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AIMS To compare in vivo differences of two catheter systems for urodynamics to further discover their measurement properties. METHODS Side-by-side catheterization with two catheters for intravesical and abdominal pressure during full cystometry in 36 prospectively recruited patients with analysis of mean and absolute differences at urodynamic events and post hoc in-depth signal analysis comparing the full pressure traces of both systems. RESULTS The mean pressure differences at urodynamic events between air-filled and water-filled systems are small, however, with a large variation, without a systematic difference. The majority of the intersystem differences are significantly larger than 5 cmH2 O. Further analysis showed that urodynamic event pressure differences of both systems at the start of the test were carried forward throughout the remainder of the test without subsequent or additional tendency to differ. Post hoc whole test signal analysis with pressures equalized from the first sample shows high cross-correlation (>0.981) between the pressure signals per location (rectum and bladder) per test and almost zero-time shift (

Purpose: To assess baseline clinical and urodynamic profiles of a contemporary cohort of men undergoing radical prostatectomy (RP) as part of the ROSE (Robotic and Open Surgery for Prostate Cancer: A Prospective, Multi-centre, Comparative Study of Functional and Oncological Outcomes) study.Methods: Men with localized prostate cancer undergoing RP were prospectively recruited to undergo clinical assessment and urodynamic testing prior to surgery as part of a clinical trial. The International Prostate Symptoms Score (IPSS) was used to determine participants’ degree of lower urinary tract symptoms (LUTS).Results: Eighty-five men with a median age of 64.5 years and a median prostate-specific antigen level of 6.3 ng/mL were prospectively recruited. Of patients with complete baseline data, 36 (50.7%), 28 (39.4%), and 7 (9.9%) had mild (IPSS20) LUTS, respectively. Obstruction was identified in 18 men (29.5%), and 9 (14.8%) showed detrusor underactivity. Of the 15 patients with detrusor overactivity, 12 (80%) reported overactive bladder (OAB). Of men with urodynamic obstruction, 5 (31.3%), 10 (62.5%), and 1 (6.3%) reported mild, moderate, and severe LUTS, respectively. Of men without OAB, 4 (11.8%, P=0.002) showed filling phase abnormalities, 13 (46.4%, P=0.611) had flow rates of

Context Understanding men’s values and preferences in the context of personal, physical, emotional, relational, and social factors is important in optimising patient counselling, facilitating treatment decision-making, and improving guideline recommendations. Objective To systematically review the available evidence regarding the values, preferences, and expectations of men towards the investigation and treatment (conservative, pharmacological, and surgical) of male lower urinary tract symptoms (LUTS). Evidence acquisition We searched electronic databases until August 31, 2020 for quantitative and qualitative studies that reported values and preferences regarding the investigation and treatment of LUTS in men. We assessed the quality of evidence and risk of bias using the Grading of Recommendation, Assessment, Development and Evaluation (GRADE) and GRADE Confidence in the Evidence from Reviews of Qualitative Research (CERQual) approaches. Evidence synthesis We included 25 quantitative studies, three qualitative studies, and one mixed-methods study recruiting 9235 patients. Most men reported urodynamic testing to be acceptable, despite discomfort or embarrassment, as it significantly informs treatment decisions (low certainty evidence). Men preferred conservative and less risky treatment options, but the preference varied depending on baseline symptom severity and the risk/benefit characteristics of the treatment (moderate certainty). Men preferred pharmacological treatments with a low risk of erectile dysfunction and those especially improving urgency incontinence (moderate certainty). Other important preference considerations included reducing the risk of acute urinary retention or surgery (moderate certainty). Conclusions Men prefer lower-risk management options that have fewer sexual side effects and are primarily effective at improving urgency incontinence and nocturia. Overall, the evidence was rated to be of low to moderate certainty. This review can facilitate the treatment decision-making process and improve the trustworthiness of guideline recommendations. Patient summary We thoroughly reviewed the evidence addressing men’s values and preferences regarding the management of urinary symptoms and found that minimising adverse effects is particularly important. Further research to understand other factors that matter to men is required.

Coital incontinence (CI) is an underreported symptom among sexually active women. It has been assumed that incontinence at penetration (CIAP) is due to urodynamic stress incontinence (USI), while coital incontinence at orgasm (CIAO) is thought to be due to detrusor overactivity (DO). To evaluate demographic and urodynamic findings associated with coital incontinence (CI) and to confirm the hypotheses ‘CIAP is associated with USI’ and ‘CIAO is associated with DO we performed a retrospective study of 661 sexually active women attending a tertiary clinic between January 2017 and December 2019 for pelvic floor dysfunction. All patients filled in a standardized questionnaire and had a clinical examination and multichannel urodynamic testing. Women were asked if they experienced urine leakage during intercourse and the timing of such leakage. Of 661 sexually active women, one third (n = 220) reported coital incontinence. While 121 (18%) women experienced CIAP, 172 (26%) had CIAO and 76 (11.5%) suffered both. For women with pure USI, the prevalence of CIAP (61.7%) and CIAO (69.5%) was significantly higher than for women with pure DO, where only 12.3% had CIAP and 8.6% had CIAO. Factors significantly associated with CI were body mass index, mid-urethral closure pressure (MUCP) and abdominal leak point pressure (ALPP). When only women with pure USI or DO were included, USI remained associated with CI while DO was not. CI is clearly associated with SUI and USI and is likely to share etio-pathogenetic mechanisms. CI seems to be a manifestation of USI, even when it occurs during orgasm.

We report on the first regulatory approved clinical trial of a prospective open-label physician-initiated study assessing the safety and efficacy of intradetrusor injected Autologous Muscle Derived Cells (AMDC) treatment for underactive bladder (UAB).20 non-neurogenic UAB patients were treated. Approximately 50-250 mg of quadriceps femoris muscle was collected using a spirotome 8-gauge needle. The muscles biopsy samples were sent to Cook MyoSite (Pittsburgh, PA) for processing, isolation, and propagation of cells. Research patients received approximately 30 intradetrusor injections of 0.5 mL delivered to the bladder, for a total of 15 mL and 125 million AMDC, performed utilizing a flexible cystoscope under direct vision using topical local anesthesia. Follow-up assessments included adverse events and efficacy via voiding diary and urodynamic testing at 1, 3, 6 & 12-month post-injection. An optional second injection was offered at the end of the 6 months visit.20 patients received the first injection and all 20 patients requested and received a second injection. Median patient age was 65 years old (range 41-82 years). There were 16 male (80%) and 4 female (20%) patients. Etiology included 7 men (35%) with persistent urinary retention after transurethral resection of the prostate for benign prostatic hyperplasia and 13 patients (65%) with idiopathic chronic urinary retention. At the primary outcome time point of 12 months, 11/19 patients (58%) reported a global response assessment (GRA) ≥ 5, showing slight to marked improvement in their UAB symptoms, compared to 6/20 (30%) patients at 3-months post-injection. No serious procedure or treatment-related adverse events occurred. Noted improvements included: decreased post void residual urine volume, increased voiding efficiency, and decreased catheter use.Intradetrusor injected AMDC as a treatment for UAB was successfully completed in a 20-patient trial without serious adverse event and with signal of efficacy. Cellular therapy may be a promising novel treatment for catheter dependent chronic urinary retention. A multicenter controlled trial is needed to further assess the promise of regenerative medicine in the treatment of lower urinary tract dysfunction.

