Is there a difference between women with or without detrusor overactivity complaining of symptoms of overactive bladder?

Abstract

What's known on the subject? and What does the study add? Overactive bladder syndrome (OAB) is a highly prevalent medical condition, which is linked to the urodynamic observation of detrusor overactivity (DO). Urodynamics detect DO in about half of female patients with OAB. Our study detects significant differences between female patients with OAB with and without DO. DO could be considered as a more severe form in the wide OAB spectrum and the two terms should not be used interchangeably. The detected differences should be taken into account in the design of studies for the assessment of new selective or combination treatments of OAB and in the provision of treatment in everyday clinical practice. Objective To determine if there are differences between female patients complaining of symptoms of overactive bladder (OAB) with and without detrusor overactivity (DO). Patients and Methods The present study was a cross‐sectional study of consecutive women attending a one‐stop urodynamic assessment clinic with OAB symptoms. The King's Health Questionnaire (KHQ) and a 3‐day bladder diary incorporating the Patient's Perception of Intensity of Urgency Scale (PPIUS) were used to assess symptoms and health‐related quality of life (HRQoL). The participants underwent multichannel urodynamics (UDS) according to the International Continence Society (ICS) recommendations. Patients whose symptom of urgency was not reproduced during the laboratory test underwent a 4‐h ambulatory UDS test. Results Of the 556 patients who were included in the study, 43% were diagnosed with DO by either laboratory (227/556) or ambulatory UDS (11/39). There was no difference between the groups in age, body mass index (BMI), menopausal status or the presence of prolapse. Patients with DO had a smaller functional bladder capacity (P < 0.001), higher urgency episode frequency (P < 0.001) and larger maximum and mean urge ratings (P < 0.001). No significant differences were found in daytime or nocturnal micturitions between the groups. The presence of DO had a more negative impact on the quality of life, with a statistically significant difference between the groups in six of the domains of the KHQ. Conclusions The present study detects objective and subjective differences between female patients with OAB with and without DO. Women with DO experience more significant impairment to their quality of life and have a greater degree of bladder dysfunction.

Are voiding parameters a marker for the severity of quality of life impairment in women with overactive bladder symptoms?

“…Previous studies examining the prognostic value of urodynamics in women with OAB have focused on findings during filling cystometry, as opposed to voiding cystometry, and these findings are highly variable. The presence of DO during filling has been shown in some studies to be associated with a greater degree of quality of life impairment, although this was not the case in this cohort. In other studies, no difference in symptom scores is observed …”

“…There are conflicting data regarding the relevance of the finding of DO in women with OAB in the literature. Although women with OAB and proven DO have been found to have a greater degree of bladder dysfunction than those with normal urodynamics, the presence or absence of DO has not been found to influence response to treatment . The analysis of the women with DO as a separate sub‐group was performed in order to address this issue.…”

Urodynamic findings in women with refractory overactive bladder symptoms

“…reported that DO was more commonly associated with urgency (87%) than UUI (70%) . The presence of DO in patients with OAB was associated with a more negative impact of the quality of life . In addition to urgency and UUI, multivariate analysis among our patients showed that nocturia was also a statistically significant independent factor for DO (odds ratio 1.86).…”

“…17 The presence of DO in patients with OAB was associated with a more negative impact of the quality of life. 18 In addition to urgency and UUI, multivariate analysis among our patients showed that nocturia was also a statistically significant independent factor for DO (odds ratio 1.86). This is in accordance with Van Brummen et al, who found a correlation between DO and nocturia in 95 female patients with OAB symptoms.…”

Considering the prominent complaint as a guide in medical therapy for overactive bladder syndrome in women over 45 years

“…The prevalence of OAB is estimated to be 16.6% among adults aged 40 years and older . While OAB is not inevitable, its prevalence increases with age . OAB is linked to the urodynamic observation of DO.…”