Invasive urodynamic studies for the management of lower urinary tract symptoms (LUTS) in men with voiding dysfunction

Clement, Keiran; Burden, Helena; Warren, Katherine; Lapitan, Marie Carmela; Omar, Muhammad Imran; Drake, Marcus

doi:10.1002/14651858.cd011179.pub2

Cited by 41 publications

(31 citation statements)

References 28 publications

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“…However, Katz et al [ 2 ] reported discordance between clinical and UDI findings in 45% of patients with storage, 25% with voiding and 54% with combined storage and voiding problems, respectively. Although UDI did change clinical decision making and therapy in a relevant percentage of men with voiding dysfunction, it remained unclear whether this also leads to reduced symptoms after treatment [ 27 ]. Based on our study, identifying pathological findings in more than 70%, UDI seems not be appropriate in healthy subjects to define normal lower urinary tract function.…”

Section: Discussionmentioning

confidence: 99%

Urodynamic Investigation: A Valid Tool to Define Normal Lower Urinary Tract Function?

et al. 2016

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ObjectivesTo evaluate whether urodynamic investigation (UDI), the gold standard to assess refractory lower urinary tract symptoms (LUTS), is appropriate to select healthy volunteers with apparent normal lower urinary tract function as control subjects for comparative studies.Subjects and Methods42 healthy subjects (22 women, mean age 32±10 years; 20 men, mean age 37±12 years) without LUTS were included into this prospective single-centre cohort study. All subjects recorded a 3-day bladder diary, completed validated questionnaires regarding LUTS, and underwent neuro-urological assessment as well as free uroflowmetry. Same session repeat UDI was performed according to “Good Urodynamic Practice” recommended by the International Continence Society, but using an air-charged instead of a water-filled catheter, and evaluated by a blinded investigator.ResultsAll 3-day bladder diaries, LUTS questionnaires, neuro-urological assessments and free uroflowmetries were within normal limits. Overall (either during the first or second UDI), same session repeat UDI revealed pathological findings in 71% (30/42): Detrusor overactivity was detected in 14% (3/22) and 30% (6/20), post void residual >100mL in 14% (3/22) and 25% (5/20), bladder outlet obstruction in 9% (2/22) and 20% (4/20) and detrusor sphincter dyssynergia in 77% (17/22) and 65% (13/20) of our women and men, respectively.Repeatability of detrusor overactivity (κ = 0.78, 95% CI: 0.54–1.02) and detrusor sphincter dyssynergia (κ = 0.77, 95% CI: 0.55–0.98) showed substantial agreement between both UDIs. All other assessed urodynamic parameters had wide 95% limits of agreement for differences in the parameters indicating poor repeatability.ConclusionsMore than 70% of our healthy subjects showed pathological urodynamic findings. Although UDI is the gold standard to assess refractory LUTS, it seems not to be applicable in healthy subjects to define normal lower urinary tract function. Therefore, we do not recommend using UDI to select healthy control subjects.

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Section: Discussionmentioning

confidence: 99%

Urodynamic Investigation: A Valid Tool to Define Normal Lower Urinary Tract Function?

et al. 2016

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“…Optimal LUTS treatment depends on identifying causal mechanisms. Urodynamic testing is well established in functional urological assessment for men with LUTS, to determine underlying pathologic lower urinary tract conditions . Urodynamics with invasive multichannel cystometry involves inserting small catheters in the bladder and rectum to measure bladder function and capacity.…”

Section: Introductionmentioning

confidence: 99%

Recommendations for conducting invasive urodynamics for men with lower urinary tract symptoms: Qualitative interview findings from a large randomized controlled trial (UPSTREAM)

Selman

Ochieng

Lewis

et al. 2018

Neurourology and Urodynamics

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AimsTo capture in‐depth qualitative evidence regarding attitudes to and experiences of urodynamic testing among men with lower urinary tract symptoms (LUTS) at each end of the clinical pathway.MethodsSemi‐structured interview study conducted within the Urodynamics for Prostate Surgery: Randomized Evaluation of Assessment Methods (UPSTREAM) trial, which randomized men to a care pathway including urodynamics or routine non‐invasive tests from 26 secondary care urology sites across England. Men were interviewed after assessments but prior to treatment, or after surgery for LUTS. Men were purposively sampled to include those who had urodynamics and those who did not, and diversity in demographic characteristics and symptom burden. Interviews were analyzed using inductive thematic analysis.ResultsForty‐one men participated (25 pre‐treatment, 16 post‐surgery), ages 52‐89. The 16 men who had not previously experienced urodynamics said they would accept the test in their assessment, but some were apprehensive or wanted more information. The 25 men who had experienced urodynamics all found it acceptable, though some reported pain, infection, or embarrassment. Embarrassment was minimized by informing patients what the procedure would be like, and ensuring privacy. Urodynamics was valued for its perceived diagnostic insight. Information deficits were reported before, during, and after the test. How and when results were explained and the adequacy of explanations varied.ConclusionsUrodynamics is acceptable to men with LUTS and generally well‐tolerated. To ensure patients are prepared and informed, good communication before and during the procedure is essential. Privacy should be prioritized, and test results discussed promptly and in sufficient detail. Staff require training and guidance in these areas.

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“…The guidance states that when considering surgery in men with bothersome predominantly voiding LUTS, pressure flow studies should be performed in men aged <50 years, and may be performed in men aged >80 years. The slightly different recommendations reflect the paucity of evidence on which to base conclusions [8,9]. In men who are physically unfit or who suffer from a medical condition, DUA should probably be considered more seriously, though BOO may ultimately be present.…”

Section: Clinical and Therapeutic Implicationsmentioning

confidence: 99%

Is Urodynamics Necessary when Assessing a Patient with Male Lower Urinary Tract Symptoms?

Drake

2018

European Urology Focus

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Invasive urodynamic studies for the management of lower urinary tract symptoms (LUTS) in men with voiding dysfunction

Cited by 41 publications

References 28 publications

Urodynamic Investigation: A Valid Tool to Define Normal Lower Urinary Tract Function?

Urodynamic Investigation: A Valid Tool to Define Normal Lower Urinary Tract Function?

Recommendations for conducting invasive urodynamics for men with lower urinary tract symptoms: Qualitative interview findings from a large randomized controlled trial (UPSTREAM)

Is Urodynamics Necessary when Assessing a Patient with Male Lower Urinary Tract Symptoms?

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