corresponding to not frail, pre-frail, and frail, respectively. Urodynamic studies were reviewed for the presence of DO. Univariate and multivariate logistic regression were used to examine the relationship between frailty, age, and the presence of DO.

RESULTS

In total, 549 older adults underwent urodynamics during the study period, and 48.5% had a study that demonstrated DO. Individuals with DO tended to be older (18.4% vs 11.0% were ≥80 years; P = .01) and more frail (19.5% vs 13.4% with TUGT ≥5 seconds; P < .01). Multivariate regression demonstrated that DO was associated with both pre-frail and frail TUGT times (adjusted odds ratio [aOR], 2.1; 95% confidence interval [CI], 1.3-3.4; P < .01 for TUGT 11-14 seconds, and aOR, 2.1; 95% CI, 1.1-4.0; P = .02 for TUGT ≥15 seconds). Age was not found to be significantly associated with DO (P's > .05).

CONCLUSIONS

Frailty, not age, is associated with DO among older adults undergoing urodynamics. Further research on the role of frailty in the evaluation and management of older adults with DO is warranted to best serve the needs of this population.

When should we use urodynamic testing? Recommendations of the Italian Society of Urodynamics (SIUD). Part 1 - Female population

Although, until a few years ago, the diagnostic power of urodynamic testing had never been questioned, recent studies in the literature have raised some doubts on the routine use of this tool. The benefits of the urodynamic studies (UDS) should be weighted against costs, time-consumption and patient discomfort. These recommendations are intended to guide clinicians in the right selection of the female patients to submit to a urodynamic evaluation. We reviewed the literature, regarding the use of UDS in female adults with lower urinary tract symptoms (LUTS) and pelvic floor dysfunction. Specifically, we analyzed and compared the guidelines and recommendations of the most important urology and uro-gynecology international scientific societies. These publications were used to create the evidence basis for characterizing the recommendations to perform urodynamic testing. A panel of 10 experts was composed and Delphi process was followed to obtain the panelist consensus. The final recommendations were approved by the unanimous consensus of the panel and compared with the best practice recommendations available in the literature. The recommendations are provided for diagnosis and management of common LUTS in female population. This review provides a summary of the most effective utilization of urodynamic studies for the global evaluation of patients with lower urinary tract symptoms and how to use them when really needed, avoiding unnecessary costs and patient inconveniences.

Racial and Ethnic Differences in Urodynamic Parameters in Women With Overactive Bladder Symptoms

OBJECTIVES

This study aimed to identify differences in severity of overactive bladder (OAB) symptoms in women of different races and ethnicities using urodynamic study (UDS) parameters.

METHODS

We performed a 5-year retrospective chart review from January 2014 to January 2019 of women 18 years and older who endorsed OAB symptoms and underwent UDS at a racially and ethnically diverse academic urban medical center. Logistic and linear regressions were used to examine the associations of various UDS parameters between racial/ethnic groups, after adjusting for age, diabetes, and parity.

RESULTS

A total of 161 women with an average age of 59 years were included in the study. The racial/ethnic composition of the group was Hispanic (62%), black (24%), and white (11%). Symptoms on presentation included urgency and/or frequency (11.8%), urge incontinence (23.0%), or mixed urinary symptoms (65.2%). Black and Hispanic women presented with differing symptoms (urgency/frequency vs mixed urinary symptoms). Half of the patients (n = 82) had detrusor overactivity. Compared with whites, blacks were 3.4-fold more likely to have detrusor overactivity (95% confidence interval, 0.99-11.40) and had lower volumes at time of "strong desire" (-102.6 mL, P = 0.003). Hispanics had on average 75.88 mL less volume at sensation of "strong desire" (P = 0.016) than did whites.

CONCLUSIONS

Our study suggests that minority race and ethnicity may be associated with worse performance on certain UDS parameters. Future studies should aim to understand if these differences are due to genetic, disease-related, behavioral, and/or socioeconomic factors and whether these differences are associated with worse subjective OAB.

Clinical and urodynamic impact of detrusor overactivity in women with overactive bladder

OBJECTIVE

To evaluate the clinical and urodynamic differences (associated with the presence or absence of detrusor overactivity [DO]) in women with overactive bladder (OAB) referred to Functional Urology and Urodynamic Units in Spain.

