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A prospective study investigating the diagnostic agreement between urodynamics and dynamic cystoscopy in women presenting with mixed urinary incontinence

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Abstract

Introduction and hypothesis

Patient history is often insufficient to identify type of urinary incontinence (UI). Multichannel urodynamic testing (UDS) is often used to clarify the diagnosis. Dynamic cystoscopy (DC) is a novel approach for testing bladder function. The primary objective of this study was to investigate the diagnostic agreement of UDS and DC in evaluating women with mixed urinary incontinence (MUI).

Methods

Women presenting with MUI were approached for enrollment if UDS and DC were planned for further investigation. Investigators were blinded to history and comparative test results. McNemar’s test and kappa coefficient were calculated to assess agreement between UDS and DC. Receiver operating characteristic (ROC) analysis was used to explore the best possible filling sensation cutoffs for DC that would best predict the filling sensation cutoffs from UDS.

Results

Sixty participants were included, of whom, four were excluded for protocol violation. For the primary outcome measure of agreement, UDS and DC were concordant in 44/56 of stress urinary incontinence (SUI) cases (79%) with a κ= 0.54 and in 43/56 of urinary urge incontinence (UUI) cases (77%) with a κ= 0.54, indicating moderate, nearly substantial agreement. ROC analysis identified the best prediction of DC first urge to void as 148 cm3, strong urge 215 cm3, and maximum capacity at 246 cm3. These parameters were used to compare UDS UUI to DC UUI and resulted in a κ = 0.61 (p = 0.37), indicating substantial agreement.

Conclusions

When compared with UDS, DC shows moderate agreement for detection of SUI and substantial agreement for detection of UUI.

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Abbreviations

UDS:

Urodynamic testing

DC:

Dynamic cystoscopy

MUI:

Mixed urinary incontinence

ROC:

Receiver operating characteristic

SUI:

Stress urinary incontinence

UUI:

Urge urinary incontinence

ICS:

International Continence Society

DO:

Detrusor overactivity

UU:

Urinary urgency

OAB:

Overactive bladder

UTI:

Urinary tract infection

POP-Q:

Pelvic Organ Prolapse Quantification

PVR:

Postvoid residual

MCC:

Maximum cystometric capacity

IUGA:

International urogynecological association

ISD:

Intrinsic sphincter deficiency

MUCP:

Maximum urethral closure pressure

QUID:

Questionnaire for urinary incontinence diagnosis

SUDS:

Subjective Units of Distress Scale

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Division of Urogynecology, University of Manitoba, Winnipeg, MB, Canada

    Dobrochna Globerman

  2. Department of Obstetrics and Gynecology, Division of Urogynecology, University of Toronto, Toronto, ON, Canada

    Louise-Helene Gagnon

  3. Department of Obstetrics and Gynecology, Division of Urogynecology, University of Calgary, Calgary, AB, Canada

    Selphee Tang, Erin Brennand, Shunaha Kim-Fine & Magali Robert

Authors
  1. Dobrochna Globerman
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  2. Louise-Helene Gagnon
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  3. Selphee Tang
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  4. Erin Brennand
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  5. Shunaha Kim-Fine
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Correspondence to Dobrochna Globerman.

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Globerman, D., Gagnon, LH., Tang, S. et al. A prospective study investigating the diagnostic agreement between urodynamics and dynamic cystoscopy in women presenting with mixed urinary incontinence. Int Urogynecol J 30, 823–829 (2019). https://doi.org/10.1007/s00192-018-3671-x

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  • DOI: https://doi.org/10.1007/s00192-018-3671-x

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