Current Urology Reports

, Volume 13, Issue 5, pp 370–378 | Cite as

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

  • Matthew P. Rutman
  • Doh Yoon Cha
  • Jerry G. Blaivas
Voiding Dysfunction and Lower Urinary Tract Symptoms (GH Badlani and HB Goldman, Section Editors)

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.

Keywords

Urinary bladder Overactive bladder Urodynamics Hypersensitivity Bladder outlet obstruction Detrusor overactivity Urgency Lower urinary tract symptoms Sensory Motor Nocturia Classification Lower urinary tract symptoms 

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    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.PubMedCrossRefGoogle Scholar
  2. 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
  3. 3.
    Maake C, Landman M, Wang X, et al. Expression of smoothelin in the normal and the overactive human bladder. J Urol. 2006;175:1152.PubMedCrossRefGoogle Scholar
  4. 4.
    Digesu GA, Khullar V, Cardozo L, et al. Overactive bladder symptoms: do we need urodynamics? Neurourol Urodyn. 2003;22:105–8.PubMedCrossRefGoogle Scholar
  5. 5.
    Hashim H, Abrams P. Is the bladder a reliable witness for predicting detrusor overactivity? J Urol. 2006;175:191–4.PubMedCrossRefGoogle Scholar
  6. 6.
    Flisser AJ, Walmsley K, Blaivas JG. Urodynamic classification of patients with symptoms of overactive bladder. J Urol. 2003;169:529–33.PubMedCrossRefGoogle Scholar
  7. 7.
    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.PubMedCrossRefGoogle Scholar
  8. 8.
    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.PubMedCrossRefGoogle Scholar
  9. 9.
    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.PubMedCrossRefGoogle Scholar
  10. 10.
    Lowenstein L, Pham T, Abbasy S, et al. Observations related to urinary sensation during detrusor overactivity. Neurourol Urodyn. 2009;28:497–500.PubMedCrossRefGoogle Scholar
  11. 11.
    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.PubMedCrossRefGoogle Scholar
  12. 12.
    Heslington K, Hilton P. Ambulatory monitoring and conventional cystometry in asymptomatic female volunteers. Br J Obst Gynecol. 1996;103:434–41.CrossRefGoogle Scholar
  13. 13.
    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.PubMedCrossRefGoogle Scholar
  14. 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
  15. 15.
    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.PubMedCrossRefGoogle Scholar
  16. 16.
    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.PubMedCrossRefGoogle Scholar
  17. 17.
    Rapp DE, Neil NJ, Govier FE, et al. Bladder sensation measures and overactive bladder. J Urol. 2009;182(3):1050–4.PubMedCrossRefGoogle Scholar
  18. 18.
    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.PubMedCrossRefGoogle Scholar
  19. 19.
    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.PubMedCrossRefGoogle Scholar
  20. 20.
    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.CrossRefGoogle Scholar
  21. 21.
    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.PubMedCrossRefGoogle Scholar
  22. 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. 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
  24. 24.
    Blaivas JG, Groutz A. Bladder outlet obstruction nomogram for women with lower urinary tract symptomatology. Neurourol Urodyn. 2000;19(5):553–64.PubMedCrossRefGoogle Scholar
  25. 25.
    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.PubMedCrossRefGoogle Scholar
  26. 26.
    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.CrossRefGoogle Scholar
  27. 27.
    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.PubMedCrossRefGoogle Scholar
  28. 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
  29. 29.
    Serels SR, Rackley RR, Appell RA. Surgical treatment for stress urinary incontinence associated with valsalva induced detrusor instability. J Urol. 2000;163:884–7.PubMedCrossRefGoogle Scholar
  30. 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

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Matthew P. Rutman
    • 1
    • 3
  • Doh Yoon Cha
    • 1
  • Jerry G. Blaivas
    • 2
  1. 1.Department of UrologyColumbia University College of Physicians and SurgeonsNew YorkUSA
  2. 2.Department of Urology, SUNY-Downstate Medical CenterWeill Medical College of Cornell UniversityNew YorkUSA
  3. 3.Department of UrologyColumbia University Medical CenterNew YorkUSA

Personalised recommendations