Comparison of ambulatory versus conventional urodynamics in females with urinary incontinence

Dökmeci, Fulya; Seval, Murat; Gök, Haydar

doi:10.1002/nau.20821

Cited by 33 publications

(30 citation statements)

References 25 publications

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“…It has been hypothesised that the absence of smooth muscle sphincter seen in men and known to prevent reflux ejaculation predisposes women to coital incontinence (8) 19 (14) 12 (6) USI urodynamic stress incontinence, DOA detrusor overactivity if they suffer from urinary incontinence. The mechanism of coital leakage in women with normal urodynamics is poorly understood; however, in view of the limitations of the test, it is likely that women [12] with normal investigations had a mild underlying urodynamic diagnosis rather than a negative one. The prevalence of coital incontinence in women without urinary incontinence has been poorly studied and further research into this area may shed more light on the exact pathophysiology of this condition and its treatment.…”

Section: Discussionmentioning

confidence: 99%

Incontinence during intercourse: myths unravelled

2012

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Section: Discussionmentioning

confidence: 99%

Incontinence during intercourse: myths unravelled

2012

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“…Urinary diaries, for example, are used to complement clinical history and provide a joint decision based on clinicians' assessment rather than on patient's history alone. Furthermore, ambulatory UDS has been shown to be more sensitive in detecting DO, 194 or generally the underlying syndrome of UI, 195,196 than conventional UDS and thus the results of the economic evaluation may overstate the cost-effectiveness of UDS, as it has been used as a reference standard. Ambulatory UDS was used as part of the primary study in situations of a negative UDS, but in the subgroup population used for the model, the number of observations were not enough to be tested in a sensitivity analysis (n = 7).…”

Section: Strengths and Limitations Of The Studymentioning

confidence: 99%

“…Evidence suggests that ambulatory UDS is more sensitive in detecting DO 194 and other syndromes of UI. 195,196 Furthermore, a more appropriate comparator for UDS would have been the clinical assessment, which would provide an overall clinical diagnosis based on the clinical history (validated questionnaires) and urinary diaries. Thus, a comparative evaluation of the costs and benefits of UDS and clinical assessment using ambulatory UDS as a reference standard would help gain further insight into the cost-effectiveness of UDS in women with predominant symptoms of OAB.…”

Section: Unanswered Questions and Future Researchmentioning

confidence: 99%

Bladder ultrasonography for diagnosing detrusor overactivity: test accuracy study and economic evaluation

Rachaneni

McCooty

Middleton

et al. 2016

Health Technol Assess

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BackgroundUrodynamics (UDS) has been considered the gold standard test for detrusor overactivity (DO) in women with an overactive bladder (OAB). Bladder ultrasonography to measure bladder wall thickness (BWT) is less invasive and has been proposed as an alternative test.ObjectivesTo estimate the reliability, reproducibility, accuracy and acceptability of BWT in women with OAB, measured by ultrasonography, in the diagnosis of DO; to explore the role of UDS and its impact on treatment outcomes; and to conduct an economic evaluation of alternative care pathways.DesignA cross-sectional test accuracy study.Setting22 UK hospitals.Participants687 women with OAB.MethodsBWT was measured using transvaginal ultrasonography, and DO was assessed using UDS, which was performed blind to ultrasonographic findings. Intraobserver and interobserver reproducibility were assessed by repeated measurements from scans in 37 and 57 women, respectively, and by repeated scans in 27 women. Sensitivity and specificity were computed at pre-specified thresholds. The smallest real differences detectable of BWT were estimated using one-way analysis of variance. The pain and acceptability of both tests were evaluated by a questionnaire. Patient symptoms were measured before testing and after 6 and 12 months using the International Consultation on Incontinence modular Questionnaire Overactive Bladder (short form) (ICIQ-OAB) questionnaire and a global impression of improvement elicited at 12 months. Interventions and patient outcomes were analysed according to urodynamic diagnoses and BWT measurements. A decision-analytic model compared the cost-effectiveness of care strategies using UDS, ultrasonography or clinical history, estimating the cost per woman successfully treated and the cost per quality-adjusted life-year (QALY).ResultsBWT showed very low sensitivity and specificity at all pre-specified cut-off points, and there was no evidence of discrimination at any threshold (p = 0.25). Extensive sensitivity and subgroup analyses did not alter the interpretation of these findings. The smallest detectable difference in BWT was estimated to be 2 mm. Pain levels following both tests appeared relatively low. The proportion of women who found the test ‘totally acceptable’ was significantly higher with ultrasonography than UDS (81% vs. 56%;p < 0.001). Overall, subsequent treatment was highly associated with urodynamic diagnosis (p < 0.0001). There was no evidence that BWT had any relationship with the global impression of improvement responses at 20 months (p = 0.4). Bladder ultrasonography was more costly and less effective than the other strategies. The incremental cost-effectiveness ratio (ICER) of basing treatment on the primary clinical presentation compared with UDS was £491,500 per woman successfully treated and £60,200 per QALY. Performing a UDS in those women with a clinical history of mixed urinary incontinence had an ICER of £19,500 per woman successfully treated and £12,700 per QALY compared with the provision of urodynamic to all women. For DO cases detected, UDS was the most cost-effective strategy.ConclusionThere was no evidence that BWT had any relationship with DO, regardless of the cut-off point, nor any relationship to symptoms as measured by the ICIQ-OAB. Bladder ultrasonography has no diagnostic or prognostic value as a test in this condition. Furthermore, despite its greater acceptability, BWT measurement was not sufficiently reliable or reproducible.Trial registrationCurrent Controlled Trials ISRCTN46820623.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 20, No. 7. See the NIHR Journals Library website for further project information.

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“…However, a majority of patients with symptoms of urge incontinence fail to demonstrate DOA on urodynamics [11,12]. We report the response of patients with refractory OAB treated with intradetrusor BTX-A in the absence of urodynamic DOA.…”

Section: Introductionmentioning

confidence: 94%