Can we predict detrusor overactivity in women with lower urinary tract symptoms? The King's Detrusor Overactivity Score (KiDOS).

OBJECTIVE: Traditionally, urodynamic studies (UDS) have been used to assess lower urinary tract symptoms (LUTS), but their routine use is now discouraged. While urodynamic stress incontinence is strongly associated with the symptom of stress urinary incontinence (SUI) and a positive cough test, there is a weak relationship between symptoms of overactive bladder and detrusor overactivity (DO). The aim of our study was to develop a model to predict DO in women with LUTS. STUDY DESIGN: This prospective study included consecutive women with LUTS attending a urodynamic clinic. All women underwent a comprehensive clinical and urodynamic assessment. The effect of each variable on the odds of DO was estimated both by univariate analysis and adjusted analysis using logistic regression. RESULTS: 1006 women with LUTS were included in the study with 374 patients (37%) diagnosed with DO. The factors considered to be the best predictors of DO were urgency urinary incontinence, urge rating/void and parity (p-value<0.01). The absence of SUI, vaginal bulging and previous continence surgery were also good predictors of DO (p-value<0.01). We have created a prediction model for DO based on our best predictors. In our scoring system, presence of UUI scores 5; mean urge rating/void≥3 scores 3; parity≥2 scores 2; previous continence surgery scores -1; presence of SUI scores -1; and the complaint of vaginal bulging scores -1. If a criterion is absent, then the score is 0 and the total score can vary from a value of -3 to +10. The Receiver Operating Characteristic (ROC) analysis for the overall cut-off points revealed an area under the curve of 0.748 (95%CI 0.741, 0.755). CONCLUSION: This model is able to predict DO more accurately than a symptomatic diagnosis alone, in women with LUTS. The introduction of this scoring system as a screening tool into clinical practice may reduce the need for expensive and invasive tests to diagnose DO, but cannot replace UDS completely.

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

UNLABELLED: 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.

Radiation exposure during videourodynamics in women.

INTRODUCTION AND HYPOTHESIS: Our aim was to calculate the total radiation exposure and the dose absorbed by specific organs during videourodynamics (VUDS) in women. METHODS: This was a retrospective study of consecutive women attending for VUDS in a tertiary referral urodynamics unit. Tests with missing data and those that were terminated during the filling phase of the cystometry were excluded from the study. The VUDS examination was tailored according to the indication for the test and the urodynamic question to be answered. The PCXMC simulation program (version 2.0) was utilised to calculate the effective dose and the dose absorbed by individual organs. RESULTS: Out of 345 consecutive VUDS, 264 were included in the study. The mean effective dose was 0.34 mSv (SD: 0.15) and the mean fluoroscopic time was 63.15 s (SD: 21.81). Multivariate linear regression analysis of factors affecting the radiation dose showed that BMI (p = 0.009) and fluoroscopy time (p < 0.001) were the only statistically significant factors. The final linear regression model for the estimation of the effective dose was Eff. Dose (mSv) = -0.049 + 0.003 · BMI (kg/m(2)) + 0.005 · fluoroscopy time (s). CONCLUSIONS: This study reveals that women are exposed to relatively small amounts of radiation during VUDS. The use of fluoroscopy only without additional static radiographic images minimises exposure to a level consistent with the "as low as reasonably achievable" radiological principle.

Use of near infrared spectroscopy as an alternative to videourodynamics to detect detrusor overactivity in women with the overactive bladder syndrome.

