Association between frailty and detrusor overactivity with detrusor underactivity in older women.

PURPOSE: While detrusor overactivity (DO) with detrusor underactivity (DU) (DO-DU) has been described as typical of aging, the pathogenesis of DO-DU is highly multifactorial, and often thought to involve medical conditions beyond the urinary tract. We aimed to explore potential associations between idiopathic DO-DU and frailty in older women after accounting for age. METHODS: The design of the study is a cross-sectional single-center study, in an outpatient urodynamic unit specializing in geriatrics. Participants are consecutive female patients aged ≥65 years without contributory neurological conditions or bladder outlet obstruction who completed a comprehensive geriatric assessment followed by urodynamic evaluation from 2015 to 2019. Participants were categorized as having DO, DU, combined DO-DU, or a negative study. Multinomial logistic regression analysis was used to assess the relationship between urodynamic outcomes and frailty, as quantified using the Frailty index (FI). RESULTS: Ninety-five patients were included (median age 78 [interquartile range: 70-83] years), among whom 29% had combined DO-DU. The median FI score was 0.27 (0.2-0.32) (5-12). A higher FI was associated with significantly greater age-adjusted odds of DO-DU when either DU or subjects with a negative urodynamic assessment were used as the reference group. Age was not significantly associated with DO-DU across all multivariable analyses. CONCLUSION: A higher FI was associated with an increased likelihood of DO-DU, which could not be attributed to the effect of age alone. The pathogenesis of DO-DU is likely more complex than chronological aging in and of itself and merits further study.

Long-term functional outcomes of artificial urinary sphincter (AMS 800™) implantation in women aged over 75 years and suffering from stress urinary incontinence caused by intrinsic sphincter deficiency.

PURPOSE: To assess the outcomes after artificial urinary sphincter (AUS) implantation in older women aged over 75 years. METHODS: A monocentric retrospective study included all non-neurological women aged over 75 years suffering from stress urinary incontinence (SUI) due to intrinsic sphincter deficiency and undergoing an AUS placement between 1991 and 2015. Early postoperative complications were reported according to Clavien-Dindo classification. Continence, defined as no pad use, was assessed at the end of follow-up. Explantation, revision and deactivation rates of the AUS were reported. A Kaplan-Meier survival curve was generated to evaluate the survival rate of the device without revision or explantation. RESULTS: Among 393 AUS implantations, a total of 45 patients, median age 77 years (IQR 75-79), were included. Twenty-six early postoperative complications occurred in 18 patients (40%) patients. All were minor Clavien grades (I-II) except one (grade IVa). Median follow-up was 36 months (IQR 16-96). Overall, 32 women (71.1%) still had their AUS in place at the end of the follow-up, without revision or explantation. The AUS was definitively removed in four (8.9%). The AUS required revisions in nine (20%) women. The 5- and 10-year survival rates of the device without revision or explantation were 78 and 50%, respectively. Three patients (6.7%) had their AUS deactivated. At last follow-up, in an intention-to-treat analysis, the continence rate was 68.9%. CONCLUSION: In women aged over 75-years-old, suffering from SUI, the AUS provides satisfactory functional results comparable to the general population.

Detrusor contractility in post-menopausal women: Impact of ageing, complaint and urodynamic diagnosis.

INTRODUCTION: Detrusor contractility (DC) can have a considerable impact on the management oflower urinary tract symptoms (LUTS). However, it is currently impossible to predict, based on clinical data alone, which woman has an impaired DC. Our aim was to determine if DC, assessed by projected isovolumetric pressure-1 (PIP1) and VBN contractility parameter k, was associated with age, main complaint, and urodynamic diagnosis in a population of older women. METHODS: Pressure-flow studies of non-neurologic post menopausal women over 65 referred for investigation of LUTS were retrospectively analyzed. Associations between DC indices PIP1 and k, and age, main complaint and urodynamic diagnosis were assessed in univariate analysis. RESULTS: One hundred and ninety women were included (mean age 74.5 years). There was no significant association between detrusor contractility indices and age considered as a continuous or a categorical variable. Urge urinary incontinence was significantly associated with greater detrusor contractility regardless of age. Regarding urodynamic diagnoses, DC was greater when bladder outlet obstruction and detrusor overactivity were diagnoses vs. detrusor underactivity alone or associated with detrusor overactivity, regardless of age. CONCLUSION: PIP1 and k indices allow an easy evaluation of detrusor contractility. In that population of older, post menopausal women, no significant change in the value of the indices is observed with aging whatever the complaint or the urodynamic diagnosis. None of these indices has predominance. LEVEL OF EVIDENCE: 4.