MATERIAL AND METHODS

Observational, cross-sectional, multicenter and prospective study conducted in Spain in women with clinical diagnosis of OAB, who had been referred to urodynamic study (UDS) of which centralized reading was performed. Patients completed the 3-day voiding diary (DM3d) with the PPIUS scale (Patient Perception of Intensity of Urgency Scale), the B-SAQ (Bladder Self-Assessment Questionnaire) and the OABq-SF (Overactive Bladder Questionnaire Short Form). The questionnaires and UDS variables of women with OAV, with or without DO, were compared using the Mann-Whitney test (continuous variables) and the chi-square test (χ²) (categorical variables).

RESULTS

A total of 247 women with OAB were evaluated, and 103 of them had DO. According to the presence or absence of DO, significant differences were observed in the number of episodes of urge urinary incontinence (UUI), urinary frequency, nocturia, mean micturition volume and number of pads (P<.05 for all comparisons). A higher percentage of patients with OAB and DO presented reduced bladder capacity, urgency, urge urinary incontinence (UUI) and lower volume for first voiding desire, strong desire to void and maximum cystomanometric capacity in UDS compared with patients without DO (P<.05 for all comparisons). The only significant differences between both groups were regarding the B-SAQ symptoms scale (P=.011).

CONCLUSIONS

The presence of DO in women with OAB is related to a more severe alteration of the bladder filling phase.

Rectal diameter assessment in enuretic children-exploring the association between constipation and bladder function

OBJECTIVES

Detrusor overactivity and constipation often co-exist in children with enuresis. Constipation is known to be linked to detrusor overactivity. The voiding chart is the best non-invasive way to investigate bladder function, whereas the ultrasonographical detection of rectal dilatation is the best way to objectify constipation. We wanted to investigate a possible relationship between the rectal diameter and voiding chart data in enuretic children.

METHODS

Children with therapy-resistant enuresis were retrospectively evaluated. All had completed a voiding chart for at least 48 h. The rectal diameter was assessed ultrasonographically. The cutoff for rectal dilatation was set at 30 mm.

RESULTS

We evaluated 74 patients (12 girls) aged 10.2 ± 2.8 years, 35 of whom had rectal dilatation. No significant differences in voiding chart parameters were found between children with normal versus dilated rectum. Neither did urgency or a history of daytime incontinence differ between the groups. Boys were more likely to have rectal dilatation than girls (p = 0.02).

CONCLUSIONS

The absence of differences regarding voiding chart data may be explained as two mechanisms neutralizing each other: behavioral factors may make the constipated children void seldom and with large volumes, whereas detrusor overactivity caused by rectal compression of the bladder may have the opposite effect. Another option may be that the voiding chart is too blunt an instrument to detect detrusor overactivity. Constipation, and thus presumably bladder dysfunction, seems to be more important in enuretic boys than girls.

Report and Research Agenda of the American Geriatrics Society and National Institute on Aging Bedside-to-Bench Conference on Urinary Incontinence in Older Adults: A Translational Research Agenda for a Complex Geriatric Syndrome

The American Geriatrics Society, with support from the National Institute on Aging and other funders, held its ninth Bedside-to-Bench research conference, entitled "Urinary Incontinence in the Older Adult: A Translational Research Agenda for a Complex Geriatric Syndrome," October 16 to 18, 2016, in Bethesda, Maryland. As part of a conference series addressing three common geriatric syndromes-delirium, sleep and circadian rhythm disturbance, and urinary incontinence-the series highlighted relationships and pertinent clinical and pathophysiological commonalities between these conditions. The conference provided a forum for discussing current epidemiology, basic science, and clinical and translational research on urinary incontinence in older adults; for identifying gaps in knowledge; and for developing a research agenda to inform future investigative efforts. The conference also promoted networking involving emerging researchers and thought leaders in the field of incontinence, aging, and other fields of research, as well as National Institutes of Health program personnel.

A comparison of normal and high post-void residual urine and urodynamic parameters in women with overactive bladder

Objective

To investigate voiding functions and assess the relationships of voiding parameters to overactive bladder symptoms and postvoiding residue volumes.

Materials and Methods

This is a retrospective study analyzing urodynamic parameters in patients who were diagnosed as having overactive in our urogynecology clinic between April 2014 and April 2016. A total of 290 women who met the selection criteria were included in the study. The patients were divided into two groups according to postvoiding residue volumes: group 1, postvoiding residue volumes <100 mL (n=135); group 2, postvoiding residue volumes ≥100 mL (n=155).