OBJECTIVE: To evaluate near infrared spectroscopy as a noninvasive alternative to cystometry for detecting detrusor overactivity in women with overactive bladder (OAB). Although cystometry is considered the "gold standard" investigation for the lower urinary tract, it is invasive. Recently, a noninvasive form of assessment of the lower urinary tract has been introduced using near infrared spectroscopy. METHODS: This was a prospective pilot study. Women with symptoms of OAB, referred to a tertiary referral one-stop urodynamics clinic were studied. A urodynamic diagnosis was made according to the International Continence Society guidelines. The near infrared spectroscopy monitoring results were analyzed by an independent near infrared spectroscopy Clinical Research Assessor. Both the urodynamics and near infrared spectroscopy assessors reported whether detrusor overactivity was present. Primary outcome measurement was the performance of near infrared spectroscopy as a new diagnostic test. We evaluated the performance of this by calculating the sensitivity and specificity. The clinical usefulness of near infrared spectroscopy was evaluated using positive and negative predictive values. RESULTS: One hundred patients were recruited of whom 95 had traces that could be interpreted. Thirty-one patients were found to have detrusor overactivity on cystometry. Twenty-five of these patients (26%) had detrusor overactivity on near infrared spectroscopy analysis. In 6% of these cases, no near infrared spectroscopy changes identified as suggestive of detrusor overactivity were seen. No detrusor overactivity was detected by cystometry in 64 patients, and in 19% of cases by near infrared spectroscopy. Forty-six patients (48%) had near infrared spectroscopy monitoring events identified as detrusor overactivity but no cystometry changes diagnostic of detrusor overactivity. CONCLUSION: The results of our study suggest that near infrared spectroscopy is an unreliable method for detecting detrusor overactivity in women with OAB symptoms.

What do we do when a midurethral tape fails? Rediscovery of open colposuspension as a salvage continence operation.

INTRODUCTION AND HYPOTHESIS: Our aim was to evaluate the outcome of open colposuspension for women with urodynamic stress incontinence who had previously undergone a failed midurethral tape. METHODS: A retrospective study of 13 women who had undergone open colposuspension after a failed midurethral tape was conducted. RESULTS: At a median follow-up of 12 months, subjective and objective cure rate were 85% and 77%, respectively. Thirty percent of the women developed de novo detrusor overactivity that responded to antimuscarinic treatment. Long-term voiding difficulty was observed in only one patient, who performed clean intermittent self-catheterization for 3 months. Posterior vaginal wall prolapse requiring pelvic floor repair was found in three women (23%) postoperatively. CONCLUSIONS: Open colposuspension is an effective option for treating persistent or recurrent stress urinary incontinence after failed midurethral tape, with a high success rate.

Redefining urological history taking - anal intercourse as the cause of unexplained symptoms in heterosexuals.

INTRODUCTION: Symptoms suggestive of genito-urinary infection are frequent reasons for visits to general practitioners and account for approximately 15% of referrals to out-patient urology. The symptoms may be non-specific, and patients can undergo multiple investigations in an attempt to identify a cause. PATIENTS AND METHODS: We have seen several such patients, all of whom had engaged in unprotected heterosexual anal intercourse prior to the onset of their symptoms. Presenting complaints included urethral discomfort, acute epididymitis resistant to standard antibiotics, and sudden onset of overactive bladder symptoms. RESULTS: These patients illustrate the importance of careful history taking. Whilst some questions may be difficult to ask, they may reveal precipitating factors that the patient will be reluctant to volunteer. The repetitive nature of the behaviour may explain the chronicity of symptoms experienced by the patients, and avoidance of this activity may be the only management needed to improve them. For those with infective symptoms, the clinician's choice of antibiotic can be altered to provide anaerobic cover. CONCLUSIONS: A history of anal intercourse should be sought in patients with unexplained genito-urinary symptoms.

Retroperitoneoscopic nephrectomy for giant hydronephrosis in pregnancy.

BACKGROUND: A 32-year-old primiparous woman presented with a painful left-sided giant hydronephrotic kidney secondary to pelvi-ureteric junction obstruction (PUJO). INVESTIGATIONS: Renal ultrasonography, intravenous urography and MAG-3 renography. DIAGNOSIS: Symptomatic non-functioning left PUJO in first trimester. MANAGEMENT: Following counselling, the patient had an uncomplicated retroperitoneoscopic nephrectomy at 9 weeks' gestation for symptom relief and to prevent future risks to both mother and fetus during the remainder of the pregnancy. She had an uneventful recovery and delivered a healthy 3.2 kg male at term per vaginum.