Nocturia in patients with cognitive dysfunction: a systematic review of the literature.

BACKGROUND: The objective of this study is to evaluate current literature on the association between cognitive dysfunction and nocturia. METHODS: A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was conducted through MEDLINE, EMBASE and COCHRANE databases and completed in November 2019. Randomized and non-randomized studies were included if they assessed the association between cognitive dysfunction and nocturia in older participants with or without neurological diseases. The quality of included studies was evaluated using the Risk of Bias Assessment tool for Non-randomized Studies (RoBANS). RESULTS: A total of 8 cross-sectional studies conducted in older patient populations met the criteria for inclusion. A statistically significant association was identified in 6 studies on univariate analysis, which persisted in 2 studies after controlling for confounding factors. The association between cognitive dysfunction and nocturia was positive for all 6 significant analyses. The overall risk of bias was unclear. CONCLUSION: A significant positive association between cognitive dysfunction and nocturia was identified. However, research has been limited to cross-sectional studies, which precludes identification of causality between cognitive dysfunction and nocturia. Heightened awareness of the complex interplay between cognition and nocturia would allow professionals involved in the care of cognitively impaired patients with concomitant nocturia to more effectively manage these symptoms.

Predictive factors of adherence to urinary self-catheterization in older adults.

AIMS: The primary aim is to explore the adherence predicting factors in clean intermittent self-catheterization (CISC) in patients aged over 65 years. The secondary aim is to assess whether in this population, the non-adherence risk is greater, compared with patients under 65. METHODS: All patients older than 65 that successfully learned CISC between January 2011 and January 2016 were included. A control population younger than 65 matched with sex, body mass index, and pathology was selected. RESULTS: One hundered and thirteen (66.9%) out of the 169 patients older than 65 included were adherent at 1 month, and 80 (47.3%) at 6-12 months. Obesity (P = 0.027), a low PP test (Pencil and Paper test) score (P = 0.037), significant urinary stress incontinence (SUI) (P = 0.048), and prescription of CISC less than three per day (P = 0.03) were the risk factors predicting stopping CISC at 1 month, but none was associated with non-adherence at 6-12 months. Compared with the younger group, age was a risk factor for poor adherence at 1 month. CONCLUSION: Obesity, low PP test score, and important SUI are factors of poor adherence to CISC at 1 month in older adults. Necessity of more than three CISC per day is in favor of treatment continuation, possibly due to absence of spontaneous voiding in these patients. Long-term adherence to CISC in older adults in this study remains close to adherence to other treatments prescribed in urinary disorders, and thus shows that CISC could be an easily purposed therapeutic option in this population, either on a long-term or transitory basis.

Intermittent Self-catheterization in Older Adults: Predictors of Success for Technique Learning.

PURPOSE: The main goal of this retrospective study is to explore the predictors of success in learning clean intermittent self-catheterization (CISC) in patients over 65 years of age. The secondary goal is to assess whether in this population, the risk of failure to perform CISC is greater, compared with patients under 65 with similar pathologies. METHODS: All patients older than 65 consulting between January 2011 and January 2016 for learning CISC were included. A control population younger than 65 matching with sex, body mass index, and pathology was selected. RESULTS: One hundred sixty-nine of the 202 patients (83.7%) over 65 succeeded in learning CISC. Obesity (P<0.05), low pencil and paper test (PP test) (P<0.01) and low functional independence measure (FIM) (P<0.01) scores were risk factors of failure. No significant differences were found with sex or pathology. In multivariate analysis, low PP test perineum access (odds ratio [95% confidence interval], 2.30 [1.32-4.42]), low FIM motor (1.04 [1.01-1.08]), and FIM cognition (1.18 [1.03-1.37]) scores were independent factors of learning failure. Compared to control group, age over 65 was not predictive of failure (P=0.15). CONCLUSIONS: Our study shows that success in learning CISC does not depend on age but on difficulties in mobility, access to perineum and probably cognitive disorders.