Urethral closure mechanism dysfunction in female stress urinary incontinence (SUI) is poorly understood. We aimed to quantify these mechanisms through changes in urethral shape and position during squeeze (voluntary closure) and Valsalva (passive closure) via endovaginal ultrasound in women with varying SUI severity. In this prospective cohort study, 76 women who presented to our tertiary center for urodynamic testing as preoperative assessment were recruited. Urodynamics were performed according to International Continence Society criteria. Urethral pressures were obtained during serial Valsalva maneuvers. Urethral lengths, thicknesses, and angles were measured in the midsagittal plane via dynamic anterior compartment ultrasound. Statistical shape modeling was carried out by a principal component analysis on aligned urethra shapes. Age, parity, and BMI did not vary by SUI group. Ultrasound detected a larger retropubic angle, urethral knee-pubic bone angle (a novel measure developed for this study), and infrapubic urethral length measurements at Valsalva in women with severe SUI (p = 0.016, 0.015, and 0.010). Shape analysis defined increased “c” shape concavity and distal wall pinching during squeeze and increased “s” shape concavity and distal wall thickening during Valsalva (p

Symptoms of obstructed defecation (OD) and anatomical abnormalities of the posterior compartment are prevalent in urogynecological patients. The aim of this study was to determine whether perineal hypermobility is an independent predictor of OD, as is the case for rectocele, enterocele and rectal intussusception. This is a retrospective study of 2447 women attending a tertiary urodynamic center between September 2011 and December 2016. The assessment included a structured interview, urodynamic testing, a clinical examination and 4D transperineal ultrasound. After exclusion of previous pelvic floor surgery and defined anatomical abnormalities of the anorectum, 796 patients were left for analysis. Perineal hypermobility was defined as rectal descent ≥ 15 mm below the symphysis pubis, determined in stored ultrasound volume datasets offline, using proprietary software, blinded to all other data. Any association between perineal hypermobility and symptoms of obstructed defecation was tested for by chi-square (X2) test. For the 796 patients analyzed, median age was 52 (range, 16–88) years with a mean BMI of 27 (range, 15–64) kg/m2. Average vaginal parity was two (range, 0–8). Reported OD symptoms in this group included sensation of incomplete emptying in 335 (42%), straining at stool in 300 (37%) and digitation in 83 (10%). At least one of those symptoms was reported by 424 (53%) women; 153 showed perineal hypermobility. There was no significant association between perineal hypermobility and OD symptoms on univariate testing. We found no evidence of an independent association between perineal hypermobility and obstructed defecation.

OBJECTIVE Our objective was to determine if there is a difference in anxiety during urodynamics in women given lavender aromatherapy (lavender) versus placebo. METHODS This was a randomized, controlled trial of women scheduled for urodynamic testing with baseline anxiety. Participants rated their anxiety and pain immediately before the examination and then were randomized to lavender or placebo. Anxiety and pain were assessed immediately after catheter placement and 15 minutes after termination of the study. RESULTS Data for 40 women who received lavender and 38 women who received placebo were available for analysis. Decrease in anxiety from baseline to catheter placement (-2 vs -0.5, P = 0.01) and 15 minutes post procedure was significantly greater in the lavender group. Postprocedure anxiety was lower in the lavender group compared with controls (0 vs 0.5, P = 0.001). No differences were seen in pain. CONCLUSIONS Lavender aromatherapy reduces anxiety during urodynamics.

Objective Urodynamic testing of women is a common procedure to evaluate lower urinary tract symptoms but may cause discomfort. The objective of our study was to determine the effect of externally applied periurethral 2% lidocaine gel on pain scores after complex urodynamic testing in women. Methods This prospective, double-blinded, placebo-controlled randomized trial compared 2% lidocaine gel to water-based lubricant applied to the periurethral area before urodynamic testing in women. Discomfort was measured using a visual analog pain scale (VAS) ranging from 0 to 100. The primary outcome was the difference in VAS from baseline to 4 to 6 hours after urodynamic testing. Secondary outcomes included: VAS difference from baseline to immediately postprocedure and 24 hours after urodynamic testing; VAS scores: at baseline, immediately postprocedure, after 4-6 hours, and after 24 hours; urodynamic testing results; and any adverse events. Sixty-four women per group were needed to provide a power of 80% to detect a 10-mm difference on a 100-point VAS. Results From January 2018 to March 2019, 134 subjects were randomized, 6 subjects were excluded, which resulted in 64 subjects in both the water-based lubricant group and 2% lidocaine gel group. There was no difference in baseline demographics. There was no significant difference in the change in VAS from baseline to 4 to 6 hours after UDT (0, 0 P = 0.88). No difference in secondary outcomes was noted. Conclusions Topically applied 2% lidocaine gel does not decrease pain compared with water-based lubricant. For most women, complex urodynamic testing is not associated with any significant pain. Clinical trial registration www.ClinicalTrials.gov,-NCT03390790, "Lidocaine for Pain After Urodynamic Testing".

Aim To determine the prevalence of stress urinary incontinence (SUI) and intrinsic sphincter deficiency (ISD) in women with stage IV pelvic organ prolapse. Methods Retrospective analysis of women with stage IV prolapse who underwent multichannel urodynamic testing. Abdominal leak point pressures (ALPP) and maximum urethral closure pressures (MUCP) were recorded. ISD was defined as ALPP ≤60 cm of water and/or MUCP ≤20 cm of water. Percentages were used to present the proportion of subjects diagnosed with SUI and ISD. Results A total of 145 patients met inclusion criteria. Mean age was 69 years; most patients were Caucasian (56%). Eighty-two (56%) patients were found to have SUI on urodynamic testing. Thirty-six (44%) of these were asymptomatic and identified as having occult SUI. Sixteen (19.5%) patients were diagnosed with ISD using ALPP and/or MUCP. Six (37%) of the ISD patients had at least one MUCP value ≤20 cm of water and 12 (75%) had observed leakage with at least one ALPP value ≤60 cm of water. The number of patients with leakage at ALPP ≤60 cm of water increased with increasing bladder volumes. Five ISD patients (31%) had ALPP ≤60 cm of water at 200 mL, six (37.5%) had ALPP ≤60 cm of water at 300 mL and seven (43.8%) had ALPP ≤60 cm of water at 400 mL. Conclusion Greater than 50% of patients with stage IV pelvic organ prolapse had SUI on urodynamic testing, and 20% were found to have ISD. Of the patients diagnosed with SUI, 40% were asymptomatic. These findings may assist in counseling and preoperative planning for women with stage IV prolapse.

OBJECTIVES The accurate, rapid diagnosis of stress urinary incontinence (SUI) in women can profoundly improve their sexual and psychosocial life. In this study, the diagnostic power of SUI was assessed by transperineal ultrasound. METHODS In this hospital-based case-control study, married women who were referred to the gynecologic and ultrasound wards with negative urinalysis and culture results were enrolled by random sampling. Patients with positive cough signs based on the urodynamic testing data were considered cases, whereas control women showed no cough symptoms and were recruited from the same ward. RESULTS There was a significant difference (P < .001) in bladder neck descent (mean ± SD, 10.89 ± 5.51 versus 7.08 ± 2.60 mm, respectively; P = .0001) and the retrovesical (β) angle with the Valsalva maneuver (144.22° ± 19.63° versus 111.81° ± 24.47°; P < .001) between the case and control groups. Also, the β angle without the Valsalva maneuver was higher in the case group (112.35° ± 23.10°) than the control group (120.17° ± 25.16°; P = .001). There was no case of a urinary leak, urethral diverticulitis, a bladder stone or mass, and cystourethrocele in the patients of each group. The results of multivariate logistic regression with a backward method showed that bladder neck descent (odds ratio [OR], 1.24; 95% confidence interval [CI], 1.09-1.40), the β angles with and without the Valsalva maneuver (OR, 1.1; 95% CI, 1.06-1.13; and OR, 1.04; 95% CI, 1.01-1.06) were the predictors of SUI. A β angle higher than 127° with the Valsalva maneuver, with an area under the curve of 0.89 (95% CI, 0.75-0.96), could very well predict the SUI response. This finding shows that it can be very well used to distinguish between normal and non-normal responses, with 89% sensitivity and 79% specificity. CONCLUSIONS The β angle with the Valsalva maneuver could very well predict the SUI response.