Results

A total of 290 women were included in the study; the mean age was 71.4 years. A total of 158 (54.5%) patients had detrusor over-activity during urodynamic testing. The mean maximum bladder capacity in elevated group 2 (postvoiding residue volumes ≥100 mL) was significantly higher than in group 1 (postvoiding residue volumes <100 mL) (p<0.01). Additionally, there was a significant difference between detrusor pressure at Q_max in both study groups (p<0.05). There were no significant differences in the first-sensation volume between the normal and elevated postvoiding residue volumes groups.

Conclusion

In conclusion, patients with overactive with elevated postvoiding residue volumes showed increased maximum bladder capacity, but detrusor over-activity was not more prevalent in these women compared with women with normal postvoiding residue volumes.

Monocyte Chemotactic Protein-1 (MCP-1) as a Predictor of Prolonged Urinary Incontinence After Radical Prostatectomy

Objectives:

To investigate monocyte chemotactic protein-1 (MCP-1) as a novel urinary biomarker to predict prolonged post prostatectomy incontinence.

Methods:

Men submitted urine samples prior to robotic radical prostatectomy. MCP-1 values were derived using an ELISA test. Pad usage at 7, 30, and 60 days were documented by patient post cards mailed when zero pads was reached. The primary outcome was defined as no incontinence pad usage at 30 days at prostatectomy.

Results:

After exclusions, 76 patients were included in analyses. Continence was reached by 29% (22/76), 56% (42/76), and (75/76) 98% at 7, 30, and 60 days, respectively. The average MCP-1 (p=0.258) was not different between the continent and incontinent groups. Highest quartile of MCP-1 (MCP > 166 pg/mL) and normalized MCP-1 (MCP-1/TV >0.53) noted a significant delay in continence at 30 days (p=0.050 and p=0.003). Only 26% (5/19) in the highest MCP1/TV quartile were continent, whereas 65% (37/57) of men in the 3 lower quartiles reached zero pad continence (p=0.003). In a logistic regression model the highest quartile of MCP1/TV had a significant chance of being incontinent at 30 days (OR 0.22; 95% CI 0.058-0.80; p=0.022).

Conclusion:

MCP-1/TV is a urinary biomarker that may predict prolonged urinary incontinence after radical prostatectomy.

Potential Biomarkers Utilized to Define and Manage Overactive Bladder Syndrome

Clinical diagnosis of overactive bladder (OAB) syndrome has great variation and usually can only be based on subjective symptoms. Measurement of urgency severity score in adjunct with voiding diary may reflect the occurrence of OAB and incontinence severity in daily life. Urodynamic study can detect detrusor overactivity (DO), but not in all OAB patients. A more objective way and less invasive tool to diagnose and assess therapeutic outcome in OAB patients is needed. Recent investigations of the potential biomarkers for OAB include urinary and serum biomarkers and bladder wall thickness. Evidence has also shown that urinary proteins, such as nerve growth factor (NGF) and prostaglandin E2 (PGE2 ) levels increase in patients with OAB, bladder outlet obstruction (BOO) and DO. Patients with OAB have significantly higher urinary NGFlevels and urinary NGF levels decrease after antimuscarinic therapy and further decrease after detrusor botulinum toxin injections. However, the sensitivity of single urinary protein in the diagnosis of OAB is not high and several lower urinary tract diseases may also have elevated urinary NGF levels. Searching for a group of inflammatory biomarkers by microsphere-based array in urine might be a better method in differential diagnosis of OAB from interstitial cystitis, urinary tract infection (UTI) or urolithiasis. Bladder wall thickness has been widely investigated in the diagnosis of BOO and pediatric voiding dysfunction.The role of bladder wall thickness in the diagnosis of OAB, however, has not reach a consistent conclusion. We hereby review the latest medical advances in this field.

Voiding dysfunction in older women with overactive bladder symptoms: A comparison of urodynamic parameters between women with normal and elevated post-void residual urine

AIMS

To compare urodynamic parameters in two groups of older women who have overactive bladder (OAB) symptoms: those with normal and those with elevated post-void residual (PVR).

METHODS

Secondary data analyses were conducted on medical record data from 203 women who were 65 years or older and who completed urodynamic testing. Of these, 151 (74%) medical records met the study criteria. A PVR of 100 ml or greater during the pressure-flow study was considered elevated for this study. Maximal flow rate (Qmax ) and detrusor pressure at Qmax , bladder capacity, voiding volume, and voiding pattern were compared between these two groups.

