[Cystomanometric study of bladder sensation during sacral neuromodulation test]. / Etude cystomanométrique de la sensation vésicale pendant le test de neuromodulation sacrée.

PURPOSE: Prospective clinical and urodynamic study evaluating modification of bladder sensation during sacral neuromodulation (SNM). MATERIALS AND METHODS: 24 consecutive patients with non-neurological hyperactive bladder underwent an SNM test. Questioned about their symptoms before and during the test by the urinary handicap assessment scale, patients were divided into two groups: A (improved) and B (not improved). Group A consisted of patients obtaining 50% improvement of their symptoms with SNM followed by return of symptoms at the end of the test, while the other patients constituted group B. We then compared the cystomanometric results according to their clinical response. RESULTS: The mean age was 53 years: 10 patients with a good response constituted group A (n=10, i.e. 42%) and 14 patients with a poor response constituted group B (n=14, i.e. 58%). Clinically, in patients with a good response, SNM decreased urge incontinence by 100%, day-time frequency by 89% and protections by 55%. Urodynamic assessment in group A during the test demonstrated a significant increase of +23% of bladder capacity (p<0.01), +57% of the volume of onset of the first unstable contraction (p<0.004), +83% of bladder volume to the first urge to urinate BI (p<0.001) and +46% to urgency B3 (p<0.04). During SNM, cystometry revealed that 1 or 2 bladder filling volumes were increased at B1 and/or B3 in 100% of improved subjects. In contrast, 1 or 2 volumes decreased at B1 and/or B3 in 58% of non-improved subjects. No significant difference of intensity of unstable contractions was observed between the 2 groups during SNM (p=0.31). CONCLUSION: A significant correlation was observed between the two methods of clinical and urodynamic assessment. Our results suggest the use of the cystomanometric increase of bladder volume at B1 and B3 as selection criterion for candidates for SNM with non-neurological hyperactive bladder.

[Relationship between the Area Under the Curve of detrussor contraction during micturition and the usual parameters of flow-pressure rate in women]. / Relations entre l'Aire Sous la Courbe de la contraction du détrusor pendant la miction et les paramètres usuels de l'examen pression-débit chez la femme.

OBJECTIVES: The aim of this work was to assess the relationship between a new urodynamic parameter Area Under Curve of detrusor pressure during voiding (AUCdet) and the usual pressure flow study parameters. MATERIAL AND METHODS: 103 women with various urinary symptoms (incontinence, dysuria, chronic bladder pain or frequent urinary infection) had a urodynamic evaluation with pressure flow analysis. The intravesical pressure was measured through a 6CH Porges Neoplex and the intra-abdominal pressure through a 6CH rectal catheter in an empty rectum. Pressure-flow study was performed one time in each patient. The maximum flow rate (Qmax), the detrusor pressure at maximal flow (PdetQmax), the vesical pressure at maximal flow (PvesQmax), the urethral resistance defined as the ratio between the PvesQmax and Qmax2 (RU) and the AUCdet/Vol were recovered. RESULTS: 85 women were included and mean age was 55 years old. The averages were 19.42 for Qmax, 28.91 for PdetQmax, 63.85 for PvesQmax, 2.10 for RU and 7.83 for AUCdet/Vol. The correlation with AUCdet/Vol were for Qmax -0.80 p < 0.0001, for PdetQmax 0.71 p < 0.0001, for PvesQmax 0.42 p < 0.001 and for RU 0.84 p < 0.0001. CONCLUSIONS: AUCdet/Vol is the first urodynamic parameter which takes into account the whole detrusor contraction during voiding. AUCdet/Vol is relatively close to the urethral resistance. The very high degree of correlation between RU and AUCdet/Vol confirms clinically this definition of the RU. Further studies are needed to assess the validity of AUCdet/Vol.

Diagnosis of female bladder outlet obstruction and relevance of the parameter area under the curve of detrusor pressure during voiding: preliminary results.

PURPOSE: The diagnosis of bladder outlet obstruction in women by pressure flow study may be difficult because there are several definitions of bladder outlet obstruction, several parameters and no standard cutoffs. We evaluated the ability of pressure flow studies to separate women into unobstructed, equivocal and obstructed groups. MATERIALS AND METHODS: In a prospective study 85 women with lower urinary tract symptoms underwent clinical evaluation, including physical examination, voiding cystourethrography, endoscopy, flow rate and post-void residual volume measurement. A pressure flow study was performed 15 days later. The pressure flow study parameters were maximum flow, post-void residual volume, detrusor pressure at maximum flow, vesical pressure at maximum flow, area under the curve of detrusor pressure during voiding and area under the curve of detrusor pressure during voiding adjusted for voided volume. After considering the clinical evaluation 2 urologists classified the patients into 3 groups, namely unobstructed, equivocal and obstructed, as the traditional classification. Linear discriminant analysis was then performed using the traditional classification and pressure flow study data. RESULTS: Mean patient age was 55 years (range 18 to 83). According to the traditional classification there were 36 unobstructed, 28 equivocal and 21 obstructed cases. Significant differences were noted in all pressure flow study parameters (analysis of variance p <0.05). Linear discriminant analysis showed that area under the curve of detrusor pressure during voiding adjusted for voided volume was the most statistically discriminating parameter. Of the cases 86%, 36% and 57% were identically categorized by the traditional and area under the curve of detrusor pressure during voiding adjusted for voided volume parameter classifications in the unobstructed, equivocal and obstructed groups, respectively. The other pressure flow study parameters showed less satisfactory results. CONCLUSIONS: Area under the curve of detrusor pressure during voiding adjusted for voided volume appears to be the most discriminating urodynamic parameter of female bladder outlet obstruction. Other studies are needed to test the reliability and validity of this new parameter.