The value of synchro-cystourethrometry for evaluating the relationship between urethral instability and overactive bladder

Hua, Chaoyang; Wen, Yibo; Zhang, Yan; Feng, Quande; He, Xiaofu; Li, Yunlong; Wu, Junwei; Feng, Jian; Bauer, Stuart B.; Wen, Jianguo

doi:10.1007/s11255-017-1783-8

Cited by 2 publications

(4 citation statements)

References 32 publications

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“…| 1607 represents a specific type of relaxation incompetence, or "urethral instability." 12 Our observation of pelvic floor opening during laugher-provoked DO would favor the explanation of giggle incontinence by DO as a trigger for urethral relaxation.…”

Section: Discussionmentioning

confidence: 69%

“…However, an alternative explanation might be that giggle incontinence occurs as an interplay between the actions of the detrusor and the sphincter. One possibility is that laughter induced DO above a pressure threshold forces urine into the urethra and triggers reflex pelvic floor relaxation (as supported by our observation bladder neck opening secondary to DO in ¾ patients before incontinence is demonstrated) Alternatively, it is possible that giggle incontinence represents a specific type of relaxation incompetence, or “urethral instability.” 12 Our observation of pelvic floor opening during laugher‐provoked DO would favor the explanation of giggle incontinence by DO as a trigger for urethral relaxation.…”

Section: Discussionmentioning

confidence: 83%

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Urodynamic characterization of giggle incontinence in children

Kunnath

Clothier

Solomon

et al. 2021

Neurourology and Urodynamics

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Aims: Giggle incontinence is a rare condition resulting in excessive urinary incontinence with laughter, where bladder function is otherwise "normal." Urodynamic descriptions of the condition to date are limited. We believe that giggle incontinence has characteristic urodynamic findings. We tested this hypothesis. Methods: We retrospectively reviewed the urodynamic investigations of patients with giggle incontinence managed in a tertiary regional bladder unit between February 2014 and November 2019. Results:We identified the studies of seven patients, median age 13.5 years (10.4-15.7) of whom 6 were female. All had videourodynamics. Two went on to have further invasive investigation; one had urethral pressure profile and one had ambulatory urodynamics. Detrusor overactivity (DO) was observed in six. DO was asensate in all. In five DO was triggered by laughter and was associated with laughter induced incontinence in four. Six had DO that was not provoked by laugher. In one amplitude of DO was proportional to vigour of laughter. In three patients there was identification of sudden pelvic floor relaxation during laughter resulting in incontinence. Stress urinary incontinence was not observed in any.Conclusions: Giggle incontinence is a complex phenomenon. Urodynamic diagnosis is challenging and is dependent on eliciting laughter. We present the first urodynamic demonstration that giggle incontinence is associated with laughter-induced, asensate DO and concurrent, momentary pelvic floor relaxation. We hope this will provide a more consistent basis for defining this condition in the future.

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Section: Discussionmentioning

confidence: 69%

Section: Discussionmentioning

confidence: 83%

Urodynamic characterization of giggle incontinence in children

Kunnath

Clothier

Solomon

et al. 2021

Neurourology and Urodynamics

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“…This increased tonic activity can lead to chronic tightening and fibrosis of the external sphincter with resultant turbulent urine flow, urethral instability, and urethritis. 5,6 These findings suggest that PFMs are affected in children with OAB and PFMs may play an important role in the treatment of bladder problems in children. 7 In contrast, dysfunctional voiding (DV) may lead to secondary activation of bladder (DV/SBO).…”

Section: Introductionmentioning

confidence: 89%

“…In addition, OAB in children may lead to increased tonic activity of the external urethral sphincter and PFMs. This increased tonic activity can lead to chronic tightening and fibrosis of the external sphincter with resultant turbulent urine flow, urethral instability, and urethritis . These findings suggest that PFMs are affected in children with OAB and PFMs may play an important role in the treatment of bladder problems in children .…”

Section: Introductionmentioning

confidence: 96%

The effects of pelvic floor muscle therapy on symptoms, voiding, and pelvic floor muscle activity parameters in children with overactive bladder

Pekbay¹,

Ergin

Topuz

et al. 2019

Neurourology and Urodynamics

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Introduction Refractory overactive bladder (OAB) in children can be treated with second line modalities such as as biofeedback, transcutaneous electrical stimulation (TENS), and botulinum toxin. In this study, we aimed to investigate the efficacy of biofeedback‐assisted pelvic floor muscle therapy (PFMT) on symptoms, bladder capacity, uroflowmetry, and pelvic floor muscle activity (PFMA) in children with resistant OAB or dysfunctional voiding (DV) with associated seconder bladder overactivity (DV/SBO). Materials and Methods A total of 24 children with resistant OAB were included in the study. Patients were divided into two groups as: group‐1 pure OAB and group‐2 DV/SBO. Children were evaluated with voiding diary, uroflowmetry‐EMG, PFMA before and after treatment. All patients were treated with PFMT. Results Urgency cured or improved in 12 of 17 (71%) of children in group‐1 and in six of seven (86%) children in group‐2 (P < 0.0001 and 0.031, respectively). Other symptoms cured or improved with 64%‐100% recovery rates in group‐1 and 50%‐80% in group‐2. Maximum voided volume (maxVV) in voiding diary increased from 81.6 to 150.9 mL in group‐1 and from 115.6 to 175.7 mL in group‐2 (P < 0.0001 and 0.063, respectively). Mean work value of PFMA increased and mean rest value of PFMA decreased significantly (P < 0.0001, 0.018 and P = 0.002 and 0.018, respectively). Conclusion The measurement of PFMA in children with refractory OAB or DV/SBO gives information on the strength and endurance of PFMs. In children with refractory OAB or DV/SBO, biofeedback‐assisted PFMT provides symptomatic improvement and increases functional bladder capacity.

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The value of synchro-cystourethrometry for evaluating the relationship between urethral instability and overactive bladder

Cited by 2 publications

References 32 publications

Urodynamic characterization of giggle incontinence in children

Urodynamic characterization of giggle incontinence in children

The effects of pelvic floor muscle therapy on symptoms, voiding, and pelvic floor muscle activity parameters in children with overactive bladder

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