Comparison of bladder voiding efficiency in women when calculated from a free flow versus an intubated flow.

OBJECTIVES: To assess the reproducibility of bladder voiding efficiency (BVE, Void%) between free flow (FF) and intubated flow (IF) and to correlate BVE measurements with urinary incontinence (UI) complaints and urodynamic (UDS) findings in women. METHODS: UDS recordings of women referred for LUTD evaluation to our UDS center were reviewed. Each file included FF at arrival, filling cystometry, and IF. Post-void residual volumes (PVR) were measured by catheterization after FF and IF. Women unable to void during the study or who expelled the catheter during IF, as well as studies with voided volume < 100 ml were excluded. Data was sub-analyzed according to 3 age categories, and UI complaints and UDS findings. RESULTS: Over the past 3 years, 237 UDS studies for FF and IF met all criteria. There was significant difference between voided volumes (232 vs. 335 ml) and PVR (24 vs. 71 ml) respectively (P < 0.0001). For the whole population, BVE IF (79.8 ± 28.6) was significantly lower than BVE FF (90.7 ± 15.9) (P < 0.0001). A significant decrease of BVE during IF was only noted for UI. BVE IF was significantly different in women in the peri-menopause and older groups. PVR IF increased with age and was significantly higher than PVR FF for women older than 45 years (P < 0.0001). CONCLUSIONS: BVE measurement in women has a role, but is most reliable from a FF. BVE is influenced by age and urinary incontinence complaints as well as UDS findings.

Detrusor after-contraction: a new insight.

AIMS: Detrusor after-contractions (DAC) are non-common in adults. Both definition (nothing in ICS reports) and significance (artefact, link with detrusor overactivity (DO) or bladder outlet obstruction (BOO)) remain discussed. Our purpose was to carry out an analysis of the urodynamic parameters during voidings with DAC and, using the VBN model, to simulate pathophysiological conditions able to explain both voiding phase and DAC. MATERIALS AND METHODS: From large urodynamic database of patients referred for evaluation of lower urinary tract dysfunction, DAC were observed in 60 patients (5.7%). Criteria for DAC were post-void residual <30mL and increase of detrusor pressure >10cmH(2)O. VBN model was used for analysis of both pressure and flow curves, and simulations of pathophysiological conditions. RESULTS: Onset of DAC (ODAC) occurred when Q=7.3±5.7mL/s and bladder volume=17.9±15.4mL. Urgency-frequency syndrome and urodynamic diagnosis of DO were the more frequent scenarios associated with DAC. ODAC was associated to an inversion of the slope of detrusor pressure curve without any perturbation in flow curve. Among tested pathophysiological hypothesis (great, abnormal, detrusor force, sphincter contraction), none allowed restoring all recorded curves (flow rate, voiding pressure and DAC). CONCLUSION: No urodynamic characteristic of the first part of voiding is an index of occurrence of DAC. ODAC is a significant phenomenon linked with the bladder collapse. DAC is not associated with BOO but more probably with DO and appears as the result of local conditions in an almost empty bladder (concentration of stresses around a transducer); thus DAC seems of weak clinical significance.

Detrusor after-contraction: a new insight

Detrusor after-contractions (DAC) are non-common in adults. Both definition (nothing in ICS reports) and significance (artefact, link with detrusor overactivity (DO) or bladder outlet obstruction (BOO)) remain discussed. Our purpose was to carry out an analysis of the urodynamic parameters during voidings with DAC and, using the VBN model, to simulate pathophysiological conditions able to explain both voiding phase and DAC.

Functional outcomes of adjustable continence therapy (ACT™) balloons in women aged >80 years and suffering from stress urinary incontinence caused by intrinsic sphincter deficiency.