Background To investigate the functions of the hyperpolarization-activated cation currents in medium-size dorsal root ganglion cells in a rat model of overactive bladder syndrome. Methods Rats with OAB were screened using a urodynamic testing device. The whole-cell patch clamp technique was used to investigate changes in excitability and hyperpolarization-activated cation current (Ih) of medium-size cells in the L6 dorsal root ganglia (DRG) of the OAB rats. Intrathecal injection of the specific Ih inhibitor ZD7288 was used to investigate changes of voiding function and Ih of medium-size cells in the L6 DRG. Results The urinary bladder weight of the OAB rats was significantly increased (p p Ih current density, which was blocked by ZD7288. Conclusions The Ih current density significantly increased in medium-size cells of the L6 DRG in the OAB model. A decrease of the Ih current was able to significantly improve the voiding function of the OAB rats, in addition to lowering their urinary bladder weight. Our finding suggested that the observed increase of Ih current in the medium-size DRG neurons might play an important role in the pathological processes of OAB.

Background. After radical hysterectomy for cervical cancer, the most common complication is lower urinary tract symptoms. Post-operatively, bladder capacity can alter bladder function for a prolonged period. This study aimed to identify factors affecting bladder storage function. Methods. A multicenter, retrospective cohort study was conducted. Information of patients with stages IA2 to IIB cervical cancer with urodynamic study results were retrospectively collected from nine hospitals between June 2013 and June 2018 according to the inclusion criteria. Demographic, surgical, and oncological data were collected. The univariate and multivariate logistic regression was used to identify clinical factors associated with bladder storage function. Results. Two hundred and three patients with cervical cancer had urodynamic testing post-operatively. Ninety-five (46.8%) patients were diagnosed with stress urinary incontinence (SUI). The incidence of low bladder compliance (LBC) was 23.2%. Twenty-seven (13.3%) patients showed detrusor overactivity (DO). Fifty-seven patients (28.1%) presented with a decreased maximum cystometric capacity (DMCC). The probability of composite bladder storage dysfunction was 68.0%. Multivariate analysis confirmed that laparoscopy represents a protective factor for SUI with an odds ratio of 0.498 (P = 0.034). Patients who underwent a nerve-sparing procedure were less odds to experience SUI (P = 0.014). A significant positive correlation between LBC and DO was observed (P

Introduction and hypothesis Urinary tract infection is the most common complication after urodynamic studies (UDS). Practice guidelines recommend against antibiotic prophylaxis based on an outdated review of the literature, which advised on the premise of “a lack of good quality studies” and based on an assumed low incidence not consistently supported by the literature. Objectives This systematic review aims to update the assessment of the efficacy of antibiotic prophylaxis compared with placebo or no treatment for prevention of urinary tract infection in females over the age of 18 years undergoing UDS. Methods MEDLINE, EMBASE, COCHRANE, DISSERTATIONS, conference proceedings and clinical trial registries were searched for relevant randomized controlled trials. Two authors independently screened and selected articles, assessed these for quality according to Cochrane guidelines and extracted their data. Results A total of 2633 records were screened, identifying three relevant randomized controlled trials. The one study that was critically appraised as being the least likely biased showed a statistically significant effect of antibiotic prophylaxis in reducing bacteriuria post UDS in female patients. The other two studies included in the review did not. None of the studies included were powered to show a significant change in the incidence of urinary tract infection following UDS in female patients receiving antibiotic prophylaxis versus no prophylaxis. Conclusions Similar to the 2012 Cochrane review on this subject, this systematic review demonstrated that antibiotic prophylaxis may decrease bacteriuria in women post UDS; however, further research is required to assess its effect on urinary tract infections in this context.

Risk factors can be used to determine what patients will develop delayed postoperative urinary retention after female pelvic reconstructive surgery. A case-control study was performed including all female pelvic reconstructive surgeries necessitating a voiding trial. All patients passed their previous voiding trial. Cases had an acute encounter for urinary retention. Controls did not have acute postoperative urinary retention. Cases and controls were stratified based on procedure. Demographics, medical/surgical histories, voiding symptoms, urodynamic testing, and intraoperative data were collected. Cases were matched to controls in a 1:3 ratio. Mann-Whitney U and chi-square tests were used for univariate analyses; logistic regression was used to determine predictors of delayed postoperative urinary retention (DPOUR). A total of 1219 patients underwent pelvic reconstructive surgery that met eligibility; 51 cases of DPOUR (4.3%) were identified and matched with 153 controls without postoperative urinary retention. Of the procedures performed, 41.2% had prolapse surgery, 10.3% had incontinence surgery, and 48.5% had both prolapse and incontinence surgery. There were no differences between cases and controls in age, race, prior surgery, medical comorbidities, prolapse stage ≥ 3, voiding symptoms, and surgical characteristics. Cases had a lower BMI than controls (p

Objective To explore the relationship between frailty, age, and detrusor overactivity (DO) in older adults presenting to an academic urology practice. Materials and methods This study uses the University of California, San Francisco Geriatric Urology Database to examine all adults ages ≥65 years who underwent urodynamic testing from December 2015 to April 2019. All subjects had a timed up and go test (TUGT) as a measure of frailty and were categorized as fast (≤10 seconds), intermediate (11-14 seconds), or slow (≥15 seconds), corresponding to not frail, pre-frail, and frail, respectively. Urodynamic studies were reviewed for the presence of DO. Univariate and multivariate logistic regression were used to examine the relationship between frailty, age, and the presence of DO. Results In total, 549 older adults underwent urodynamics during the study period, and 48.5% had a study that demonstrated DO. Individuals with DO tended to be older (18.4% vs 11.0% were ≥80 years; P = .01) and more frail (19.5% vs 13.4% with TUGT ≥5 seconds; P .05). Conclusions Frailty, not age, is associated with DO among older adults undergoing urodynamics. Further research on the role of frailty in the evaluation and management of older adults with DO is warranted to best serve the needs of this population.

Summary Introduction Patients with neurogenic bladder (NGB) require periodic urodynamics (UDS) to evaluate bladder function, which in turn helps guide management. At times, bladder decompensation or hydronephrosis may develop in patients between urodynamic testing intervals. Increased surveillance has improved outcomes in other chronic conditions (e.g., diabetes). Two novel devices, the cystomanometer (CM) and cystoelastometer (CEM), have been developed at the authors' institution to allow for home bladder pressure monitoring. The handheld CM can be attached to the end of any catheter and records the opening bladder pressure along with a time stamp. In addition, the CEM actively evacuates urine via a pump and records the urine volume evacuated. For safety, the pump slows and stops as it detects increasing resistance. Data are stored and transmitted wirelessly from both devices to a smartphone. A novel phone application stores, displays, and transmits data to a secure hospital server. Objective This aim of this study was to validate the function of the CM and CEM and their accuracy relative to UDS. Study design Institutional review board approval was obtained. All patients with NGB managed with intermittent catheterization undergoing routine UDS were eligible for study inclusion. At the completion of UDS, the instillation port of the 6-French dual-lumen UDS catheter was connected to the CM or CEM. Bladder parameters were simultaneously recorded using the device and UDS during bladder emptying. Correlative statistics were calculated. Results A total of 36 patients (30 children/6 adults; age range from 1.2 to 38 years [median: 7.5 years]) underwent CM testing. Strong pressure correlation with UDS was identified (R2 = 0.89). A total of 42 patients (30 children/12 adults; age range of 2.9–85.2 years [median: 12.2 years]) underwent CEM testing. Again, strong pressure correlation was found (R2 = 0.77). Cystoelastometer volume measurements were highly correlated with measured volumes (Fig. 4, R2 = 0.98). Discussion Both the CM and CEM functioned well and transmitted the data wirelessly to a smartphone. The data from these devices were strongly correlated with simultaneous data from the UDS. A limitation is that these devices were used by healthcare providers, and therefore, use by patients or their parents/caregivers at home has not been demonstrated. Conclusion The CM and CEM devices provide accurate bladder pressure and volume measurements. The potential for improved patient monitoring and care is promising. Reliability testing and the effects of such monitoring on patient outcomes remain to be determined. Download : Download high-res image (352KB) Download : Download full-size image Summary Figure .

