Does the method of cystometry affect the incidence of involuntary detrusor contractions? A prospective randomized urodynamic study

Abstract

The International Continence Society (ICS) de®nes overactive detrusor as ``one that is shown objectively to contract during the ®lling phase while the patient is attempting to inhibit micturition.'' The aim of the present study was to assess whether instructing the patient neither to try void nor to inhibit micturition during ®lling cystometry may improve the detection rate of involuntary detrusor contractions (IDCs). Forty-two consecutive patients (mean age 65 AE 13.5 years), referred for urodynamic evaluation of persistent irritative lower urinary tract symptoms were prospectively enrolled. All patients were presumed, by history, to have IDCs. Cystometry was performed twice at the same session, each time by using randomly different instructions: Method 1, patients were instructed to try to inhibit micturition during bladder ®lling; and Method 2, patients were instructed to neither try to void nor try to inhibit micturition, but simply report his or her sensations to the examiner. The occurrence, as well as the urodynamic characteristics of IDCs, were analyzed separately and compared between the two ®lling methods. Method 1 identi®ed only 20 cases of IDCs, while Method 2 identi®ed 27 cases (48 versus 64% of the study population, respectively; P 0.02). Analysis of urodynamic characteristics revealed a clear trend of reduced bladder volume at which IDCs occurred when patients were instructed to neither try to void nor to inhibit micturition during bladder ®lling; however, statistical signi®cance was not established (189 AE 122 versus 240 AE 149 mL, respectively; P 0.13). All other urodynamic characteristics of IDCs were similar in both methods. In conclusion, better detection rates of IDCs were achieved by instructing the patient to neither try to void nor try to inhibit micturition, but simply report his or her sensations to the examiner, during ®lling cystometry. If the patient is instructed to inhibit micturition during bladder ®llingÐabout 26% of the IDC cases are misdiagnosed. Neurourol. Urodynam. 20:141±145, 2001.

Does posture affect cystometric parameters and diagnoses?

“…Choe et al [7] suggested that sitting on the toilet with the bladder at maximal capacity is the best provocative manoeuvre for detecting detrusor overactivity. In another study, it was confirmed that if patients are instructed to inhibit micturition during bladder filling, about 26% of the detrusor overactivity cases are missed [8]. These two studies are in consistent with our results.…”

“…Various studies have confirmed that postural change to sitting or standing improved detection rates of detrusor overactivity [7,8,11,12]. Results of this study suggest better Values expressed as mean ± standard deviation, p = Paired Student's t-test detection rates of detrusor overactivity (55% vs. 9%) as well as stress incontinence (55% vs. 2%) and mixed incontinence (17% vs. 0%) when cystometry is performed in the sitting position.…”

Mixed incontinence: does preoperative urodynamic detrusor overactivity affect postoperative quality of life after pubovaginal sling?

“…In 2003, Sriram et al performed an audit of United Kingdom urodynamic practitioners and found considerable disagreement among standardization of catheter zeroing techniques and application of urodynamic definitions (19). Verbal instructions given to patients during testing have also been shown influence the detection of idiopathic detrusor overactivity in patients with clinical symptoms of urinary urgency (20). Although we acknowledge the difficulty in reproducing urodynamic data, we attempted to minimize patient to patient variability by adhering to a written urodynamic protocol and having a single practitioner perform all studies.…”

Urogynecological conditions associated with overactive bladder symptoms in women

“…These findings are consistent with other studies where urodynamic DO is demonstrated in 40-60% of patients. 8,9 In this series, 37% of patients had SUI in addition to OAB. This is not surprising, as mixed stress and urge incontinence is evident in up to 50% of women with incontinence, 25,26 and approximately 18-67% of these patients have DO on urodynamic evaluation.…”

“…The ICS confirmed this was not their intent, 6 as it is known that urodynamic DO is demonstrated in only 40-60% of patients with OAB. 8,9 OAB is diagnosed and managed at almost all levels of patient care, with a significant proportion of patients presenting to and being initially managed by their primary care provider. The guidelines for diagnosis and management of OAB were published by the American Urological Association (AUA)/Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction (SUFU).…”