Ultrasound detrusor wall thickness measurement in combination with bladder capacity can safely detect detrusor underactivity in adult men

Aims To identify the clinical and urodynamic factors associated with the large capacity bladder and incomplete bladder emptying after prolapse repair. Methods We identified 592 women who underwent anterior and/or apical prolapse repair at our institution from 2009 to 2015. Women were stratified by urodynamic capacity. The primary outcome was incomplete emptying at the longest follow‐up (postvoid residual [PVR] > 200 mL). Data were analyzed in the Statistical Analysis System software. Results Two hundred and sixty‐six women (mean age, 61 years) had preoperative urodynamic tracings available for review. After surgery, there were 519 PVRs in 239 women recorded at up to 2949 days (mean, 396) and nine time points (median, 2; IQR, 1‐3). The receiver operator curve for predicted probability of longest follow‐up PVR greater than 200 mL (area under curve = 0.67) identified the 600 mL cutpoint which defined large capacity bladder. Large capacity bladders (capacity, >600 mL [n=79] vs ≤600 mL, [n=160]) had a mean: detrusor pressure at maximum flow (21 vs 22 cm H2O; P = 0.717), maximum flow rate (19 vs 17 mL/s; P = 0.148), significantly elevated PVR (202 vs 73 mL; P < 0.001), and significantly lower voiding efficiency (VE) (74 vs 82%, P < 0.05). Following prolapse repair, elevated PVR was associated with large capacity (PVR 101 vs 49 mL, P < 0.05). Large bladders had a two‐ to three‐fold risk of longest follow‐up PVR greater than 200 mL (14.3%‐20.3% [capacity, >600 mL] vs 4.1%‐7.0% [capacity, ≤600 mL]). VE was similar after surgery regardless of the capacity (87% vs 88%, P = 0.772). Conclusions The decision to pursue prolapse repair should be individualized and take into account, the bladder capacity and goals for PVR improvement after surgery.

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Urodynamic factors associated with the large capacity bladder and incomplete emptying after prolapse repair (2009‐2015)

Dobberfuhl

Shaffer

Goodman

et al. 2019

“…DWT might, therefore, be a proxy for detrusor contractility. Rademakers et al reported that a combination of low DWT and large bladder capacity accurately defines the presence of detrusor underactivity. De Nunzio et al observed a correlation between increased DWT and detrusor overactivity.…”

Section: How Do Histological and Biochemical Changes In The Bladder Cmentioning

confidence: 99%

“…De Nunzio et al observed a correlation between increased DWT and detrusor overactivity. A summary of findings from these studies that correlate detrusor or bladder wall thickness (DWT/BWT) with detrusor dysfunction is presented in Table A and B.…”

Section: How Do Histological and Biochemical Changes In The Bladder Cmentioning

confidence: 99%

“…Summary of findings from studies that correlate detrusor or bladder wall thickness (DWT/BWT) with detrusor dysfunction A. Details of findings from a comparative cohort study by Rademakers et al24 in 143 treatment naive men aged ≥ 40 y (median 62 y), suffering from nonneurogenic LUTS, with or without detrusor underactivity (DU). This study correlates urodynamic parameters of DU with DWT.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Do functional changes occur in the bladder due to bladder outlet obstruction? ‐ ICI‐RS 2018

Bosch

Abrams

Averbeck

et al. 2019

Studies on bladder dysfunction (BD), more specifically functional‐urodynamic changes in the bladder as a result of bladder outlet obstruction (BOO) have been summarized for this TT. Based on available, but limited evidence from human studies a three‐stage model can be hypothesized to characterize BOO‐induced bladder remodeling: hypertrophy, compensation (increased detrusor contractility during the voiding phase, often in combination with filling phase detrusor overactivity) followed by the phase of decompensation [detrusor underactivity]. The time between the start of compensation and eventual decompensation seems to be determined by age of onset, severity, and type of obstruction and clinical mitigating factors such as vascular and metabolic problems. Understanding the relative contributions of these factors may allow the development of personalized timelines and probabilities for these obstructed patients.

Is coexistent overactive–underactive bladder (with or without detrusor overactivity and underactivity) a real clinical syndrome? ICI‐RS 2019

Mancini

Tarcan

Serati

et al. 2020

Aims Lower urinary tract symptoms (LUTS) can be classified into symptom syndromes based on which symptoms are predominant. Overactive bladder (OAB) syndrome, a storage dysfunction, and underactive bladder (UAB) syndrome, a voiding dysfunction, are common syndromes, which urodynamic tests may show to be caused by detrusor overactivity (DO) and detrusor underactivity (DU), but can also be associated with other urethro‐vesical dysfunctions. Sometimes OAB and UAB can coexist in the same patient and, if so, need a specific approach beyond treatment of the single and apparently opposing syndromes. Methods During its 2019 meeting in Bristol, the International Consultation on Incontinence Research Society held a literature review and expert consensus discussion focused on the emerging awareness of the coexisting overactive–underactive bladder (COUB). Results The consensus considered whether COUB is the combination of OAB and UAB syndromes, or a real unique clinical syndrome in the same patient, possibly with a common etiology. Definitions, pathophysiology, diagnosis, and treatment were discussed, and high‐priority research questions were identified. Conclusions COUB (with or without urodynamic evidence of DO and DU) may be considered a real clinical syndrome, because it differs from single OAB and UAB, and may not be the combination of both syndromes. Urodynamic tests may be necessary in unclear cases or in cases not responding to initial treatment of the most troublesome symptoms. It is pivotal to define the evolution of the syndrome and the characteristic population, and to recognize predictive or phenotyping factors to develop a specific approach and adequate outcome measures.