Purpose: Transcutaneous electrical neural stimulation (TENS), as a non-invasive modality, has been clinically used as an alternative treatment for children with overactive bladder (OAB). We conducted a pooled analysis to explore the effect of TENS on OAB.Methods: The Preferred Reporting Items for Systematic Reviews and Meta-analysis guideline was followed in this study. The MEDLINE, Embase, and Cochrane Central Register of Controlled Trials databases, as well as the reference lists of the retrieved studies, were used to find trials relevant for assessing the use of TENS to treat OAB.Results: Of the 246 records identified, 8 publications were analyzed in our study. Our analysis found that TENS resulted in a greater decrease of wet days/wk, daily voiding frequency, daily incontinence episodes, and daily number of voids than was observed in the control group. Furthermore, TENS-treated patients showed similar visual analogue scale (VAS) scores to patients in the control group, demonstrating that the application of TENS did not increase patients’ discomfort and pain. TENS had a relative advantage in the number of partial responses, but no clear differences were found in frequency of no response or a full response compared to the control group. In urodynamic testing, TENS led to obvious improvements in average voided volume and maximum voided volume in children with OAB.Conclusions: TENS had a remarkable effect on the improvement of urodynamic indexes and objective OAB symptoms without a significant increase in VAS scores for children with OAB.

Purpose: This study investigated the sensations reported during filling cystometry in patients with spinal cord lesions (SCLs) of different levels and completeness. Methods: In this retrospective cohort study, information was gathered on patients' age and sex, cause of SCL, American Spinal Injury Association Impairment Scale (AIS), and lower urinary tract-related sensations in daily life. Filling cystometry (video-urodynamics) was performed following the International Continence Society Good Urodynamic Practice Guidelines. In addition to bladder filling sensations (first sensation of bladder filling, first desire to void, strong desire to void), other sensations, such as detrusor overactivity related sensation and pain, were noted. Results: In total, 170 patients were included (age, 45 +/- 17 years; 114 males and 56 females, 92 with complete and 78 with incomplete SCL). The test was done 6 +/- 4 years post-SCL. Sensation was reported by 57% of all patients. Half of the patients with complete SCL (46 of 92) had sensation, while 36% of those with incomplete SCL (28 of 78) reported no sensation. Bladder awareness was not predictable by the AIS. The filling sensations reported were equivalent to those given in the terminology of ICS. Pain was seldom present (6%, 10 of 170), and detrusor overactivity contraction was felt by 45 of 78 (58%). Very few patients used sensory information for bladder management at home. Conclusions: After SCL, most patients retained the ability to be aware of the lower urinary tract, and were assessable and gradable during urodynamic testing. The filling sensations were not different from those described in healthy individuals, but the number and sequence of the sensations were altered in a minority of patients. Pain and a sensation of unstable contractions gave additional important information. As different sensations relate to different spinal afferent pathways, the sensory evaluation during cystometry provided additional important information on the spinal cord's condition.

Conservative treatment is recommended as first-line therapy for stress urinary incontinence (SUI). We hypothesized that CO2 laser treatment would demonstrate safety and efficacy for women with SUI. A prospective, open-label, cohort study of 33 women (mean age 43 years) referred from a continence clinic after urologist/urogynecologist assessment, with a verified stress urinary incontinence diagnosis based on urodynamic testing. The participants completed three outpatient treatments with laser therapy and were subsequently evaluated at 1, 3 and 6 months. The independent t and chi-square tests were used to assess changes in sanitary pad usage and SUI symptoms. Sanitary pad usage decreased from a median of 12 per day at baseline to 7 at 1–3 months post-treatment (P

Aims To determine if the air-charged urethral sensor balloon currently used in urodynamic testing (UDS) significantly impacts Valsalva leak point pressure (VLPP) measurements. Methods This is a prospective cohort study of women undergoing UDS at an academic institution. VLPPs were obtained at 150 mL and urodynamic capacity with and without the urethral pressure sensor in the urethra. VLPP measurements were analyzed using a Wilcoxon signed-rank test. Median and interquartile range are presented. Results Sixty-three patients were enrolled in the study, 53 were included in the primary analysis. The mean age of the subjects was 56.2 ± 12.1 years. Nine patients (16%) solely leaked when the balloon was not present in the urethra either with cough or during VLPP measurement. At both 150 mL and urodynamic capacity, when VLPP testing was performed, there was a significant difference (cmH2 O) between the control and intervention values, (76.2 [55.0, 97.0] vs 68.8 [46.3, 93.3], P = .0012; 79.3 [53, 96.5] vs 72.5 [50.8, 92.3], P = .04). There was also a statistically significant difference between the control and intervention values for the lowest leak value at 150 mL and capacity (70.5 [51, 94.5] vs 60.0 [40, 88] P = .002; 73.5 [49.5, 91.5] vs 61 [45, 88], P = .017). Conclusions The higher VLPPs obtained with the urethral balloon in place indicate that the balloon may be the cause of falsely elevated VLPPs during urodynamic testing. Additionally, the balloon may mask a diagnosis of stress urinary incontinence in some patients.

INTRODUCTION AND OBJECTIVE:Lack of a catheter-free, physiological method for evaluating bladder pressure is considered to be a major challenge in urodynamic testing. We hypothesize that pressure se...

INTRODUCTION AND OBJECTIVE:Because of the invasiveness, patient risk, and cost of urodynamic testing, non-invasive oral hydration protocols have been developed to evaluate overactive bladder (OAB)....

The objective was to discuss the evaluation and management of stress urinary incontinence (SUI) following traumatic pelvic injury by use of a video case. We present a patient with severe SUI following pelvic trauma and our surgical approach to her case. Her injuries included two sacral compression fractures and four un-united bilateral pubic rami fractures, with her right-upper pubic rami impinging on the bladder. Preoperative assessment included detailed review of her pelvic imaging, multichannel urodynamic testing, cystoscopy, and examination of periurethral and bony pelvis anatomy. We proceeded with a synthetic retropubic mid-urethral sling, which required medial deviation of the trocar passage owing to her distorted anatomy. Rigid cystoscopy provided an inadequate bladder survey following sling placement, thus flexible cystoscopy was used to confirm the absence of bladder perforation. Postoperatively, our patient experienced resolution of SUI. In patients who sustain pelvic fractures, imaging to evaluate bony trauma and genitourinary tract injury is essential. Urodynamic testing provides clarity of the nature and severity of incontinence symptoms. Rigid and/or flexible cystoscopy should be performed for diagnostic purposes pre-operatively and after operative intervention. Typical anti-incontinence procedures can be offered to these patients, but since bony anatomy can be unreliable, an individualized approach to their specific injury should be utilized.

