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Published in: Current Urology Reports 5/2012

01-10-2012 | Voiding Dysfunction and Lower Urinary Tract Symptoms (GH Badlani and HB Goldman, Section Editors)

How Do Urodynamics Findings Influence the Treatment of the Typical Patient With Overactive Bladder?

Authors: Matthew P. Rutman, Doh Yoon Cha, Jerry G. Blaivas

Published in: Current Urology Reports | Issue 5/2012

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Abstract

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.
Literature
1.
go back to reference Abrams P, Cardoza LD, Fall M, et al. The standardization of terminology of lower tract function: report from the Standardization Sub-Committee of the International Continence Society. Neurourol Urodyn. 2002;21:167.PubMedCrossRef Abrams P, Cardoza LD, Fall M, et al. The standardization of terminology of lower tract function: report from the Standardization Sub-Committee of the International Continence Society. Neurourol Urodyn. 2002;21:167.PubMedCrossRef
2.
go back to reference Coyne KS, Sexton CC, Irwin DE, et al. The impact of overactive bladder, incontinence and other lower urinary tract symptoms on quality of life, work productivity, sexuality and emotional well-being in men and women: results from the EPIC study. BJU Int. 2008;101(11):1388–95.PubMedCrossRef Coyne KS, Sexton CC, Irwin DE, et al. The impact of overactive bladder, incontinence and other lower urinary tract symptoms on quality of life, work productivity, sexuality and emotional well-being in men and women: results from the EPIC study. BJU Int. 2008;101(11):1388–95.PubMedCrossRef
3.
go back to reference Maake C, Landman M, Wang X, et al. Expression of smoothelin in the normal and the overactive human bladder. J Urol. 2006;175:1152.PubMedCrossRef Maake C, Landman M, Wang X, et al. Expression of smoothelin in the normal and the overactive human bladder. J Urol. 2006;175:1152.PubMedCrossRef
4.
go back to reference Digesu GA, Khullar V, Cardozo L, et al. Overactive bladder symptoms: do we need urodynamics? Neurourol Urodyn. 2003;22:105–8.PubMedCrossRef Digesu GA, Khullar V, Cardozo L, et al. Overactive bladder symptoms: do we need urodynamics? Neurourol Urodyn. 2003;22:105–8.PubMedCrossRef
5.
go back to reference Hashim H, Abrams P. Is the bladder a reliable witness for predicting detrusor overactivity? J Urol. 2006;175:191–4.PubMedCrossRef Hashim H, Abrams P. Is the bladder a reliable witness for predicting detrusor overactivity? J Urol. 2006;175:191–4.PubMedCrossRef
6.
go back to reference Flisser AJ, Walmsley K, Blaivas JG. Urodynamic classification of patients with symptoms of overactive bladder. J Urol. 2003;169:529–33.PubMedCrossRef Flisser AJ, Walmsley K, Blaivas JG. Urodynamic classification of patients with symptoms of overactive bladder. J Urol. 2003;169:529–33.PubMedCrossRef
7.
go back to reference Caruso DJ, Kanagarajah P, Cohen BL, et al. What is the predictive value of urodynamics to reproduce clinical findings of urinary frequency, urge urinary incontinence, and/or stress urinary incontinence? Int Urogynecol J. 2010;21(10):1205–9.PubMedCrossRef Caruso DJ, Kanagarajah P, Cohen BL, et al. What is the predictive value of urodynamics to reproduce clinical findings of urinary frequency, urge urinary incontinence, and/or stress urinary incontinence? Int Urogynecol J. 2010;21(10):1205–9.PubMedCrossRef
8.
go back to reference Pannek J, Pieper P. Clinical usefulness of ambulatory urodynamics in the diagnosis and treatment of lower urinary tract dysfunction. Scand J Urol Nephrol. 2008;42:428–32.PubMedCrossRef Pannek J, Pieper P. Clinical usefulness of ambulatory urodynamics in the diagnosis and treatment of lower urinary tract dysfunction. Scand J Urol Nephrol. 2008;42:428–32.PubMedCrossRef
9.