OBJECTIVE: To determine the functional outcomes of adjustable continence therapy (ACT™) balloons in elderly women suffering from stress urinary incontinence (SUI) caused by intrinsic sphincter deficiency (ISD). MATERIAL AND METHODS: A monocentric retrospective study included all non-neurological women aged >80 years who suffered from SUI due to ISD and undergoing ACT™ balloon placement between 2000 and 2013. Early post-operative complications were reported according to the Clavien-Dindo classification. Continence was assessed subjectively by the patients. RESULTS: A total of 52 female patients were included, median age 83 years (IQR 81-85). Among them, 35 (67.3 %) had already undergone previous surgery for SUI. Balloon implantations were achieved under local anaesthesia for 33 (63.5 %) patients. Clavien grade I-II early post-operative complications occurred in five (9.6 %) patients. Median follow-up was 10.5 months (IQR 3-24.25). Eleven patients (21.1 %) were lost to follow-up. At last follow-up, seven patients (13.5 %) declared themselves fully continent after the first implantation, 13 patients (25 %) had an >80 % improvement rate (10 patients after first implantation, two after second implantation and one after third implantation). Four patients (7.7 %) found the procedure unsuccessful even after several consecutive implantations. Ten patients (19.2 %) reported a partial result and were still having successive balloon inflations. Explantation occurred in 22 patients, caused by infection, erosion or balloon migration. In intention-to-treat analysis, the failure rate was 42.3 %. CONCLUSION: Although the success rate of ACT™ balloons in women aged >80 years is lower than that reported for younger women, it remains satisfactory because these patients would not otherwise have benefited from another surgical treatment.

Contribution of behavioral and cognitive therapy to managing overactive bladder syndrome in women in the absence of contributive urodynamic diagnosis.

Overactive bladder (OAB) is a syndrome characterized by symptoms of urgency with or without incontinence, frequency, and nocturia. Pathophysiology of OAB is incompletely characterized. Therefore, there is great variability surrounding OAB evaluation. In some cases, urodynamics is normal and the challenge is to propose the least invasive treatment. Behavioral therapies have been used for decades as they are conservative, inexpensive, and do not induce side effect. Our purpose was to describe which usual techniques of pelvic floor rehabilitation in association with behavioral and cognitive therapy could be proposed to manage OAB syndrome in the absence of urodynamic diagnosis and when no targeting drug treatment could be proposed.

Idiopathic and neurogenic detrusor overactivity: do the different patterns have urodynamic characteristics related to gender or neurological condition?

OBJECTIVES: To evaluate the urodynamic characteristics of the two patterns (phasic, P and terminal, T) of detrusor overactivity (DO) according to gender and neurological condition. MATERIALS AND METHODS: Urodynamic characteristics of DO were analysed in a population with proven urodynamic DO (127 women and 76 men, respectively with 48 and 43 neurological diseases (encephalic, incomplete medullar lesion or peripheral)). Phasic DO is characterized by phasic waves with or without leakage while terminal DO is defined by a single non-inhibited contraction resulting in incontinence. Parameters analysed for both patterns of DO (among other parameters) included: volume and amplitude of the first non-inhibited detrusor contraction (NIDC#1), and for phasic DO: duration of pressure rise during NIDC#1 and number of NIDC. RESULTS: Phasic DO was observed in younger patients in the whole population whatever the gender (women: 55.9 years vs. 64.7 years, p = 0.0052; men: 57.4 years vs. 67.8 years, p = 0.0038). Volume at NIDC#1 was greater for neurological PDO (significant in women: 185 vs. 125 mL, p = 0.0223). Other parameters were not significantly different whatever the gender. Amplitude of NIDC#1 during PDO was significantly lower than that of NIDC during terminal DO (TDO) in both genders whatever the neurological condition (p < 0.0001). Volume at NIDC#1 in both patterns was dependent on the level of neurological lesion. CONCLUSION: The main difference between the patterns of DO is that PDO occurs in younger individuals. There is no significant difference between urodynamic characteristics of each pattern whatever gender or neurological status. Further studies will provide additional information on the impact of the level of neurological lesion on the pattern of DO.

Idiopathic and neurogenic detrusor overactivity: do the different patterns have urodynamic characteristics related to gender or neurological condition?

