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Current Bladder Dysfunction Reports

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01-09-2018 | Overactive Bladder and Lower Urinary Tract Symptoms (U Lee and S Adelstein, Section Editors)

New Concepts in Bladder Sensation and Urinary Urgency

Authors: Hameeda A. Naimi, John E. Speich, Adam P. Klausner

Published in: Current Bladder Dysfunction Reports | Issue 3/2018

Abstract

Purpose of Review

The purpose of this review is to summarize the current state of knowledge regarding the evaluation and measurement of urinary urgency and bladder sensation.

Recent Findings

New technologies have been developed to improve our diagnostic capabilities in urinary urgency and bladder sensation. Recent developments include MRI-based neuroimaging and novel tablet-based sensation meters that can be used during urodynamics as well as during oral hydration.

Summary

Commonly used metrics for urinary urgency and bladder sensation include the use of validated surveys/void diaries and standardized verbal sensory thresholds during urodynamics. However, these metrics are highly subjective and prone to significant bias. There has been an evolution in evaluation metrics ranging from the use of reflex testing to electrical perception testing to the use of neuroimaging and the development of sensation meters. Neuroimaging allows for mapping of specific brain areas involved in the different phases of voiding and provides an anatomic basis for different forms of overactive bladder. The sensation meter allows for generation of real-time sensation-capacity curves which enables easy and objective comparison between patients as well as potential subtyping of different forms of overactive bladder. In addition, new research supports the concept of differing forms of urgency and the use of novel patient-derived terminologies for urinary urgency and bladder sensation.

Cardona-Grau D, Spettel S. History of the term overactive bladder. Curr Bladder Dysfunct Rep. 2014;9:48–51. https://doi.org/10.1007/s11884-013-0218-3.CrossRef

Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, et al. The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn. 2002;21:167–78. https://doi.org/10.1002/nau.10052.CrossRefPubMed

Coyne KS, Sexton CC, Vats V, Thompson C, Kopp ZS, Milsom I. National community prevalence of overactive bladder in the United States stratified by sex and age. Urology. 2011;77:1081–7. https://doi.org/10.1016/j.urology.2010.08.039.CrossRefPubMed

Coyne KS, Kvasz M, Ireland AM, Milsom I, Kopp ZS, Chapple CR. Urinary incontinence and its relationship to mental health and health-related quality of life in men and women in Sweden, the United Kingdom, and the United States. Eur Urol. 2012;61:88–95. https://doi.org/10.1016/j.eururo.2011.07.049.CrossRefPubMed

Abrams P, Chapple CR, Junemann KP, Sharpe S. Urinary urgency: a review of its assessment as the key symptom of the overactive bladder syndrome. World J Urol. 2012;30:385–92. https://doi.org/10.1007/s00345-011-0742-8.CrossRefPubMed

Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn. 2010;29:4–20. https://doi.org/10.1002/nau.20798.PubMedCrossRef

van Melick HH, Gisolf KW, Eckhardt MD, van Venrooij GE, Boon TA. One 24-hour frequency-volume chart in a woman with objective urinary motor urge incontinence is sufficient. Urology. 2001;58:188–92.CrossRefPubMed

Fitzgerald MP, Ayuste D, Brubaker L. How do urinary diaries of women with an overactive bladder differ from those of asymptomatic controls? BJU Int. 2005;96:365–7.CrossRefPubMed

Locher JL, Goode PS, Roth DL, Worrell RL, Burgio KL. Reliability assessment of the bladder diary for urinary incontinence in older women. J Gerontol A Biol Sci Med Sci. 2001;56:M32–5.CrossRefPubMed

10.

Shy M, Fletcher SG. Objective evaluation of overactive bladder: which surveys should I use? Curr Bladder Dysfunct Rep. 2013;8:45–50. https://doi.org/10.1007/s11884-012-0167-2.CrossRefPubMedPubMedCentral

11.

Rosier PF. The evidence for urodynamic investigation of patients with symptoms of urinary incontinence. F1000Prime Rep. 2013;5:8. https://doi.org/10.12703/P5-8.CrossRefPubMedPubMedCentral

12.

Klevmark B. Volume threshold for micturition. Influence of filling rate on sensory and motor bladder function. Scand J Urol Nephrol Suppl. 2002;210:6–10.CrossRef

13.

Wyndaele JJ. The normal pattern of perception of bladder filling during cystometry studied in 38 young healthy volunteers. J Urol. 1998;160:479–81.CrossRefPubMed

14.

