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

Abstract

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.

The aging bladder phenotype is not the direct consequence of bladder aging

“…However, despite an accumulation of age‐associated declines, many old people are symptom‐free. Linkages between function (cystometry) and perceptions are inconsistent and unreliable . Therapies, especially pharmacologic/molecular therapies, are frequently inadequate.…”

“…Linkages between function (cystometry) and perceptions are inconsistent and unreliable. 6,7 Therapies, especially pharmacologic/molecular therapies, are frequently inadequate. Rather than a close correspondence of structure to function to perceptions, urinary functionality might be better considered as a systemic response to accumulating renal output, in the context of other systemic and social demands.…”

Validation of a real‐time bladder sensation meter during oral hydration in healthy adults: Repeatability and effects of fill rate and ultrasound probe pressure

“…This test has well‐known risks and requires expensive technology operated by an experienced technician. Furthermore, the urodynamics procedure produces uncomfortable and embarrassing experiences for patients and is non‐physiologic in the assessment of bladder sensation during filling …”

“…Furthermore, the urodynamics procedure produces uncomfortable and embarrassing experiences for patients and is non-physiologic in the assessment of bladder sensation during filling. 4,5 Due to the invasiveness, patient risk, and cost of this test, noninvasive hydration protocols have been developed to characterize realtime bladder sensation in patients with and without OAB. [6][7][8][9][10][11] Some of these studies have used a tablet-based sensation meter that participants used to track real-time, unprompted bladder sensation.…”

Novel implantable pressure and acceleration sensor for bladder monitoring

“…Bladder pressure is a net result of overall bladder activity, abdominal pressure and outlet resistance. Events identified through these methods, such as detrusor overactivity, correlate poorly with urgency symptoms 2,3 …”