Detrusor instability associated with menstruation. Case report

The impact of the menstrual cycle on urinary symptoms and the results of urodynamic investigation

Four hundred and eighty-three consecutive women referred for videocystourethrography completed a structured questionnaire about their menstrual status and urinary symptoms. Women were included in the study if they were premenopausal, had a regular menstrual cycle and were not taking hormonal therapy. One hundred and thirty-three women satisfied the inclusion criteria of whom 55 (41%) complained that their urinary symptoms were cyclical. The times at which symptoms were said to be at their worst were reported by the women as follows: during a period (n = 20; 36%); just after a period (n = 4; 7%); middle of the month (n = 8; 15%); just before a period (n = 23; 42%). The prevalence of abnormal detrusor activity on videocystourethrography increased significantly with time from the last menstrual period (chi2 for trend = 6.56, P = 0.01) and might reflect increases in the circulating level of progesterone following ovulation. This study provides further indirect evidence that progesterone could have an adverse effect on female lower urinary tract function. In addition, it might be necessary to consider the stage within the menstrual cycle when interpreting the results of urodynamic investigation.

Influence of gender and the oestrous cycle on in vitro contractile responses of the rat urinary bladder to cholinergic stimulation

1. Experiments were done to determine the influence of gender and the oestrous cycle on rat urinary bladder contractility in response to cholinergic stimulation. 2. Bladder strips from female rats responded to high frequency stimulation with smaller contractile responses than did strips from males, and to low concentrations of carbachol with greater responses. The decreased responsiveness of bladder strips from female rats to electrical field stimulation can be primarily attributed to the rats in the oestrous stage of the oestrous cycle. 3. Bladder strips from female rats in all stages of the oestrous cycle were more sensitive to carbachol than those from males, but there were no differences in sensitivity to electrical field stimulation. 4. The contractile responses of strips from both male and female rats to carbachol were antagonized by muscarinic antagonists with the following rank order of affinity (pA(2)) estimates: 4-DAMP>>pirenzepine>methoctramine, suggesting that the receptor mediating contraction was the M3 subtype. There were no differences in pA(2) values between bladder strips from male and female rats. 5. The data indicate that responsiveness of bladder strips to electrical field stimulation and carbachol is altered in female rats in the oestrous stage of the oestrous cycle. Furthermore, gender influences the sensitivity of rat bladder to muscarinic stimulation.

Effects of menstrual cycle and urinary tract instrumentation on uroflowmetry

We sought to compare bladder emptying function in normal women during the proliferative and secretory phases of the menstrual cycle and to evaluate whether urethral catheterization affected uroflowmetry parameters. Forty-nine normal volunteers (ages 19-42 years) were recruited and underwent uroflowmetry in the proliferative and secretory phases of the menstrual cycle. A serum progesterone level of <3.0 ng/mL defined the proliferative phase. During the proliferative phase, volunteers underwent uroflowmetry analysis when a sensation of fullness was appreciated. A post-void residual volume was determined, and the bladder was filled with 400 mL of normal saline. Repeat uroflowmetry analysis was then performed. This two-step procedure was repeated at a separate visit during the secretory phase. Voided volume, residual volume, maximum and average flow rates, time-to-maximum flow, and duration of flow were recorded. Wilcoxon signed-rank tests were used for statistical analysis. A two-tailed alpha value of <0.05 defined statistical significance. Our analysis was limited to the 33 patients whose predicted menstrual dating correlated with the obtained progesterone levels. During the follicular phase, we found significantly faster maximum (P < 0.0001) and average flow rates (P = 0.01), along with a shorter time-to-maximum flow (P < 0.0001) and shorter duration of flow (P < 0.0001), during the pre-catheterized void than the post-catheterized void. Similar results were observed in the secretory phase with the exception of a slightly higher residual volume (P = 0.05). No difference was seen in any measured uroflowmetry parameter when comparing similar voids between phases of the menstrual cycle. We conclude that when evaluating pre-menopausal patients, uroflowmetry may be scheduled and performed during either phase of the menstrual cycle. Neurourol. Urodynam. 19:147-152.

Does the menstrual cycle influence cystometry?

Alterations in the hormonal milieu associated with the menstrual cycle appear to influence the dynamic interaction between the bladder and urethra as well as detrusor function, probably because of the common embryological origin of the lower genital and urinary tracts. In this retrospective study we investigated the effect of the menstrual cycle on cystometric diagnosis. A retrospective case note review of 687 consecutive patients attending the urogynecology unit of St Georges University Hospital, a tertiary referral center, was carried out. The study group comprised 57 women with regular menstrual periods. In both patients whose symptoms were adversely affected premenstrually and those whose symptoms were not influenced by the menstrual cycle, the majority of normal cystometric diagnoses were made in the luteal phase: 45.5% vs. 25% (P < or = 0.002) and 38.5% vs. 4.8% (P < or = 0.05), respectively. Diagnoses of genuine stress incontinence, detrusor instability and mixed genuine stress incontinence and detrusor instability were most frequently made in the follicular phase of the cycle. More normal cystometric diagnoses were made in the influenced group (36.8%) than in the uninfluenced group (21%) (P < 0.02). The results of this preliminary study indicate that the timing of cystometric evaluation may influence the detection of a positive diagnosis. The luteal phase may not be the correct time to make an accurate diagnosis, especially in patients whose symptoms are influenced by their menstrual cycle.