Wyndaele JJ, De Wachter S. Cystometrical sensory data from a normal population: comparison of two groups of young healthy volunteers examined with 5 years interval. Eur Urol. 2002;42:34–8.CrossRefPubMed

15.

Erdem E, Tunckiran A, Acar D, Kanik EA, Akbay E, Ulusoy E. Is catheter cause of subjectivity in sensations perceived during filling cystometry? Urology. 2005;66:1000–3. discussion 1003-4CrossRefPubMed

16.

Erdem E, Akbay E, Doruk E, Cayan S, Acar D, Ulusoy E. How reliable are bladder perceptions during cystometry? Neurourol Urodyn. 2004;23:306–9. https://doi.org/10.1002/nau.20045. discussion 10CrossRefPubMed

17.

Starkman JS, Dmochowski RR. Urgency assessment in the evaluation of overactive bladder (OAB). Neurourol Urodyn. 2008;27:13–21. https://doi.org/10.1002/nau.20472.CrossRefPubMed

18.

Lowenstein L, FitzGerald MP, Kenton K, Brubaker L, Gruenwald I, Papier I, et al. Validation of a real-time urodynamic measure of urinary sensation. Am J Obstet Gynecol. 2008;198:661.e1-4; discussion 661.e4-5. https://doi.org/10.1016/j.ajog.2008.02.023.CrossRef

19.

Steanu ID, Albu SE, Persu C. The place of the ice water test (IWT) in the evaluation of the patients with traumatic spinal cord injury. Maedica (Buchar). 2012;7:125–30.

20.

Geirsson G, Lindstrom S, Fall M, Gladh G, Hermansson G, Hjalmas K. Positive bladder cooling test in neurologically normal young children. J Urol. 1994;151:446–8.CrossRefPubMed

21.

van Meel TD, de Wachter S, Wyndaele JJ. Repeated ice water tests and electrical perception threshold determination to detect a neurologic cause of detrusor overactivity. Urology. 2007;70:772–6.CrossRefPubMed

22.

De Wachter S, Wyndaele JJ. Can the sensory threshold toward electrical stimulation be used to quantify the subjective perception of bladder filling? A study in young healthy volunteers. Urology. 2001;57:655–8. discussion 658-9CrossRefPubMed

23.

De Wachter S, Smith PP, Tannenbaum C, Van Koeveringe G, Drake M, Wyndaele JJ, et al. How should bladder sensation be measured? ICI-RS 2011. Neurourol Urodyn. 2012;31:370–4. https://doi.org/10.1002/nau.22214.CrossRefPubMed

24.

Yamada Y, Ukimura O, Liu G, Miki T, Daneshgari F. Efficacy of neuroselective and site-specific nociceptive stimuli of rat bladder. Urology. 2012;79:483.e7–12. https://doi.org/10.1016/j.urology.2011.10.006.CrossRef

25.

De Laet K, De Wachter S, Wyndaele JJ. Current perception thresholds in the lower urinary tract: sine- and square-wave currents studied in young healthy volunteers. Neurourol Urodyn. 2005;24:261–6. https://doi.org/10.1002/nau.20095.CrossRefPubMed

26.

Ukimura O, Ushijima S, Honjo H, Iwata T, Suzuki K, Hirahara N, et al. Neuroselective current perception threshold evaluation of bladder mucosal sensory function. Eur Urol. 2004;45:70–6.CrossRefPubMed

27.

•• Gao Y, Liao L, Blok BF. Erratum to: a resting-state functional MRI study on central control of storage: brain response provoked by strong desire to void. Int Urol Nephrol. 2015;47:1363. https://doi.org/10.1007/s11255-015-1057-2. Non-invasive hydration protocol with concurrent MRI imaging techniques which confirmed earlier studies of brain activity during micturition and suggested differences between male and female healthy individuals. CrossRefPubMed

28.

Krhut J, Tintera J, Holy P, Zachoval R, Zvara P. A preliminary report on the use of functional magnetic resonance imaging with simultaneous urodynamics to record brain activity during micturition. J Urol. 2012;188:474–9. https://doi.org/10.1016/j.juro.2012.04.004.CrossRefPubMed

29.

Shy M, Fung S, Boone TB, Karmonik C, Fletcher SG, Khavari R. Functional magnetic resonance imaging during urodynamic testing identifies brain structures initiating micturition. J Urol. 2014;192:1149–54. https://doi.org/10.1016/j.juro.2014.04.090.CrossRefPubMedPubMedCentral

30.