RESULTS

The mean Qmax and detrusor pressure at Qmax were 19.63 ml/sec (SD = 8.74) and 16.15 cmH2 O (SD = 11.19) for the overall sample, respectively. The elevated PVR group (n = 54) had significantly higher detrusor pressure at Qmax and bladder capacity than the normal PVR group (n = 97) (P < 0.05, P < 0.01, respectively). An interrupted voiding pattern accounted for 47.4% of the normal PVR group and 77.4% of the elevated PVR group, respectively (P < 0.01).

CONCLUSIONS

Older women with an elevated PVR required on average a higher detrusor pressure at Qmax and greater bladder capacity than women with a normal PVR. Although an interrupted voiding pattern was more prevalent in the elevated PVR group, many women in the normal PVR group also had an interrupted voiding pattern. These findings indicate that many women may habitually strain to void as well as strain due to inadequate detrusor function.

Chronic lower urinary tract symptoms in young men without symptoms of chronic prostatitis: urodynamic analyses in 308 men aged 50 years or younger

Purpose

We investigated the etiologies of lower urinary tract symptoms (LUTS) and compared urodynamic characteristics between different diagnostic groups in young men with chronic LUTS.

Materials and Methods

We reviewed the medical records of 308 men aged 18 to 50 years who had undergone a urodynamic study for chronic LUTS (≥6 months) without symptoms suggestive of chronic prostatitis.

Results

The men's mean age was 40.4 (±10.1) years and their mean duration of symptoms was 38.8 (±49.2) months. Urodynamic evaluation demonstrated voiding phase dysfunction in 62.1% of cases (primary bladder neck dysfunction [PBND] in 26.0%, dysfunctional voiding [DV] in 23.4%, and detrusor underactivity [DU]/acontractile detrusor [AD] in 12.7%) and a single storage phase dysfunction in 36.4% of cases (detrusor overactivity [DO] in 13.3%, small cystometric capacity in 17.9%, and reduced bladder sensation in 5.2%). Most of the demographic characteristics and clinical symptoms did not differ between these diagnostic groups. Whereas 53.9% of patients with voiding dysfunction had concomitant storage dysfunction, 69.6% of those with storage dysfunction had concomitant voiding dysfunction. Men with DV or DU/AD exhibited lower maximum cystometric capacity than did those with normal urodynamics. Low bladder compliance was most frequent among patients with PBND (10.0%, p=0.025). In storage dysfunctions, men with DO exhibited higher detrusor pressure during voiding than did those with other storage dysfunctions (p<0.01).

Conclusions

Because clinical symptoms are not useful for predicting the specific urodynamic etiology of LUTS in this population, urodynamic investigation can help to make an accurate diagnosis and, potentially, to guide appropriate treatment.

Association between self-reported urinary incontinence and musculoskeletal conditions in community-dwelling elderly women: a cross-sectional study

AIMS

Urinary incontinence (UI) and musculoskeletal conditions, particularly low back pain (LBP), and osteoarthritis (OA), are common problems that have been associated with mobility limitations and future dependence in activities of daily living in the elderly. The purpose of this study was to explore the relationship between UI, UI types, and musculoskeletal conditions in elderly community-dwelling women.

METHODS

A cross-sectional study was performed on 1,399 community-dwelling Japanese women aged 75-84 years. Face-to-face interviews, body composition, and physical function, including grip strength, and usual walking speed, were conducted. UI was defined as experience of urine leakage episodes more than once per week. Self-reported presence and degree of pain, LBP, and OA were assessed. Student's t-tests and chi-square tests were used to analyze continuous and categorical variables. Associations between selected variables, UI, and UI types were assessed using stepwise multiple logistic regression models.

RESULTS

A total of 260 participants had UI (18.6%) and 399 had LBP (28.5%). Participants with UI were more likely to experience pain (76.0%) and LBP (36.2%) than those without UI (P < 0.001 and P = 0.002, respectively). Age, body mass index, falls, walking speed, grip strength, LBP, and pain coupled with OA were significantly associated with UI. There were significant associations between urge UI and mild (odds ratio (OR) = 1.653, 95% confidence interval (CI) = 1.031-2.650) and severe LBP (OR = 2.617, 95% CI = 1.193-5.739).

