Can we predict detrusor overactivity in women with lower urinary tract symptoms? The King's Detrusor Overactivity Score (KiDOS)

Abstract

A prediction model is able to predict detrusor overactivity more accurately than a symptomatic diagnosis alone, in women with lower urinary tract symptoms. Abstract ObjectiveTraditionally, urodynamic studies (UDS) have been used to assess lower urinary tract symptoms (LUTS), but their routine use is now discouraged. While urodynamic stress incontinence is strongly associated with the symptom of stress urinary incontinence (SUI) and a positive cough test, there is a weak relationship between symptoms of overactive bladder and detrusor overactivity (DO). The aim of our study was to develop a model to predict DO in women with LUTS. Study DesignThis prospective study included consecutive women with LUTS attending a urodynamic clinic. All women underwent a comprehensive clinical and urodynamic assessment. The effect of each variable on the odds of DO was estimated both by univariate analysis and adjusted analysis using logistic regression. Results1006 women with LUTS were included in the study with 374 patients (37%) diagnosed with DO. The factors considered to be the best predictors of DO were urgency urinary incontinence, urge rating/void and parity (p-value <0.01). The absence of SUI, vaginal Page 3 of 26 A c c e p t e d M a n u s c r i p t 3 bulging and previous continence surgery were also good predictors of DO (p-value < 0.01).We have created a prediction model for DO based on our best predictors. In our scoring system, presence of UUI scores 5; mean urge rating/void ≥ 3 scores 3; parity ≥ 2 scores 2; previous continence surgery scores -1; presence of SUI scores -1; and the complaint of vaginal bulging scores -1. If a criterion is absent, then the score is 0 and the total score can vary from a value of -3 to +10. The Receiver Operating Characteristic (ROC) analysis for the overall cut-off points revealed an area under the curve of 0.748 (95%CI 0.741, 0.755). ConclusionThis model is able to predict DO more accurately than a symptomatic diagnosis alone, in women with LUTS. The introduction of this scoring system as a screening tool into clinical practice may reduce the need for expensive and invasive tests to diagnose DO, but cannot replace UDS completely.

A Comprehensive Review of Overactive Bladder Pathophysiology: On the Way to Tailored Treatment

“…The coexistence of voiding LUTS may suggest detrusor underactivity, while urgency on standing may suggest a urethral origin of urgency. The existence of urgency with or without incontinence (OAB wet vs OAB dry) could help in differentiating DO-versus hypersensitivity-driven urgency (and then hypothetically myogenic vs urotheliogenic dysfunction) [111] with possible therapeutic implications (eg, scant evidence to support the use of botulinum toxin in OAB dry patients) [2,6]. Uroflowmetry and measurement of postvoid residual would be of interest to help in the screening for detrusor underactivity.…”

Outcomes of intradetrusor onabotulinum toxin A injection in patients with Parkinson's disease

“…28 Several studies have evidenced that the presence of DO is strongly associated with urgency incontinence. 29 Hence, although not supported by current evidence, 30 some authors hypothesize that BoNT-A might be better tailored to "OAB wet"/motor urgency (ie, DO-driven), while SNM might be more appropriate for "OAB dry"/sensory urgency (ie, without DO on urodynamics). All the patients in our series had both DO and urgency incontinence at baseline which could explain the satisfactory outcomes obtained in the light of the aforementioned assumption.…”

“…In contrast, numerous series suggest that SNM may be effective in OAB dry patients . Several studies have evidenced that the presence of DO is strongly associated with urgency incontinence . Hence, although not supported by current evidence, some authors hypothesize that BoNT‐A might be better tailored to “OAB wet”/motor urgency (ie, DO‐driven), while SNM might be more appropriate for “OAB dry”/sensory urgency (ie, without DO on urodynamics).…”