Heeringa R, de Wachter SG, van Kerrebroeck PE, van Koeveringe GA. Normal bladder sensations in healthy volunteers: a focus group investigation. Neurourol Urodyn. 2011;30:1350–5. https://doi.org/10.1002/nau.21052.PubMedCrossRef

31.

Heeringa R, van Koeveringe GA, Winkens B, van Kerrebroeck PE, de Wachter SG. Do patients with OAB experience bladder sensations in the same way as healthy volunteers? A focus group investigation. Neurourol Urodyn. 2012;31:521–5. https://doi.org/10.1002/nau.21232.CrossRefPubMed

32.

Blaivas JG, Panagopoulos G, Weiss JP, Somaroo C. Two types of urgency. Neurourol Urodyn. 2009;28:188–90. https://doi.org/10.1002/nau.20525.CrossRefPubMed

33.

•• Nagle AS, Speich JE, De Wachter SG, Ghamarian PP, Le DM, Colhoun AF, et al. Non-invasive characterization of real-time bladder sensation using accelerated hydration and a novel sensation meter: an initial experience. Neurourol Urodyn. 2017;36:1417–26. https://doi.org/10.1002/nau.23137. Description of a novel sensation meter interface, which was developed to advance characterization of urgency in healthy and OAB individuals. CrossRefPubMed

34.

Naimi H, Nagle A, Vinod N, Kolli H, Sheen D. Characterization of bladder sensation event descriptions during non-invasive oral hydration in healthy adults. Neurourol Urodyn. 2018;37:S518–669. Abstract #S654CrossRef

35.

Speich JE, Nagle AS, De Wachter SG, Klausner AP. The sensation meter: an unprompted method to characterize patient-reported bladder sensation in real-time:V001T04A001-V001T04A001. 2017;

36.

• Nenadic I, Mynderse L, Husmann D, Mehrmohammadi M, Bayat M, Singh A, et al. Noninvasive evaluation of bladder wall mechanical properties as a function of filling volume: potential application in bladder compliance assessment. PLoS One. 2016;11:e0157818. https://doi.org/10.1371/journal.pone.0157818. Study employs non-invasive, focused ultrasound radiation in order to enhance current understanding of detrusor muscle physiology. CrossRefPubMedPubMedCentral

37.

• Bayat M, Kumar V, Denis M, Webb J, Gregory A, Mehrmohammadi M, et al. Correlation of ultrasound bladder vibrometry assessment of bladder compliance with urodynamic study results. PLoS One. 2017;12:e0179598. https://doi.org/10.1371/journal.pone.0179598. Study demonstrated the utility of bladder vibrometry in evaluating changes in detrusor muscle physiology. CrossRefPubMedPubMedCentral

38.

• Nagle AS, Bernardo RJ, Varghese J, Carucci LR, Klausner AP, Speich JE. Comparison of 2D and 3D ultrasound methods to measure serial bladder volumes during filling: steps toward development of non-invasive ultrasound urodynamics. Bladder (San Franc). 2018;5:e32. Argues for the use of ultrasound imaging alongside UDS suggesting potential for subtyping OAB.

39.

• Nagle AS, Klausner AP, Varghese J, Bernardo RJ, Colhoun AF, Barbee RW, et al. Quantification of bladder wall biomechanics during urodynamics: a methodologic investigation using ultrasound. J Biomech. 2017;61:232–41. Argues for the use of ultrasound imaging alongside UDS suggesting potential for subtyping OAB. CrossRefPubMedPubMedCentral

40.

Colhoun AF, Klausner AP, Nagle AS, Carroll AW, Barbee RW, Ratz PH, et al. A pilot study to measure dynamic elasticity of the bladder during urodynamics. Neurourol Urodyn. 2017;36:1086–90. https://doi.org/10.1002/nau.23043.CrossRefPubMed

Title: New Concepts in Bladder Sensation and Urinary Urgency
Authors: Hameeda A. Naimi
John E. Speich
Adam P. Klausner
Publication date: 01-09-2018
Publisher: Springer US
Published in: Current Bladder Dysfunction Reports / Issue 3/2018
Print ISSN: 1931-7212
Electronic ISSN: 1931-7220
DOI: https://doi.org/10.1007/s11884-018-0474-3

At a glance: The STEP trials

Springer Medicine

New Concepts in Bladder Sensation and Urinary Urgency

Abstract

Purpose of Review

Recent Findings

Summary

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose of Review

Recent Findings

Summary

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