How Do Urodynamics Findings Influence the Treatment of the Typical Patient With Overactive Bladder?
- 301 Downloads
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.
KeywordsUrinary bladder Overactive bladder Urodynamics Hypersensitivity Bladder outlet obstruction Detrusor overactivity Urgency Lower urinary tract symptoms Sensory Motor Nocturia Classification Lower urinary tract symptoms
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 2.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.PubMedCrossRefGoogle Scholar
- 14.• 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. Google Scholar
- 22.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.Google Scholar
- 23.• 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. Google Scholar
- 28.Chou EC, Flisser AJ, Panagopoulos G, et al. Effective treatment for mixed urinary incontinence with a pubovaginal sling. J. Urol. 2003;170: 494–497, 2003Google Scholar
- 30.•• 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. Google Scholar