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Moossdorff-Steinhauser H, Rademakers KLJ, Nieman F, van Koeveringe GA, Berghmans B. A Survey on Voiding Complaints in Women Presenting at a Pelvic Care Center. Curr Urol 2019; 13:31-36. [PMID: 31579228 DOI: 10.1159/000499297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 10/24/2018] [Indexed: 11/19/2022] Open
Abstract
Introduction This article reports the prevalence of self-reported voiding complaints and the relationship with other pelvic floor and bladder dysfunctions (PFD). Materials and Methods Women with a variety of PFDs were referred to the pelvic care center. A standardised questionnaire on 6 PFDs was used. Frequencies of patient characteristics, PFDs and voiding complaints were calculated. Cross tabulation was used to investigate correlations and Pearson correlation coefficients to reveal the strength of the association between PFDs and self-reported voiding complaints. Results Data of 4470 women were included. Prevalence of (self-reported) voiding Lower urinary tract symptoms was 59.5%. Incomplete bladder emptying is the most prevalent voiding complaint. Self-reported voiding complaints are weakly correlated to age (r = 0.15, p < 0.01) and have moderate correlation with self-reported recurrent urinary tract infections (r = 0.34, p < 0.01), pelvic floor, bladder and bowel complaints. However, the correlation between the feeling of incomplete bladder emptying and the presence of recurrent urinary tract infections is weak (r = 0.06, p = 0.02). Conclusion Voiding complaints have a high prevalence and symptom bother in women visiting a pelvic care center.
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Affiliation(s)
| | | | - Fred Nieman
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht, Netherlands
| | | | - Bary Berghmans
- Pelvic Care Center, Maastricht University Medical Center, Maastricht, Netherlands
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Drossaerts J, Rademakers KLJ, Rahnama'i SM, Marcelissen T, Van Kerrebroeck P, van Koeveringe G. The Value of Ambulatory Urodynamics in the Evaluation of Treatment Effect of Sacral Neuromodulation. Urol Int 2019; 102:299-305. [PMID: 30612126 DOI: 10.1159/000493988] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 09/21/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To assess the improvement of symptoms by sacral neuromodulation (SNM) in an objective way by carrying out an ambulatory urodynamic study (ambulatory-UDS). Until now, successful treatment has been defined as a ≥50% improvement recorded on voiding diaries. Voiding diaries are a patient reported outcome tool. A tool with less bias is desired to evaluate the treatment results before an expensive permanent system is implanted. METHODS Between 2002 and 2015, a total of 334 patients with lower urinary tract symptoms were included consecutively in an ambulatory-UDS database. From this database, a subgroup of patients was selected which underwent SNM. RESULTS In 51 patients, an ambulatory-UDS was performed both at baseline and during the SNM test period. A positive treatment outcome after test stimulation based on the patients' voiding diary, correlated (p < 0.0001) with an improvement on ambulatory-UDS. Twenty-six of the 30 patients, who have showed improvement of more than 50% on voiding diary parameters and who had subjective improvement of their symptoms, showed an early improvement on ambulatory-UDS. CONCLUSIONS Ambulatory-UDS can be used in clinical decision making, as it is associated with voiding diary improvement during the SNM test period. Using ambulatory-UDS to confirm success could in the future justify the shortening of the test period.
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Affiliation(s)
- Jamie Drossaerts
- Department of Urology, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands, .,School of Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, The Netherlands,
| | - Kevin L J Rademakers
- Department of Urology, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands.,School of Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, The Netherlands
| | - Sajjad M Rahnama'i
- Department of Urology, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands.,School of Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, The Netherlands
| | - Tom Marcelissen
- Department of Urology, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Philip Van Kerrebroeck
- Department of Urology, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands.,School of Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, The Netherlands
| | - Gommert van Koeveringe
- Department of Urology, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands.,School of Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, The Netherlands.,Pelvic Care Centre Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands
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Vahabi B, Wagg AS, Rosier PFWM, Rademakers KLJ, Denys MA, Pontari M, Lovick T, Valentini FA, Nelson PP, Andersson KE, Fry CH. Can we define and characterize the aging lower urinary tract?-ICI-RS 2015. Neurourol Urodyn 2017; 36:854-858. [PMID: 28444710 DOI: 10.1002/nau.23035] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 04/18/2016] [Indexed: 12/13/2022]
Abstract
The prevalence of lower urinary tract (LUT) symptoms increases with age but the etiology is unknown. This article aims to identify research directions that clarify the basis of this association. The initial question is whether biological age is the variable of interest or a time-dependent accumulation of factors that impact on LUT function at rates that differ between individuals. In particular, the accumulation of conditions or agents due to inflammatory states or tissue ischemia is important. Much of the above has been concerned with changes to bladder function and morphology. However, the outflow tract function is also affected, in particular changes to the function of external sphincter skeletal muscle and associated sacral motor nerve control. Nocturia is a cardinal symptom of LUT dysfunction and is more prevalent with aging. Urine production is determined by diurnal changes to the production of certain hormones as well as arterial blood pressure and such diurnal rhythms are blunted in subjects with nocturia, but the causal links remain to be elucidated. Changes to the central nervous control of LUT function with age are also increasingly recognized, whether in mid-brain/brainstem regions that directly affect LUT function or in higher centers that determine psycho-social and emotional factors impinging on the LUT. In particular, the linkage between increasing white matter hyperintensities and LUT dysfunction during aging is recognized but not understood. Overall, a more rational approach is being developed to link LUT dysfunction with factors that accumulate with age, however, the precise causal pathways remain to be characterized. Neurourol. Urodynam. 36:854-858, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Bahareh Vahabi