Objectives To evaluate the urodynamic characteristics of the two patterns (phasic, P and terminal, T) of detrusor overactivity (DO) according to gender and neurological condition. Materials and Methods: Urodynamic characteristics of DO were analysed in a population with proven urodynamic DO (127 women and 76 men, respectively with 48 and 43 neurological diseases (encephalic, incomplete medullar lesion or peripheral)). Phasic DO is characterized by phasic waves with or without leakage while terminal DO is defined by a single non-inhibited contraction resulting in incontinence. Parameters analysed for both patterns of DO (among other parameters) included: volume and amplitude of the first non-inhibited detrusor contraction (NIDC#1), and for phasic DO: duration of pressure rise during NIDC#1 and number of NIDC. Results Phasic DO was observed in younger patients in the whole population whatever the gender (women: 55.9 years vs. 64.7 years, p = 0.0052; men: 57.4 years vs. 67.8 years, p = 0.0038). Volume at NIDC#1 was greater for neurological PDO (significant in women: 185 vs. 125 mL, p = 0.0223). Other parameters were not significantly different whatever the gender. Amplitude of NIDC#1 during PDO was significantly lower than that of NIDC during terminal DO (TDO) in both genders whatever the neurological condition (p < 0.0001). Volume at NIDC#1 in both patterns was dependent on the level of neurological lesion. Conclusion The main difference between the patterns of DO is that PDO occurs in younger individuals. There is no significant difference between urodynamic characteristics of each pattern whatever gender or neurological status. Further studies will provide additional information on the impact of the level of neurological lesion on the pattern of DO. .

Decreased maximum flow rate during intubated flow is not only due to urethral catheter in situ.

INTRODUCTION AND HYPOTHESIS: We used the Valentini-Besson-Nelson (VBN) mathematical micturition model to analyze the potential obstructive effect of a 7-F transurethral catheter on the voiding process during intubated flow (IF) in women. Our hypothesis was that incomplete sphincter relaxation leads to residual sphincter pressure. METHODS: We reviewed a urodynamic database of women referred for evaluation of lower urinary tract dysfunction. Exclusion criteria were neurological disease or grade ≥2 prolapse. Eligible women underwent free uroflow (FF-1) before cystometry, an IF (7-F urethral catheter), and a second FF (FF-2) at the end of the session. Interpreted flows were restricted to voided volumes ≥100 ml and continuous flow patterns. Analysis of FF and IF was made using the VBN model. RESULTS: Among 472 women, 157 met the inclusion criteria. The effect of the urethral catheter was geometric only in 60 (38.2 %) patients. An additional effect, identified as incomplete sphincter relaxation, was observed in 97 (61.9 %) patients. Among this second group, the same residual sphincter excitation was found for 30 (30.97 %) patients during FF-2. CONCLUSION: When comparing IF with FF with the VBN model, the decrease in maximum flow rate (Q(max)) did not appear to result only from the geometric effect of the catheter but from incomplete sphincter relaxation during voiding, possibly because of patient's anxiety or a urethral reflex induced by the presence of the catheter. These findings emphasize the need to perform an FF before the IF to strengthen the reliability of conclusions of a urodynamic investigation.

Is a sequence of tests during urethral pressure profilometry correlated with symptoms assessment in women?

Our purpose was, applying a strictly defined protocol for urethral profilometry, 1) to test the repeatability of same session rest maximum urethral closure pressure (MUCP) and 2) to search for correlation between women complaint and the changes in MUCP value (rest and dynamic tests).

A population of 140 consecutive women referred for evaluation of lower urinary tract dysfunction was stratified in 4 groups according with the urinary symptoms: stress, urge, mixed incontinence and continent and in each group in 3 age groups (young, middle age and old). The sequence of tests recorded in supine position was: urethral pressure profile at rest bladder empty, after bladder filling at 250 mL (reference test), stress profile, fatigability (before (rest) and after 10 successive strong coughs), then in standing position.

In all groups, there was no significant difference between the two MUCP values at rest bladder filled. In the three incontinent groups, MUCP was higher bladder empty than bladder filled (p < 0.05) except in the young sub-group. Stress incontinence led to significant decrease of MUCP during dynamic tests in the young group. MUCP was not modified after fatigability test in women with urge complaint whatever age.