go back to reference Radley SC, Rosario DJ, Chapple CR, et al. Conventional and ambulatory urodynamic findings in women with symptoms suggestive of bladder overactivity? J Urol. 2001;166:2253–8.PubMedCrossRef Radley SC, Rosario DJ, Chapple CR, et al. Conventional and ambulatory urodynamic findings in women with symptoms suggestive of bladder overactivity? J Urol. 2001;166:2253–8.PubMedCrossRef
10.
go back to reference Lowenstein L, Pham T, Abbasy S, et al. Observations related to urinary sensation during detrusor overactivity. Neurourol Urodyn. 2009;28:497–500.PubMedCrossRef Lowenstein L, Pham T, Abbasy S, et al. Observations related to urinary sensation during detrusor overactivity. Neurourol Urodyn. 2009;28:497–500.PubMedCrossRef
11.
go back to reference Renganathan A, Cartwright R, Cardozo L, et al. Quality control in urodynamics: analysis of an international multi-center study. Neurourol Urodyn. 2009;28:380–4.PubMedCrossRef Renganathan A, Cartwright R, Cardozo L, et al. Quality control in urodynamics: analysis of an international multi-center study. Neurourol Urodyn. 2009;28:380–4.PubMedCrossRef
12.
go back to reference Heslington K, Hilton P. Ambulatory monitoring and conventional cystometry in asymptomatic female volunteers. Br J Obst Gynecol. 1996;103:434–41.CrossRef Heslington K, Hilton P. Ambulatory monitoring and conventional cystometry in asymptomatic female volunteers. Br J Obst Gynecol. 1996;103:434–41.CrossRef
13.
go back to reference Fan YH, Lin CC, Lin AT, et al. Are patients with the symptoms of overactive bladder and urodynamic detrusor overactivity different from those with overactive bladder but not detrusor overactivity? J Chin Med Assoc. 2011;74(10):455–9.PubMedCrossRef Fan YH, Lin CC, Lin AT, et al. Are patients with the symptoms of overactive bladder and urodynamic detrusor overactivity different from those with overactive bladder but not detrusor overactivity? J Chin Med Assoc. 2011;74(10):455–9.PubMedCrossRef
14.
go back to reference • Guralnick ML, Grimsley G, Liss M, et al. Objective differences between overactive bladder patients with and without urodynamically proven detrusor overactivity. Int Urogynecol J. 2010;21:325-329. This study presents a review of 146 women with overactive bladder to distinguish patients with and without urodynamic detrusor overactivity. On urodynamics, patients with detrusor overactivity were found to have abnormal sensation with strong desire and urgency at much lower bladder volumes, suggesting that there are objective differences between the two groups. • Guralnick ML, Grimsley G, Liss M, et al. Objective differences between overactive bladder patients with and without urodynamically proven detrusor overactivity. Int Urogynecol J. 2010;21:325-329. This study presents a review of 146 women with overactive bladder to distinguish patients with and without urodynamic detrusor overactivity. On urodynamics, patients with detrusor overactivity were found to have abnormal sensation with strong desire and urgency at much lower bladder volumes, suggesting that there are objective differences between the two groups.
15.
go back to reference Boy S, Schurch B, Mehnert U, et al. The effects of tolterodine on bladder filling sensations and perception thresholds to intravesical electoral stimulation: method and initial results. BJU Int. 2007;100:574–8.PubMedCrossRef Boy S, Schurch B, Mehnert U, et al. The effects of tolterodine on bladder filling sensations and perception thresholds to intravesical electoral stimulation: method and initial results. BJU Int. 2007;100:574–8.PubMedCrossRef
16.
go back to reference Finney SM, Andersson KE, Gillespie JI, et al. Antimuscarinic drugs in detrusor overactivity and the overactive bladder syndrome: motor or sensory actions? BJU Int. 2006;98:503–7.PubMedCrossRef Finney SM, Andersson KE, Gillespie JI, et al. Antimuscarinic drugs in detrusor overactivity and the overactive bladder syndrome: motor or sensory actions? BJU Int. 2006;98:503–7.PubMedCrossRef