- Department of Biological, Biomedical and Analytical Sciences, University of the West of England, Bristol, United Kingdom
| | - Adrian S Wagg
- Division of Geriatric Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Peter F W M Rosier
- Department of Urology, University Medical Center, Utrecht, The Netherlands
| | | | | | | | - Thelma Lovick
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, United Kingdom
| | | | - Pierre P Nelson
- ER6-Universite Pierre et Marie Curie (Paris 06), Paris, France
| | | | - Christopher H Fry
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, United Kingdom
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Rademakers KLJ, van Koeveringe GA, Oelke M. Ultrasound detrusor wall thickness measurement in combination with bladder capacity can safely detect detrusor underactivity in adult men. World J Urol 2016; 35:153-159. [PMID: 27447991 DOI: 10.1007/s00345-016-1902-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 07/18/2016] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Detrusor underactivity (DU) has lately gained increasing interest because this bladder condition is an important cause of post-void residual urine and lower urinary tract symptoms (LUTS) in adult men. Until now, DU can only be diagnosed by pressure-flow measurement. Therefore, the aim of this study was to search for noninvasive tests which can safely predict DU in adult men. METHODS Unselected, treatment-naïve male patients aged ≥40 years with uncomplicated, non-neurogenic LUTS were prospectively evaluated. All men received-after standard assessment of male LUTS-ultrasound detrusor wall thickness (DWT) measurements at a bladder filling ≥250 ml and computer urodynamic investigation. DU was defined as incomplete bladder emptying (>30 ml) in the absence of bladder outlet obstruction or dysfunctional voiding. Classification and regression tree (CART) analysis was used to determine parameters and threshold values for DU. RESULTS The study population consisted of 143 consecutive men with medians of 62 years, IPSS 16, and prostate volume 35 ml. In total, 33 patients (23.1 %) had DU. CART analysis showed that all men with DWT ≤ 1.23 mm plus bladder capacity >445 ml had DU. This multivariate model has a sensitivity of 42 %, specificity of 100 %, positive predictive value of 100 %, and negative predictive value of 85 %. CONCLUSIONS This study showed that all men with ultrasound DWT ≤ 1.23 mm + bladder capacity >445 ml have DU. Combination of these two tests could help physicians to diagnose DU noninvasively in clinical practice. A prospective independent study should confirm these results.
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Affiliation(s)
- Kevin L J Rademakers
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - Matthias Oelke
- Department of Urology, OE 6240, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
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Oelke M, Rademakers KLJ, van Koeveringe GA. Unravelling detrusor underactivity: Development of a bladder outlet resistance-Bladder contractility nomogram for adult male patients with lower urinary tract symptoms. Neurourol Urodyn 2015; 35:980-986. [DOI: 10.1002/nau.22841] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Accepted: 07/08/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Matthias Oelke
- Department of Urology; Hannover Medical School; Hannover Germany
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Van Koeveringe GA, Rademakers KLJ. Factors impacting bladder underactivity and clinical implications. MINERVA UROL NEFROL 2015; 67:139-148. [PMID: 25645344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Lower urinary tract symptoms in the voiding phase can be due to an underactive bladder, but are usually similar to symptoms of infravesical obstruction or dysfunctional voiding. The underactive bladder can be caused by an impaired detrusor contraction but also by a derangement of local and central neuro-cognitive regulatory systems or an impairment of bladder sensation. Potential risk factors of bladder underactivity include: ageing, diabetes, neurogenic disease, cardiovascular disease, obstruction and psychological causes. Comprehensive diagnostic and detection techniques for an underactive detrusor are necessary. To establish the diagnosis and follow up new treatments, useful urodynamic parameters and threshold values have to be determined. As neuro-cognitive regulation plays an important role in the control of voiding, psychological factors have to be taken into account during the assessment in these patients. Ambulatory urodynamic techniques therefore have to be considered. Voiding is determined by the balance of both the detrusor contraction and the resistance of the bladder outlet, a dysfunction in one factor can be compensated by a counter-acting function of the other factor. Therefore, to predict voiding problems in the future, it will be indicated to assess the compensatory capacity of the detrusor contractility, contractile reserve, and the outlet relaxation capacity. If novel treatments and evaluation techniques have become available, it is likely that in the future, many patients that get a TURP now, can be treated by pharmacological agents directed towards increasing the bladder contractility in a balanced combination with medication directed towards lowering the bladder outlet resistance.