Purpose To quantify the relative importance of brain regions responsible for reduced functional connectivity (FC) in their Voiding Initiation Network in female multiple sclerosis (MS) patients with neurogenic lower urinary tract dysfunction (NLUTD) and voiding dysfunction (VD). A data-driven machine-learning approach is utilized for quantification. Methods Twenty-seven ambulatory female patients with MS and NLUTD (group 1: voiders, n=15 and group 2: VD, n=12) participated in a functional magnetic resonance imaging (fMRI) voiding study. Brain activity was recorded by fMRI with simultaneous urodynamic testing. The Voiding Initiation Network was identified from averaged fMRI activation maps. Four machine-learning algorithms were employed to optimize the area under curve (AUC) of the receiver-operating characteristic curve. The optimal model was used to identify the relative importance of relevant brain regions. Results The Voiding Initiation Network exhibited stronger FC for voiders in frontal regions and stronger disassociation in cerebellar regions. Highest AUC values were obtained with 'random forests' (0.86) and 'partial least squares' algorithms (0.89). While brain regions with highest relative importance (>75%) included superior, middle, inferior frontal and cingulate regions, relative importance was larger than 60% for 186 of the 227 brain regions of the Voiding Initiation Network, indicating a global effect. Conclusion Voiders and VD patients showed distinctly different FC in their Voiding Initiation Network. Machine-learning is able to identify brain centers contributing to these observed differences. Knowledge of these centers and their connectivity may allow phenotyping patients to centrally focused treatments such as cortical modulation.

Preoperative urodynamic studies (UDS) are frequently performed before pelvic organ prolapse (POP) surgery to assess urethral and bladder function. The primary goal of this study is to examine how preoperative UDS are utilized and what value these studies have in patient treatment and/or counseling. We retrospectively reviewed patients who underwent prolapse surgery and had preoperative UDS between June 2010 and February 2015. Indications for UDS were classified into four categories: (1) occult stress urinary incontinence only, (2) overactive bladder symptoms, (3) mixed or insensible urinary incontinence, and (4) voiding symptoms and/or elevated post-void residual. We identified changes in management or counseling that were directly attributable to UDS results prior to surgery. Three hundred ninety-two patients underwent urodynamic testing for indications 2–4 above, and 316 met the inclusion criteria. Fifty-seven percent (180/316) had OAB symptoms (34.4% wet, 65.6% dry), 40.2% (127/316) had mixed incontinence, and 17.1% (54/316) had voiding symptoms and/or elevated PVR. A total of 3.5% (11/316) patients had alteration in their management or counseling based on the results of the UDS; 29.4% (50/170) of the women evaluated for occult SUI alone or with other symptoms demonstrated it and 41 underwent sling placement. UDS did not have a significant impact on preoperative management or counseling in POP surgery if demonstration of occult SUI was not the indication for preoperative study in women committed to POP surgery. Major alterations in treatment were rare and occurred mostly in women with stress incontinence that also had concomitant voiding symptoms and/or elevated PVR.

Introduction and hypothesis Patient decision aids (PDAs) facilitate shared decision making allowing patients to make decisions about their healthcare that take into account their personal values and preferences. The aim of this study was to establish whether a PDA used in women requiring stress incontinence surgery is helpful to women when making choices about the treatments they choose by using a Decision Conflict Scale (DCS). Methods Forty-five consecutive women were identified as having stress urinary incontinence and had completed all conservative treatments. All patients included in the study had stress urinary incontinence confirmed on urodynamic testing and were given the PDA at the point where they needed to make a decision about surgery. Following completion of the PDA, patients were given a DCS to complete which measures personal perceptions of uncertainty when making a decision about treatment. Results Forty-three out of 45 (95.5%) patients scored 4/4 for the DCS indicating they were sure of their decision. Two patients (4.5%) scored 3/4 and were therefore unsure of their choice. No patient scored < 3 on the DCS. The choice of procedures varied in all the ages and two women opted to have no treatment. Conclusions The use of a PDA in the surgical treatment of stress urinary incontinence reduces decision conflict and ensures patients are sure of their decision, understand the information provided as well as the risk benefit ratio of the various options and feel they have adequate support and advice to make a choice. Electronic supplementary material The online version of this article (10.1007/s00192-019-03982-1) contains supplementary material, which is available to authorized users.

Objective: To identify those myelomeningocele (MMC) patients at risk for post-urodynamic study (UDS) complications. We hypothesized that patients who manage their bladder with clean intermittent catheterization (CIC) would have a greater risk of post-instrumentation complications due to higher rates of bacteriuria compared to those who freely void (FV). Design/Methods: Urine was collected from patients with MMC without augmentation cystoplasty undergoing routine renal ultrasound or urodynamic study (UDS). Samples were divided into those with bacteriuria (urine culture ≥10,000 colony-forming units) and those without. Post-UDS complications were evaluated and compared between CIC and FV patients. Results: A total of 91 urine samples from 82 total MMC patients were included for evaluation. Significantly more patients on CIC than those who FV had bacteriuria (67% vs 33%, p = .0457). From these urine samples, 54 were obtained at time of UDS of which 45 were from patients on CIC and 9 from FV patients. More patients on CIC had bacteriuria at the time of UDS than those who FV (60% vs 33%, respectively), but this did not reach significance ( p = .1416). No patient with bacteriuria on CIC had a complication after UDS while one FV patient with bacteriuria developed post-UDS pyelonephritis. Conclusion: MMC patients with bacteriuria on CIC did not have post-UDS complications. Patients with bacteriuria who FV may be at particular risk for post-instrumentation UTI, providing guidance as to which MMC patients should undergo urine testing prior to UDS in order to prevent post-instrumentation pyelonephritis.

The aim of this study was to evaluate the functional outcomes and urodynamic findings after laparoscopic sacrocolpopexy (LSC) in patients with stages II–IV pelvic organ prolapse (POP). In this single-center prospective study, we evaluated 63 women (mean age 62.5 ± 7.5 years) women with symptomatic and advanced POP (stage II–IV) who underwent LSC without concomitant anti-incontinence surgery. The preoperative evaluation incuded history, clinical examination, and urodynamic testing. Women were followed up at 1, 3, 6, and 12 months after surgery and then annually using history, examination, and uroflowmetry. At 6 months, we performed urodynamic testing. To evaluate urinary symptoms, we used the Urogenital Distress Inventory (UDI)-6 questionnaire before and 6 months after surgery. Median follow- up was 22 months (range 8–48). After surgery, maximum flow (Qmax) significantly improved compared with baseline (14.17 ± 2.3 vs 27 ± 8.4 ml/s; p = 0.02), and the percentage of patients with elevated postvoid residual (PVR) significantly decreased (33.3% vs 11.1%; p = 0.001). Detrusor overactivity and bladder outlet obstruction disappeared in 73.6% and 85.7% of patients, respectively, while detrusor underactivity persisted in 66.6% of women. Twenty women (31.7%) reported stress urinary incontinence (SUI) before surgery (14 clinically evident and 6 as occult form), which persisted in only 7/20 (11%) patients following LSC, with no de novo cases. The most common preoperative symptoms were voiding symptoms, present in 42/63 (66.6%) patients, which resolved in 36 (85.7%). The overactive bladder syndrome disappeared in 60% of women, with no de novo cases. Results were reflected by a significant decrease in UDI-6 score from a median of 16 (0–45) at baseline to 5.5 (0–17) at the final follow-up (p = 0.001). The domain on storage symptoms (median 3 vs 1) and voiding symptoms (median 3 vs 1) of UDI-6 showed an improvement after surgery (p = 0.001). The urodynamic finding showed that LSC in women with advanced POP provides good functional outcomes.

