Idiopathic and neurogenic detrusor overactivity: do the different patterns have urodynamic characteristics related to gender or neurological condition?

Abstract

Objectives: To evaluate the urodynamic characteristics of the two patterns (phasic, P and terminal, T) of detrusor overactivity (DO) according to gender and neurological condition. Materials and Methods: Urodynamic characteristics of DO were analysed in a population with proven urodynamic DO (127 women and 76 men, respectively with 48 and 43 neurological diseases (encephalic, incomplete medullar lesion or peripheral)). Phasic DO is characterized by phasic waves with or without leakage while terminal DO is defined by a single non-inhibited contraction resulting in incontinence. Parameters analysed for both patterns of DO (among other parameters) included: volume and amplitude of the first non-inhibited detrusor contraction (nIDC#1), and for phasic DO: duration of pressure rise during nIDC#1 and number of nIDC. Results: Phasic DO was observed in younger patients in the whole population whatever the gender (women: 55.9 years vs. 64.7 years, p = 0.0052; men: 57.4 years vs. 67.8 years, p = 0.0038). Volume at nIDC#1 was greater for neurological PDO (significant in women: 185 vs. 125 mL, p = 0.0223). Other parameters were not significantly different whatever the gender. Amplitude of nIDC#1 during PDO was significantly lower than that of nIDC during terminal DO (TDO) in both genders whatever the neurological condition (p < 0.0001). Volume at nIDC#1 in both patterns was dependent on the level of neurological lesion. Conclusion:The main difference between the patterns of DO is that PDO occurs in younger individuals. There is no significant difference between urodynamic characteristics of each pattern whatever gender or neurological status. Further studies will provide additional information on the impact of the level of neurological lesion on the pattern of DO.

Are there different patterns of detrusor overactivity which are clinically relevant? ICI‐RS 2018

“…There are only few clinical publications relating to the different patterns of DO. Two studies showed no significant difference in the incidence of idiopathic or neurogenic DO patterns (TDO vs PDO) in women, although in men TDO dominates . Men and women with PDO pattern of idiopathic DO are significantly younger.…”

“…In men, the complaint of urgency is less frequent than in women, with weak association with PDO and TDO. There is a predominance of PDO in IDO and TDO in NDO …”

“…A higher incidence of TDO pattern has been reported in patients with benign prostatic obstruction (BPO) . There is a significant correlation of the severity of nocturia symptoms with the first PDO and the number of DO events …”

“…Two studies showed no significant difference in the incidence of idiopathic or neurogenic DO patterns (TDO vs PDO) in women, although in men TDO dominates. 44,45 Men and women with PDO pattern of idiopathic DO are significantly younger. In neurogenic DO, women are younger with both patterns (TDO and PDO) while there is no age difference for men.…”

Recent research on the role of urodynamic study in the diagnosis and treatment of male lower urinary tract symptoms and urinary incontinence

“…Phasic DO occurs more in young individuals with OAB syndrome. However, there is no significant difference between genders or neurological status [6]. In patients with detrusor underactivity (DU), diminished bladder sensation to volume increase was noted in nonobstructed, nonneurogenic symptomatic patients [7].…”