When recorded following a strictly defined protocol, MUCP at rest bladder filled has a good repeatability in individual. However a complex sequence of tests during urethral pressure profilometry remains discussed in middle-age and old age-groups, it allows specifying the stress component of incontinence in young women and the urgency component in all age-groups. .

Is a sequence of tests during urethral pressure profilometry correlated with symptoms assessment in women?

INTRODUCTION: Our purpose was, applying a strictly defined protocol for urethral profilometry, 1) to test the repeatability of same session rest maximum urethral closure pressure (MUCP) and 2) to search for correlation between women complaint and the changes in MUCP value (rest and dynamic tests). MATERIALS AND METHODS: A population of 140 consecutive women referred for evaluation of lower urinary tract dysfunction was stratified in 4 groups according with the urinary symptoms: stress, urge, mixed incontinence and continent and in each group in 3 age groups (young, middle age and old). The sequence of tests recorded in supine position was: urethral pressure profile at rest bladder empty, after bladder filling at 250 mL (reference test), stress profile, fatigability (before (rest) and after 10 successive strong coughs), then in standing position. RESULTS: In all groups, there was no significant difference between the two MUCP values at rest bladder filled. In the three incontinent groups, MUCP was higher bladder empty than bladder filled (p < 0.05) except in the young sub-group. Stress incontinence led to significant decrease of MUCP during dynamic tests in the young group. MUCP was not modified after fatigability test in women with urge complaint whatever age. CONCLUSION: When recorded following a strictly defined protocol, MUCP at rest bladder filled has a good repeatability in individual. However a complex sequence of tests during urethral pressure profilometry remains discussed in middle-age and old age-groups, it allows specifying the stress component of incontinence in young women and the urgency component in all age-groups.

Phasic or terminal detrusor overactivity in women: age, urodynamic findings and sphincter behavior relationships

OBJECTIVES: To search for relationships between phasic (P) and terminal (T) DO with age, urodynamic findings and sphincter behavior during involuntary detrusor contraction in woman. MATERIALS AND METHODS: Urodynamic studies (triple lumen catheter 7F, seated position) of 164 successive women referred for LUTS with diagnosis of DO were reviewed. Patients were stratified in 4 sub-groups: pre- (18-44y), peri- (45-54 y), post-menopause (55-74 y) and oldest old (≥ 75 y). The urethral sensor was positioned at the level of the maximum urethral closure pressure for sphincter behavior analysis. A variation of at least 5 cmH2O in pressure (detrusor or urethra) was chosen to assert DO or sphincter response. Sphincter response was classified as relaxation (re) before or during DO, or steady (st). RESULTS: Occurrence of P and TDO was similar: 77 P and 87 T. The PDO group was significantly younger (p = 0.0003). TDO was more frequent in patients with a history of neurological disease. The percentage of PDO remained almost constant in age groups, while that of TDO increased with age from 6.7 percent to 23.2 percent (p = 0.0013). Uninhibited contraction occurred at a smaller bladder volume in the P group: 149 ± 95 vs. 221 ± 113 mL (p < 0.0001). Steady sphincter predominated in the TDO subgroup: 45.9 percent vs. 32.1 percent and increased significantly in each DO sub-group of ³ 75y. CONCLUSION: Steady sphincter during both P and TDO, and occurrence of TDO appear as specific of aging. The last result could be related to structural changes in the detrusor muscle with aging.

Urodynamics in women from menopause to oldest age: what motive? What diagnosis?

