Phasic or terminal detrusor overactivity in women: age, urodynamic findings and sphincter behavior relationships

Abstract

Objectives: To search for relationships between phasic (P) and terminal (T) DO with age, urodynamic findings and sphincter behavior during involuntary detrusor contraction in woman. Materials and Methods: Urodynamic studies (triple lumen catheter 7F, seated position) of 164 successive women referred for LUTS with diagnosis of DO were reviewed. Patients were stratified in 4 sub-groups: pre-(18-44 y), peri-(45-54 y), post-menopause (55-74 y) and oldest old (≥ 75 y). The urethral sensor was positioned at the level of the maximum urethral closure pressure for sphincter behavior analysis. A variation of at least 5 cm H 2 O in pressure (detrusor or urethra) was chosen to assert DO or sphincter response. Sphincter response was classified as relaxation (re) before or during DO, or steady (st). Results: Occurrence of P and TDO was similar: 77 P and 87 T. The PDO group was significantly younger (p = 0.0003). TDO was more frequent in patients with a history of neurological disease. The percentage of PDO remained almost constant in age groups, while that of TDO increased with age from 6.7% to 23.2% (p = 0.0013). Uninhibited contraction occurred at a smaller bladder volume in the P group: 149 ± 95 vs. 221 ± 113 mL (p < 0.0001). Steady sphincter predominated in the TDO subgroup: 45.9% vs. 32.1% and increased significantly in each DO sub-group of ≥ 75 y. Conclusion: Steady sphincter during both P and TDO, and occurrence of TDO appear as specific of aging. The last result could be related to structural changes in the detrusor muscle with aging.

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 …”

Clinically relevant modeling of urodynamics function: The VBN model

“…Joining this specific property with some general results on muscles, we described the excitation at the pressure level as a delayed function of the efferent neurons firing rate F and showed that F is a step function of time except during the end of void . From then, we began to study the process of nervous excitation during detrusor overactivity …”

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

“…The pattern of DO has rarely been taken into account but it has been reported that TDO was more frequent in old women with or without history of neurological disease (4). In men, occurrence of TDO was reported in elderly (5), in patients with Parkinson's disease (6), and the different patterns of DO described in patients with benign prostatic hyperplasia (7,8).…”