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Affiliation(s)
- G A Van Koeveringe
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands -
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Rademakers KLJ, Drossaerts JMAFL, Rahnama'i MS, van Koeveringe GA. Differentiation of lower urinary tract dysfunctions: The role of ambulatory urodynamic monitoring. Int J Urol 2015; 22:503-7. [PMID: 25711671 DOI: 10.1111/iju.12723] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 12/24/2014] [Accepted: 12/29/2014] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To determine the value of ambulatory urodynamic monitoring in the assessment of patients with lower urinary tract symptoms. METHODS This was a cross-sectional study including patients who underwent both conventional urodynamic and ambulatory urodynamic assessment at our Center between December 2002 and February 2013. The ambulatory urodynamic studies were interpreted in a standardized way by a resident experienced with urodynamic measurements, and one staff member who specialized in incontinence and urodynamics. RESULTS A total of 239 patients (71 male and 168 female) were included in the present study. The largest subgroup of patients, 79 (33%), underwent ambulatory urodynamic monitoring based on suspicion of an acontractile bladder. However, 66 of these patients (83.5%) still showed contractions on ambulatory urodynamics. Other groups that were analyzed were patients with suspected storage dysfunction (47 patients), inconclusive conventional urodynamic studies (68 patients) and incontinence of unclear origin (45 patients). Particularly in this last group, ambulatory urodynamics appeared to be useful for discrimination between different causes of incontinence. CONCLUSIONS Ambulatory urodynamic monitoring is a valuable discriminating diagnostic tool in patients with lower urinary tract symptoms who have already undergone conventional urodynamics, particularly in the case of patients with suspected bladder acontractility and incontinence of unclear origin during ambulatory urodynamics. Further study is required to determine the clinical implications of the findings and their relationship with treatment outcome.
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Affiliation(s)
- Kevin L J Rademakers
- Department of Urology, Maastricht University Medical Center, Maastricht, The Netherlands
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Oelke M, Rademakers KLJ, van Koeveringe GA. Detrusor contraction power parameters (BCI and W max) rise with increasing bladder outlet obstruction grade in men with lower urinary tract symptoms: results from a urodynamic database analysis. World J Urol 2014; 32:1177-83. [PMID: 25007993 DOI: 10.1007/s00345-014-1358-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Accepted: 06/27/2014] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To investigate to what extent detrusor work during voiding is influenced by bladder outlet obstruction (BOO) in adult men with lower urinary tract symptoms (LUTS). MATERIALS AND METHODS We reviewed data of patients with LUTS suggestive of benign prostatic hyperplasia who received computer-urodynamic investigations as part of their baseline clinical assessment. BOO was defined by the Schäfer classification and detrusor work during voiding was quantified by calculation of the bladder contractility index (BCI) and maximum Watt factor (W max) obtained by pressure-flow analysis. RESULTS A total of 786 men with medians of 64 years, IPSS 16 and prostate volume of 35 ml, were included in the study. A total of 462 patients (58.8 %) had BOO (Schäfer 2-6). Both detrusor contraction power parameters continuously increased with rising BOO grade. Median BCI increased from 73.3 in Schäfer 0 to 188.0 in Schäfer 6, whereas W max increased from 9.6 to 23.4 W/m(2) (p < 0.001). Results of BCI and W max correlated well (p < 0.001). With increasing BOO grade, there was a significant decrease of voiding efficiency (p < 0.001). CONCLUSIONS In adult male LUTS patients, detrusor contraction power parameters-BCI and W max-continuously increase with rising BOO grade. According to our results, it is impossible to determine a single threshold value for detrusor contraction power to diagnose detrusor underactivity in a group of LUTS patients with different BOO grades. The study is limited to men with non-neurogenic LUTS. Future studies should evaluate exact threshold values for BCI and W max in BOO subgroups to adequately define detrusor underactivity and investigate men with other bladder conditions.
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Affiliation(s)
- Matthias Oelke
- Department of Urology, OE 6240, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany,
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van Koeveringe GA, Rademakers KLJ, Birder LA, Korstanje C, Daneshgari F, Ruggieri MR, Igawa Y, Fry C, Wagg A. Detrusor underactivity: Pathophysiological considerations, models and proposals for future research. ICI-RS 2013. Neurourol Urodyn 2014; 33:591-6. [PMID: 24839258 DOI: 10.1002/nau.22590] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 02/20/2014] [Indexed: 12/19/2022]
Abstract
AIMS Detrusor underactivity, resulting in either prolonged or inefficient voiding, is a common clinical problem for which treatment options are currently limited. The aim of this report is to summarize current understanding of the clinical observation and its underlying pathophysiological entities. METHODS This report results from presentations and subsequent discussion at the International Consultation on Incontinence Research Society (ICI-RS) in Bristol, 2013. RESULTS AND CONCLUSIONS The recommendations made by the ICI-RS panel include: Development of study tools based on a system's pathophysiological approach, correlation of in vitro and in vivo data in experimental animals and humans, and development of more comprehensive translational animal models. In addition, there is a need for longitudinal patient data to define risk groups and for the development of screening tools. In the near-future these recommendations should lead to a better understanding of detrusor underactivity and its pathophysiological background. Neurourol. Urodynam. 33:591-596, 2014. © 2014 Wiley Periodicals, Inc.
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