17.
go back to reference Rapp DE, Neil NJ, Govier FE, et al. Bladder sensation measures and overactive bladder. J Urol. 2009;182(3):1050–4.PubMedCrossRef Rapp DE, Neil NJ, Govier FE, et al. Bladder sensation measures and overactive bladder. J Urol. 2009;182(3):1050–4.PubMedCrossRef
18.
go back to reference McNeill SA, Hargreave TB, Geffriaud-Ricouard C, et al. Postvoid residual urine in patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia: a pooled analysis of eleven controlled studies with alfuzosin. Urology. 2001;57:459–65.PubMedCrossRef McNeill SA, Hargreave TB, Geffriaud-Ricouard C, et al. Postvoid residual urine in patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia: a pooled analysis of eleven controlled studies with alfuzosin. Urology. 2001;57:459–65.PubMedCrossRef
19.
go back to reference Kolman C, Girman CJ, Jacobsen SJ, et al. Distribution of post-void residual urine volume in randomly selected men. J Urol. 1999;161:122–7.PubMedCrossRef Kolman C, Girman CJ, Jacobsen SJ, et al. Distribution of post-void residual urine volume in randomly selected men. J Urol. 1999;161:122–7.PubMedCrossRef
20.
go back to reference Van Vernrooij GE, Van Melick HH, Eckhardt MD, et al. Correlations of urodynamic changes with changes in symptoms and well-being after transurethral resection of the prostate. J Urol. 2002;168:605–9.CrossRef Van Vernrooij GE, Van Melick HH, Eckhardt MD, et al. Correlations of urodynamic changes with changes in symptoms and well-being after transurethral resection of the prostate. J Urol. 2002;168:605–9.CrossRef
21.
go back to reference Ronchi P, Gravina GL, Galatioto GP, et al. Urodynamic parameters after solifenacin treatment in men with overactive bladder symptoms and detrusor underactivity. Neurourol Urodyn. 2009;28(1):52–7.PubMedCrossRef Ronchi P, Gravina GL, Galatioto GP, et al. Urodynamic parameters after solifenacin treatment in men with overactive bladder symptoms and detrusor underactivity. Neurourol Urodyn. 2009;28(1):52–7.PubMedCrossRef
22.
go back to reference Te A, Ghafar MA, OStad E, et al. Nomogram and urodynamic predictors of urinary retention in men with BPH and bladder outlet obstruction [Abstract]. Presented at the American Urological Association Annual Meeting. Anaheim, CA: June 2-7, 2001;1996. Te A, Ghafar MA, OStad E, et al. Nomogram and urodynamic predictors of urinary retention in men with BPH and bladder outlet obstruction [Abstract]. Presented at the American Urological Association Annual Meeting. Anaheim, CA: June 2-7, 2001;1996.
23.
go back to reference • Blaivas JG, Marks BK, Weiss JP, et al. Differential diagnosis of overactive bladder in men. J Urol 2009;182:2814-2817. This is a descriptive study that highlights the coexisting pathological conditions in men with overactive bladder. Many underlying urologic pathologies contribute to overactive bladder symptoms, and the authors stressed that a more complete knowledge of differential diagnosis in this patient population should improve treatment success. Overactive bladder should be considered to be a symptom complex, not a syndrome. • Blaivas JG, Marks BK, Weiss JP, et al. Differential diagnosis of overactive bladder in men. J Urol 2009;182:2814-2817. This is a descriptive study that highlights the coexisting pathological conditions in men with overactive bladder. Many underlying urologic pathologies contribute to overactive bladder symptoms, and the authors stressed that a more complete knowledge of differential diagnosis in this patient population should improve treatment success. Overactive bladder should be considered to be a symptom complex, not a syndrome.
24.
go back to reference Blaivas JG, Groutz A. Bladder outlet obstruction nomogram for women with lower urinary tract symptomatology. Neurourol Urodyn. 2000;19(5):553–64.PubMedCrossRef Blaivas JG, Groutz A. Bladder outlet obstruction nomogram for women with lower urinary tract symptomatology. Neurourol Urodyn. 2000;19(5):553–64.PubMedCrossRef