The lack of precedent in transitioning from pediatric to adult care poses a challenge to providers for patients with spina bifida (SB). The purpose of this study was to summarize perceptions about best practices for the care of adult spina bifida patients. A national survey was electronically distributed to 174 urologists who are current members of the Spina Bifida Association Network and AUA Working Group on Urologic Congenitalism. De-identified voluntary responses were assessed for implementation of and barriers to interdisciplinary adult SB clinics, continuity of care, and practices for transitioning from pediatric to adult care. The response rate was 40% with urologists practicing pediatrics, genitourinary reconstruction, female pelvic medicine and general urology. Patients undergoing transition or who have transitioned were seen in a multidisciplinary clinic (14%), regular adult clinic (34%), combined adult–pediatric multidisciplinary care (20%), or pediatric multidisciplinary clinic (28%). A majority believed transitioning to adult care should occur at 18 (24%) or 21 years (22%). In the absence of acute changes, providers followed adult SB patients annually with upper tract imaging (typically renal ultrasound) and serum creatinine. Acute urologic changes were preferentially managed with urodynamic testing and cystoscopy. Providers identified a need for multidisciplinary care in adult life, with neurosurgery/neurology (87%), social work (84%), and orthopedics (73%). Potential solutions to improve the urologic care of this population suggest additional national provider resources, standardized guidelines, multidisciplinary collaboration, access to care, and an advanced-training pathway to improve care of adult patients with spina bifida.

Introduction and Objective: Urodynamic testing (urodynamics) is widely used for evaluating bladder function as a result of high detrusor compliance. This aggressive and uncomfortable test is especially difficult for children. This study aimed to determine the sensitivity of shear wave ultrasound elastography (SWE) as a new method for evaluating the biomechanical characteristics of bladder to measure the anterior bladder wall pressure in children with neurogenic bladder (NB). Materials and Methods: The present prospective clinical study was carried out on 30 children with allegedly NB and 20 healthy children as control group. These children referred to Ahwaz Golestan Hospital in 2018. After clinical evaluations, urodynamics was performed for children with NB and detrusor compliance was measured in cm/H2O. The ultrasonography of the SWE was performed on the anterior wall of the bladder (Estimated bladder capacity (EBC) 50%) for the two groups. The relationship between shear wave speed (SWS) and detrusor compliance was estimated using Pearson's correlation coefficient. Independent t-test was used to compare SWS between two groups. Results: In patients with NB, there was a significant relationship between the mean SWS of the anterior bladder wall and detrusor compliance (R = 0.89, P = 0.0001). The comparison between normal and NB groups showed that the mean SWS of the anterior bladder wall in the patients was significantly higher than the healthy group (1.88 ± 0.88 m/s vs. 0.94 ± 0.15; P = 0.0001). There was also no significant relationship between SWS, gender, age, weight, and body mass index of patients (P > 0.05). Conclusion: The results showed that SWE can be used as a useful alternative for urorodynamic testing in the evaluation of NB (bladder dysfunction) in children.

Introduction: in severe post prostatectomy stress urinary incontinence (SUI), urodynamics may not identify crucial parameters because of inadequate bladder filling. This study describes evaluation of cystometry and pressure flow study (PFS) in men where severe SUI during attempted filling necessitated application of a penile clamp to allow filling to reach cystometric capacity. Methods: we identified all men who had undergone prior radical prostatectomy from a database of patients attending for videourodynamic testing between 2012-2017. Symptom scores, bladder diary and free flow rate tests were retrieved. We evaluated the measurements of the subgroup of men with severe SUI for whom a Thomson-Walker compression clamp was utilised to enable full urodynamic evaluation. Results: 166 radical prostatectomy patients were identified. In 30 (18%), severe SUI led to incomplete filling cystometry, i.e. failure to reach cystometric capacity. Following application of the penile compression clamp, it was possible to achieve further filling in each case. Applying the clamp did not alter vesical filling or impede pressure recording. These men had a lower maximum urethral closure pressure (31.6 vs 46.5cmH2O; p

OBJECTIVES: Detrusor underactivity is diagnosed using urodynamic testing. We hypothesized that nocturia is associated with detrusor underactivity. METHODS: We performed a retrospective chart review of all women who underwent urodynamic testing at our institution between 2016 and 2018. Uroflowmetry and pressure-flow study parameters were compared between women with nocturia (≥ 2 voids/night) and without nocturia (0–1 void/night). Detrusor underactivity was diagnosed using three different criteria: Bladder voiding efficiency < 90%, bladder contractility index < 100, and a composite of three urodynamic measures (Gammie criteria). RESULTS: Of 358 women, 172 (48%) were in the nocturia group and 186 (52%) in the no nocturia group. On uroflowmetry, median postvoid residual volume was similar (20 mL) in both groups. Median maximum flow rate (15 versus 17 mL/s, p < 0.05) and average flow rate (6 mL/s versus 7 mL/s, p < 0.05) were significantly lower in the nocturia compared to the no nocturia group. During pressure-flow study, a significantly greater proportion of women with nocturia were unable to void around the catheter (30% versus 27%, p < 0.01). The overall rate of detrusor underactivity varied with the criteria used: bladder voiding efficiency (54%), bladder contractility index (41%), and Gammie criteria (7%). The rate of detrusor underactivity using bladder voiding efficiency criteria was significantly higher in the nocturia group (63% versus 48%, p < 0.01), but no significant differences were noted using the other criteria. CONCLUSION: Nocturia is associated with reduced voiding efficiency in women. The diagnosis of detrusor underactivity using urodynamics is challenging.

Introduction and hypothesis: Our aim was to compare urodynamic findings in urinary incontinent (UI) women with and without diabetes. Methods: In the extensive Lolland-Falster Health Study, women with lower urinary tract symptoms were offered urodynamic testing. After excluding 6 women with incomplete urodynamic testing and 88 women without UI, our analysis ended up including 417 women (31 with and 386 without diabetes). Student’s t-test and chi-squared test were used to compare differences of urodynamic findings. Urodynamic testing consisted of a 2-day bladder diary, post-void residual urine volume, filling cystometry, pressure-flow study, cough stress test, and uroflowmetry. Three experienced physicians in urogynecology evaluated all urodynamic findings leading to an overall conclusion of the test results. Results: Self-reported data showed that compared to incontinent women without diabetes, incontinent women with diabetes had more frequent leakage, a larger amount of leakage, and a higher ICIQ score. A positive ICS Uniform cough stress test was more prevalent in women with diabetes. There were no significant differences in other urodynamic findings or overall conclusion between the two groups. Controlling for age and BMI did not affect our findings. Conclusions: Women with diabetes complained more about UI, had a higher ICIQ score, and had a positive ICS Uniform cough stress test more often than women without diabetes. Based on these findings, we recommend to include the history of urinary incontinence in the care of women with diabetes. This sample consists of women from a comprehensive health study with different severity of UI. Therefore, it can serve as a reference cohort for future studies.

Introduction and hypothesis: We aimed to assess the validity and reliability of two Danish versions of the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) in a female population. We hypothesized that the questionnaires had good predictive validity, internal consistency, patient-physician agreement, construct validity, test-retest reliability, and sensitivity to change. Methods: To test the predictive validity, we compared the ICIQ-UI SF to urodynamics (n = 153). The same answers were used for testing the internal consistency. The patient-physician agreement was assessed by comparing the self-administered questionnaire with a physician’s evaluation based on telephone interviews (n = 60). To test the construct validity, we calculated the proportion of scores ≥ 1 in questionnaires completed by women defining themselves as “not suffering from involuntary urination” (n = 69). Test-retest reliability was assessed by comparing questionnaires completed twice with an interval of 2 weeks (n = 186). Sensitivity to change was evaluated by analyzing answers before and after treatment for women treated surgically for stress urinary incontinence (n = 755) and with botulinum type A toxin for overactive bladder (n = 63). Results: Predictive validity: 26.6–27.6% agreement. Internal consistency: Cronbach’s alpha: 0.7–0.8. Patient-physician agreement: 53.9–92.9% agreement. Some interview participants misunderstood the word “leak.” Construct validity: 19% and 23% had a total score ≥ 1. Test-retest reliability: 77.0–95.7% agreement. Sensitivity to change: Significantly lower score after treatment. Conclusion: The ICIQ-UI SF had excellent internal consistency, patient-physician agreement, test-retest reliability, and sensitivity to change. The ICIQ-UI SF had questionable predictive validity and construct validity compared to urodynamic testing. We recommend precaution in diagnostics or research based solely on the questionnaire.