PURPOSE: To analyze age-associated changes as a motive for urodynamics and urodynamic diagnosis in community-dwelling menopausal women and to discuss the role of menopause and ageing. MATERIALS AND METHODS: Four hundred and forty nine consecutive menopausal women referred for urodynamic evaluation of lower urinary tract (LUT) symptoms, met the inclusion criteria and were stratified into 3 age groups: 55-64 years (A), 65-74 years (B), and 75-93 years (C). Comprehensive assessment included previous medical history and clinical examination. Studied items were motive for urodynamics, results of uroflows (free flow and intubated flow) and cystometry, urethral pressure profilometry, and final urodynamic diagnosis. RESULTS: The main motive was incontinence (66.3%) with significant increase of mixed incontinence in group C (p = 0.028). Detrusor function significantly deteriorated in the oldest group, mainly in absence of neurological disease (overactivity p = 0.019; impaired contractility p = 0.028). In the entire population, underactivity predominated in group C (p = 0.0024). A progressive decrease of maximum urethral closure pressure occurred with ageing. In subjects with no detrusor overactivity there was a decrease with age of detrusor pressure at opening and at maximum flow, and of maximum flow while post void residual increased only in the C group. CONCLUSION: In our population of community-dwelling menopausal women, incontinence was the main motive for urodynamics increasing with ageing. A brisk change in LUT function of women older than 75 years underlined deterioration in bladder function with a high incidence of detrusor hyperactivity with or without impaired contractility while change in urethral function was progressive. Effect of ageing appears to be predominant compared to menopause.

Urodynamics in women from menopause to oldest age: what motive? what diagnosis?

PURPOSE: To analyze age-associated changes as a motive for urodynamics and urodynamic diagnosis in community-dwelling menopausal women and to discuss the role of menopause and ageing. MATERIALS AND METHODS: Four hundred and forty nine consecutive menopausal women referred for urodynamic evaluation of lower urinary tract (LUT) symptoms, met the inclusion criteria and were stratified into 3 age groups: 55-64 years (A), 65-74 years (B), and 75-93 years (C). Comprehensive assessment included previous medical history and clinical examination. Studied items were motive for urodynamics, results of uroflows (free flow and intubated flow) and cystometry, urethral pressure profilometry, and final urodynamic diagnosis. RESULTS: The main motive was incontinence (66.3 percent) with significant increase of mixed incontinence in group C (p = 0.028). Detrusor function significantly deteriorated in the oldest group, mainly in absence of neurological disease (overactivity p = 0.019; impaired contractility p = 0.028). In the entire population, underactivity predominated in group C (p = 0.0024). A progressive decrease of maximum urethral closure pressure occurred with ageing. In subjects with no detrusor overactivity there was a decrease with age of detrusor pressure at opening and at maximum flow, and of maximum flow while post void residual increased only in the C group. CONCLUSION: In our population of community-dwelling menopausal women, incontinence was the main motive for urodynamics increasing with ageing. A brisk change in LUT function of women older than 75 years underlined deterioration in bladder function with a high incidence of detrusor hyperactivity with or without impaired contractility while change in urethral function was progressive. Effect of ageing appears to be predominant compared to menopause.

Phasic or terminal detrusor overactivity in women: age, urodynamic findings and sphincter behavior relationships.

OBJECTIVES: To search for relationships between phasic (P) and terminal (T) DO with age, urodynamic findings and sphincter behavior during involuntary detrusor contraction in woman. MATERIALS AND METHODS: Urodynamic studies (triple lumen catheter 7F, seated position) of 164 successive women referred for LUTS with diagnosis of DO were reviewed. Patients were stratified in 4 sub-groups: pre- (18-44 y), peri- (45-54 y), post-menopause (55-74 y) and oldest old (= 75 y). The urethral sensor was positioned at the level of the maximum urethral closure pressure for sphincter behavior analysis. A variation of at least 5 cmH(2)O in pressure (detrusor or urethra) was chosen to assert DO or sphincter response. Sphincter response was classified as relaxation (re) before or during DO, or steady (st). RESULTS: Occurrence of P and TDO was similar: 77 P and 87 T. The PDO group was significantly younger (p = 0.0003). TDO was more frequent in patients with a history of neurological disease. The percentage of PDO remained almost constant in age groups, while that of TDO increased with age from 6.7% to 23.2% (p = 0.0013). Uninhibited contraction occurred at a smaller bladder volume in the P group: 149 ± 95 vs. 221 ± 113 mL (p < 0.0001). Steady sphincter predominated in the TDO subgroup: 45.9% vs. 32.1% and increased significantly in each DO sub-group of ≥ 75 y. CONCLUSION: Steady sphincter during both P and TDO, and occurrence of TDO appear as specific of aging. The last result could be related to structural changes in the detrusor muscle with aging.