25.
go back to reference Kershen RT, Appell RA. De novo urge syndrome and detrusor instability after anti-incontinence surgery: current concepts, evaluation, and treatment. Curr Urol Rep. 2002;3:345–53.PubMedCrossRef Kershen RT, Appell RA. De novo urge syndrome and detrusor instability after anti-incontinence surgery: current concepts, evaluation, and treatment. Curr Urol Rep. 2002;3:345–53.PubMedCrossRef
26.
go back to reference Nitti VW, Rovner ES, Bavendam T. Response to fesoterodine in patients with an overactive bladder and urgency urinary incontinence is independent to the urodynamic finding of detrusor overactivity. BJU Int. 2010;105:126–1275.CrossRef Nitti VW, Rovner ES, Bavendam T. Response to fesoterodine in patients with an overactive bladder and urgency urinary incontinence is independent to the urodynamic finding of detrusor overactivity. BJU Int. 2010;105:126–1275.CrossRef
27.
go back to reference Cohen BL, Barboglio P, Rodriguez D, et al. Preliminary results of a dose-finding study for botulinum toxin-A in patients with idiopathic overactive bladder: 100 versus 150 units. Neurourol Urodyn. 2009;28:205–8.PubMedCrossRef Cohen BL, Barboglio P, Rodriguez D, et al. Preliminary results of a dose-finding study for botulinum toxin-A in patients with idiopathic overactive bladder: 100 versus 150 units. Neurourol Urodyn. 2009;28:205–8.PubMedCrossRef
28.
go back to reference Chou EC, Flisser AJ, Panagopoulos G, et al. Effective treatment for mixed urinary incontinence with a pubovaginal sling. J. Urol. 2003;170: 494–497, 2003 Chou EC, Flisser AJ, Panagopoulos G, et al. Effective treatment for mixed urinary incontinence with a pubovaginal sling. J. Urol. 2003;170: 494–497, 2003
29.
go back to reference Serels SR, Rackley RR, Appell RA. Surgical treatment for stress urinary incontinence associated with valsalva induced detrusor instability. J Urol. 2000;163:884–7.PubMedCrossRef Serels SR, Rackley RR, Appell RA. Surgical treatment for stress urinary incontinence associated with valsalva induced detrusor instability. J Urol. 2000;163:884–7.PubMedCrossRef
30.
go back to reference •• Winters CJ, Dmochowski RR, Goldman HB, et al.: American Urological Association Guideline on Adult Urodynamics, Linthicum, MD. American Urological Association (AUA)/Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU); 2012. This latest guideline represents a systematic review of literature in the appropriate selection of urodynamics in characterization of complex lower urinary tract symptoms and voiding dysfunction. Peer reviewed publications relevant to the use of urodynamics in diagnosis, management, and prognosis were analyzed, yielding 393 studies after pre-determined inclusion/exclusion criteria. •• Winters CJ, Dmochowski RR, Goldman HB, et al.: American Urological Association Guideline on Adult Urodynamics, Linthicum, MD. American Urological Association (AUA)/Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU); 2012. This latest guideline represents a systematic review of literature in the appropriate selection of urodynamics in characterization of complex lower urinary tract symptoms and voiding dysfunction. Peer reviewed publications relevant to the use of urodynamics in diagnosis, management, and prognosis were analyzed, yielding 393 studies after pre-determined inclusion/exclusion criteria.
Metadata
Title
How Do Urodynamics Findings Influence the Treatment of the Typical Patient With Overactive Bladder?
Authors
Matthew P. Rutman
Doh Yoon Cha
Jerry G. Blaivas
Publication date
01-10-2012
Publisher
Current Science Inc.
Published in
Current Urology Reports / Issue 5/2012
Print ISSN: 1527-2737
Electronic ISSN: 1534-6285
DOI
https://doi.org/10.1007/s11934-012-0265-x

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