Purpose To investigate the video-urodynamic and pelvic floor electrophysiological characteristics in patients with traumatic spinal cord injury. Methods This retrospective reviewed the clinical records, urodynamic and pelvic floor electrophysiological data of 647 patients with traumatic spinal cord injury (SCI) and out of spinal shock. Patients were classified based on American Spinal Injury Association (ASIA) Impairment Scale and urodynamic findings. Results Of the 647 patients, detrusor overactivity (DO) with or without detrusor sphincter dyssynergia (DSD) was found in 79.5%, 61%, 35.2%, 35%, and 19.2% of patients with cervical, thoracic (T1-9), thoracic (T10-12), lumbar, and conical cauda injury, respectively. Other patients manifested detrusor areflexia (DA). Patients with DO and/or DSD had a longer duration of SCI at each injury level than patients with DA. In suprasacral injury patients with DA, 63.0% (58/92) had a normal bulbocavernosus reflex (BCR) response. Compared with patients without bladder sensation, bladder capacity during urine leakage was far higher in those with bladder sensation. The manifestation of BCR and somatosensory-evoked potential (SEP) was associated with the level of injury. Conclusions This study showed a significant correlation between the level of SCI and video-urodynamic findings, but clinical examination cannot by predict bladder function; urodynamic testing is also necessary. In addition, the role of BCR and SEP for guiding bladder management is limited. Moreover, bladder sensation is important for urinary control in patients with traumatic SCI.

Aim This study aims to evaluate the intracorporeal pressures immediately after the insertion of the catheters for urodynamic testing with a water‐filled urodynamic pressure transducer system to determine the relevance of the International Continence Society (ICS) zeroing principles. Methods Here, a retrospective analysis of a random series of urodynamic recordings is performed. The initial pressures, immediately after the insertion of the catheters, have been compared with the pressures after some milliliters of filling and flushing away of the gel, used with insertion, and/or the mucus and debris from the inserted catheters. Differences of initially recorded intravesical and intrarectal pressures from those after flushing and filling are analyzed and associated with the ICS standard practice of zeroing. Results Statistically and clinically significant differences between the initial pressures and the pressures after filling and flushing are observed, with nonphysiological initial pressures in 62% of the studies. Some filling (20 ml or more in the bladder) and flushing of the pressure channels resulted in the registration of physiological pressures and synchronous response from both lines on abdominal pressure increases. Conclusions The pressure signal quality of a water‐filled urodynamic system immediately after catheter insertion is low with inaccurately displayed pressure values, but it changes to normal after flushing the pressure channels and some filling. Rezeroing of the intracorporeal pressures immediately after catheter insertion for cystometry is the inappropriate correction procedure that misleadingly modifies the false initial pressures, resulting in ongoing unrealistic urodynamic study pressures.

BACKGROUND: Multichannel urodynamics is the gold standard for the evaluation of lower urinary tract symptoms (LUTS). When performing studies to validate new adjuncts to urodynamic testing with control patients undergoing urodynamic investigation, there is difficulty in the interpretation of urodynamic results in the asymptomatic patient due to artifacts and the invasive nature of the procedure. The purpose of this investigation was to examine urodynamics in asymptomatic volunteers in order to better understand the role of control participants in urodynamic research studies. METHODS: Asymptomatic volunteers with no LUTS were recruited to undergo standard urodynamic testing as a comparison group in a study evaluating novel urodynamic techniques. To be eligible, participants had to report no LUTS, score ≤1 on all symptom questions of the International Consultation on Incontinence Questionnaire Overactive Bladder Module (ICIq-OAB) survey, have no medical conditions or to undergo any medications that affect bladder function. The urodynamics was done according to ICS standards. All tracings were evaluated by an expert neuro-urologist. Data were analyzed categorically for the presence or absence of low compliance (40), weak contractility (bladder contractility index [BCI]

OBJECTIVES Intact urethral support and normal sphincter function are deemed important for urinary continence. We aimed to test whether the location of urethral kinking (as the probable anatomical correlate of maximal pressure transmission) is associated with stress urinary incontinence and/or urodynamic stress incontinence. METHODS This was a retrospective study of women seen at a tertiary urogynecological center in 2017. Patients had undergone an interview, multichannel urodynamic testing and four-dimensional translabial ultrasound examination. Those with a history of anti-incontinence surgery, absence of urethral kinking on ultrasound and/or missing or inadequate ultrasound volume data were excluded. Volume data were used to assess urethral mobility using a semi-automated Excel® urethral motion profile program. Mobility vectors were calculated using the formula √((x valsalva - x rest )2 + (y valsalva - y rest )2 ), where x and y are the coordinates of six equidistant points along the length of the urethra from the bladder neck to the external urethral meatus. The location of urethral kinking was identified as a concave contour of the urethra on the vaginal side in the midsagittal plane on maximum Valsalva maneuver. The distance between the center of the kink and the bladder neck was measured and expressed as a centile in relation to the total length of the urethra, using the formula: (distance from bladder neck/total length of urethra) × 100. Univariate and multivariate analyses were performed to test the associations of stress urinary incontinence and urodynamic stress incontinence with age, maximum urethral pressure, urethral mobility vectors and location of urethral kinking. RESULTS Of 450 women seen during the study period, 61 were excluded owing to previous incontinence surgery and 82 owing to absence of urethral kinking, inadequate volume data or missing data, leaving 307 women included, of whom 227 (74%) complained of stress urinary incontinence and 211 (69%) complained of urgency urinary incontinence. 190 (62%) of the women were diagnosed with urodynamic stress incontinence. On multivariate analysis, maximum urethral pressure (36 vs 50 cmH2 O; P

AIMS Mitochondrial diseases present with a spectrum of clinical features, usually with multiorgan involvement and are often characterized by a loss of smooth muscle function. Hence, we hypothesized that mitochondrial dysfunction may contribute to lower urinary tract (LUT) dysfunction. METHODS We performed a prospective cohort study at a single, quaternary, mitochondrial disease referral center, enrolling consecutive adult patients with genetically confirmed mitochondrial disease. Data regarding baseline characteristics and disease burden were gathered. LUT dysfunction was assessed using the International Consultation on Incontinence Modular Questionnaire-Lower Urinary Tract Symptoms (ICIQ-LUTS) questionnaire, bladder voiding efficiency (BVE), and bladder diaries. Patients with one or more features of LUT dysfunction were offered urodynamic testing. RESULTS A total of 109 patients were included. Twenty-six percent of patients manifested at least one feature of LUT dysfunction, which was objectively confirmed in all 14 patients who consented to urodynamic investigation. Disease burden, defined by the Newcastle Mitochondrial Disease Adult Scale (NMDAS), demonstrated a linear relationship with ICIQ-LUTS severity (P = .01), with a statistically significant relationship between NMDAS-gastrointestinal scores and LUTS scores (P