CONCLUSIONS

This study showed that UI was significantly associated with musculoskeletal conditions, including LBP, and the combination of pain and OA. The risk of urge UI was greater with increasing severity of LBP.

Tissue engineering as a potential alternative or adjunct to surgical reconstruction in treating pelvic organ prolapse

INTRODUCTION AND HYPOTHESIS

Cell-based tissue engineering strategies could potentially provide attractive alternatives to surgical reconstruction of native tissue or the use of surgical implants in treating pelvic organ prolapse (POP).

METHODS

Based on a search in PubMed, this review focuses on candidate cell types, scaffolds, and trophic factors used in studies examining cell-based tissue engineering strategies to treat POP, stress urinary incontinence (SUI), and the closely related field of hernias.

RESULTS

In contrast to the field of SUI, the use of cell-based tissue engineering strategies to treat POP are very sparsely explored, and only preclinical studies exist.

CONCLUSION

The available evidence suggests that the use of autologous muscle-derived cells, fibroblasts, or mesenchymal stem cells seeded on biocompatible, degradable, and potentially growth-promoting scaffolds could be an alternative to surgical reconstruction of native tissue or the use of conventional implants in treating POP. However, the vagina is a complex organ with great demands of functionality, and the perfect match of scaffold, cell, and trophic factor has yet to be found and tested in preclinical studies. Important issues such as safety and economy must also be addressed before this approach is ready for clinical studies.

How do urodynamics findings influence the treatment of the typical patient with overactive bladder?

Overactive bladder (OAB) is a clinical symptom complex whose hallmark is the symptom of urinary urgency, usually accompanied by frequency and nocturia, with or without urgency incontinence. Historically, urodynamics (UDS) evaluation has not been recommended in the initial evaluation of OAB, since it is defined primarily by clinical symptoms. As the pathophysiology of the OAB complex has become more clearly elucidated from recent studies, the role of UDS has again become a topic of discussion as a tool that can provide objective data to reflect these new findings. The utility of UDS in the diagnosis and treatment of OAB is still evolving, but in certain clinical scenarios, especially when empiric treatment has failed, it can provide definitive information that can identify associated pathologies and/or alter the treatment course. Herein, we will discuss the current literature regarding use of UDS in OAB patients and offer our own opinions as to its use.

Clinical and urodynamic differences among women with overactive bladder according to the presence of detrusor overactivity

INTRODUCTION AND HYPOTHESIS

We tried to determine whether clinical and urodynamic differences exist between women with and without detrusor overactivity (DO) using a large database of overactive bladder (OAB) patients.

METHODS

We reviewed the medical records of 513 women who underwent urodynamic studies for OAB symptoms without neurogenic or anatomical conditions that affect micturition function. Clinical symptoms were evaluated using a 3-day frequency-volume chart (FVC) including the Urinary Sensation Scale and American Urological Association Symptom Index (AUA-SI). All clinical and urodynamic findings were compared between women with and without DO.

RESULTS

The patients' mean age was 58.9 years. DO was identified urodynamically in 167 (32.6 %) women. Those with DO were older (62.9 vs 57.0 years, p < 0.001); however, no differences in AUA-SI, episodes of daytime voiding, and episodes of nocturia were observed between the groups. Functional bladder capacity was smaller in women with DO; however, this difference did not reach statistical significance. Women with DO had significantly more urgency incontinence symptoms than those without DO (55.1 vs 29.5 %, p < 0.001). In urodynamic parameters, the volumes at first desire to void and strong desire to void and maximum cystometric capacity were significantly smaller, and detrusor pressure at the opening was significantly higher in women with DO compared to subjects without DO (26.2 vs 21.2 cmH(2)O, p = 0.004).

CONCLUSIONS

Our findings suggest a more severe disturbance of bladder function when DO exists, although no differences were observed in symptom scores and 3-day FVC parameters among women with OAB symptoms according to the presence of DO.

Brain activity underlying impaired continence control in older women with overactive bladder

AIMS

To identify, in subjects with overactive bladder (OAB), differences in brain activity between those who maintained and those who lost bladder control during functional magnetic resonance imaging (fMRI) of the brain with simultaneous urodynamics.

METHODS

Secondary analysis of a cohort of older women (aged >60) with proven urgency urinary incontinence, who, in the scanner, either developed detrusor overactivity and incontinence (the "DO group") or did not (the "no DO" group). A priori hypothesis: during urgency provoked by bladder filling, without DO, activity in regions related to continence control is diminished in the DO group; specifically (1a) less activation in supplementary motor area (SMA) and (1b) less deactivation in prefrontal cortex (PFC) and parahippocampal complex (PH). We also explored phenotypic (clinical and urodynamic) differences between the groups.

RESULTS

During urgency preceding DO, the DO group showed stronger activation in SMA and adjacent regions (hypothesis 1a rejected), and less deactivation in PH but no significant difference in PFC (hypothesis 1b partially accepted). These subjects were older, with more changes in brain's white matter, decreased tolerance of bladder filling and greater burden of incontinence.

CONCLUSIONS

(1) In older women with OAB, brain activity in the SMA is greater among those with more easily elicitable DO, suggesting a compensatory response to failure of control elsewhere. (2) OAB is heterogeneous; one possible phenotype shows severe functional impairment attributable partly to age-related white matter changes. (3) Functional brain imaging coupled with urodynamics may provide CNS markers of impaired continence control in subjects with OAB.

Clinical symptoms are not reliable in the diagnosis of lower urinary tract dysfunction in women

BACKGROUND/PURPOSE

The pathophysiology of female lower urinary tract symptoms (LUTS) may involve bladder, urethral, and pelvic floor dysfunctions. This study analyzed the relationship between clinical symptoms and lower urinary tract dysfunctions (LUTD) in women.

METHODS

A total of 1605 consecutive women were included. LUTS were classified as storage, voiding, pain, and postmicturition symptoms. All patients underwent videourodynamic study (VUDS) and the final diagnosis of LUTD was made based on VUDS findings. Patients were stratified into three major disorder groups: sensory, motor, and bladder outlet disorders. The main symptoms and associated symptoms were used for analysis in varying LUTD.

RESULTS

Normal tracing was found in 272 patients (16.9%), sensory bladder disorders in 459 (28.6%), motor bladder disorders in 560 (34.9%), and bladder outlet disorders were found in 314 patients (19.6%). Frequent urination was the main symptom in patients with normal, bladder oversensitivity, interstitial cystitis, and idiopathic detrusor overactivity (DO). In patients with voiding dysfunction due to detrusor underactivity, bladder neck dysfunction and urethral stricture, dysuria was the most common symptom. However, 707 (44%) of overall women had both storage and voiding symptoms. DO was present in 533 women and in 149 (66%) of 212 with bladder outlet obstruction. However, DO was only found in 42.5% of women with urgency and in 69.4% of women with urgency incontinence based on reported LUTS.

CONCLUSION

Storage and voiding symptoms are common in women with LUTD. The differential diagnosis of LUTD in women cannot be based on LUTS alone.

Urgency severity scale could predict urodynamic detrusor overactivity in patients with overactive bladder syndrome

AIMS

To evaluate the correlation between an urgency severity scale (USS) based on a voiding diary with detrusor overactivity (DO) in a videourodynamic study in patients with an overactive bladder (OAB).

METHODS

We prospectively enrolled 190 consecutive patients with OAB. All patients were assessed using a USS and completed a 3-day voiding diary that recorded urgency and urgency urinary incontinence (UUI) episodes and the degree of urgency severity. The highest recorded USS score in the voiding diary was considered as the USS score. A videourodynamic study was performed, and the presence of increased bladder sensation (IBS) or DO was recorded. These clinical findings and videourodynamic data were analyzed.

RESULTS

This study enrolled 65 men and 125 women. The mean patient age was 66.4 years (21-88). Among them, 82.6% had urodynamic DO, 7.9% had IBS, and 9.5% had normal urodynamic findings. The prevalence of DO was 50%, 76%, and 94% in patients with a USS = 2, 3, and 4, respectively. Multivariate analysis indicated that OAB wet, high USS and UUI were significantly associated with the presence of DO. Urodynamic DO was present in most patients with OAB wet (94.1%) or USS = 4 (95.5%); however, only 63.9% of OAB dry patients had DO. In the OAB dry patients, 11/25 (44%) with USS = 2, 30/42 (71%) with USS = 3, and 5/5 (100%) with USS = 4 had DO.

CONCLUSIONS

A high USS recorded in conjunction with a voiding diary and OAB wet were strongly associated with urodynamic DO.