AIMS To assess whether routine urodynamic testing (UDT) in women undergoing slings for uncomplicated stress urinary incontinence (SUI) has decreased following publication of the landmark VALUE study, which recommended against routine UDT in uncomplicated SUI. METHODS We identified women in the Virginia All Payers Claims Database diagnosed with SUI between 2011 and 2016 using International Classification of Disease (ICD) codes (N39.3, 625.6). Appropriate ICD/CPT (current procedural terminology) codes were used to exclude non-index patients (prior anti-incontinence/prolapse surgery, urge incontinence, neurogenic bladder). Beta regression was used to assess for changes in the monthly proportion of urethral slings with preoperative UDT. Interventional ARIMA modeling was used to assess for a relationship between the date of VALUE (The Value of Urodynamic Evaluation) publication and the incidence of slings with preoperative UDT. RESULTS Analysis identified 6740 women with SUI undergoing sling placement, with 343 non-index patients excluded. Of 6397 remaining women, 4026 (62.9%) underwent preoperative UDT. The annual number of slings with preoperative UDT declined from 748 to 402 between 2011 and 2016. Beta regression analysis demonstrated a decrease in the proportion of slings with preoperative UDT over the study (68%, 2011; 58%, 2016), with a statistically significant decrease in the proportion of slings with UDT after May 2012 (β coefficient, -.0093; P

BACKGROUND Urinary dysfunction is common in Parkinson's disease (PD) patients and management options are limited. OBJECTIVE This study aimed to explore the management of urinary dysfunction by researching the special needs of PD patients. METHODS PD patients with urinary dysfunction who underwent urodynamic testing were recruited from a single center from October 2013 to February 2019. The urinary symptoms, International Prostate Symptom Score and Hoehn-Yahr scale were evaluated. Management was made at the urologists' discretion with follow-up after three weeks. Urinary symptoms, urodynamics and the management of urinary dysfunction were analyzed. RESULTS A total of 187 patients with a median age of 66.2 and Hoehn-Yahr scale soccer of 2 were enrolled. Irritative symptoms were more common than obstructive symptoms, while obstructive symptoms were more common in male than female patients, except for incomplete voiding. There were 51% cases of detrusor overactivity, followed by 33% with bladder outlet obstruction, 13% had normal function, 12% had detrusor underactivity, 9% had stress incontinence, 7% had increased bladder sensation and 4% had an acontractile bladder. Tolterodine and tamsulosin were the most common therapeutic agents, respectively prescribed to 38.5% and 27.3% of the patients. Other treatments included catheterization, botulinum toxin A bladder wall injection, transurethral resection of the prostate and urethral dilatation. Urinary symptoms were improved significantly in 74.5% of the patients (p

Objective To determine the relationship between subcutaneous fat, visceral fat surface area (VFA), bladder wall fat distribution, and visceral adiposity index (VAI) as risk factors for overactive bladder (OAB) occurrence. Patients and Methods A cross-sectional study involved 157 participants was conducted. The participants were divided into 2 groups; study group (87 patients diagnosed with OAB) and control group (70 healthy participants). All participants were evaluated for OAB using short-form OABSS version. Physical examination including waist circumference (WC) measurement in addition to metabolic laboratory investigations (eg, High density lipoprotein (HDL), cholesterol, etc) were done. Study group underwent urodynamic testing. Using noncontrast spiral CT abdomen and pelvis, trunkal fat measurements and bladder wall fat distribution were detected. VAI was calculated for both females and males. Univariate and multivariate analyses were done to detect risk factors for OAB occurrence. Correlation between all factors and total OABSS and urodynamics was done. Results The mean age ± SD was 40.4 ± 9 years. In multivariate analysis, increased VFA, higher cholesterol level, increased VAI and focal fat distribution at bladder wall were associated with 9.4, 1.98, 5.5, and 1.6 times higher risk for OAB occurrence. VAI and VFA were strongly correlated with total OABSS, DLPP, amplitude, and frequency of bladder detrusor contractions. On the other hand, WC and body mass index were not correlated significantly. Conclusion Body mass index and WC are crude inaccurate methods correlated with OAB presence. Focal bladder wall fat distribution, higher VAI, higher VFA are novel risk factors for OAB occurrence. Both VAI and VFA are correlated significantly to total OABSS and urodynamics findings in patients with OAB.

Purpose: Wolfram syndrome is a neurodegenerative disorder characterized by childhood onset diabetes mellitus, optic nerve atrophy, diabetes insipidus, hearing impairment, and commonly bladder and bowel dysfunction. We hypothesized that there is an association between a smaller pons, which contains the pontine micturition center, and abnormal lower urinary tract function.Materials and Methods: Patients with genetically confirmed Wolfram syndrome attended an annual multidisciplinary research clinic. Subjects underwent noninvasive urodynamic testing and brain magnetic resonance imaging, and completed validated patient reported outcome measures. Bowel and bladder diaries were completed before visits. Age and gender corrected linear and logistic mixed effects models were used to correlate pons volume, corrected for whole brain size, to urodynamic and patient reported outcomes.Results: A total of 36 patients attended 142 visits between 2010 and 2016. Mean age was 16.9 years (range 7 to 30) and 64% of patients w...

AIMS: To capture in-depth qualitative evidence regarding attitudes to and experiences of urodynamic testing among men with lower urinary tract symptoms (LUTS) at each end of the clinical pathway.METHODS: Semi-structured interview study conducted within the Urodynamics for Prostate Surgery: Randomized Evaluation of Assessment Methods (UPSTREAM) trial, which randomized men to a care pathway including urodynamics or routine non-invasive tests from 26 secondary care urology sites across England. Men were interviewed after assessments but prior to treatment, or after surgery for LUTS. Men were purposively sampled to include those who had urodynamics and those who did not, and diversity in demographic characteristics and symptom burden. Interviews were analyzed using inductive thematic analysis.RESULTS: Forty-one men participated (25 pre-treatment, 16 post-surgery), ages 52-89. The 16 men who had not previously experienced urodynamics said they would accept the test in their assessment, but some were apprehensive or wanted more information. The 25 men who had experienced urodynamics all found it acceptable, though some reported pain, infection, or embarrassment. Embarrassment was minimized by informing patients what the procedure would be like, and ensuring privacy. Urodynamics was valued for its perceived diagnostic insight. Information deficits were reported before, during, and after the test. How and when results were explained and the adequacy of explanations varied.CONCLUSIONS: Urodynamics is acceptable to men with LUTS and generally well-tolerated. To ensure patients are prepared and informed, good communication before and during the procedure is essential. Privacy should be prioritized, and test results discussed promptly and in sufficient detail. Staff require training and guidance in these areas.

AIM: To investigate if Multiple Sclerosis (MS) lesion characteristics affect functional brain connectivity (FC) during bladder voiding. METHODS: Twenty-seven ambulatory female patients with MS completed our functional magnetic resonance imaging (fMRI)/urodynamic testing (UDS) platform. Individual fMRI activation maps were generated at initiation of voiding. FC patterns of these regions were calculated and compared. Similarity of the FC pattern from one patient relative to all others was expressed by a parameter FC_sim. A statistical analysis was performed to reveal the relationship of the existence of an enhancing brain lesion, the size of the largest lesion and the ability to void spontaneously to this FC similarity measure. RESULTS: FC_sim values were significantly lower for patients with an enhancing MS lesion (11.7 ± 3.1 vs 5.3 ± 2.1 P < 0.001). Lesion size smaller than 20 mm inversely correlated significantly with FC_sim (R = −0.43, P = 0.05). Patients with the ability to void spontaneously had a higher FC_sim value (12.0 ± 2.8 vs 9.3 ± 4.4 s, P = 0.08). Patients that exhibited a decrease of compliance also showed a significantly lower FC_sim value (11.3 ± 3.5 vs 4.7 ± 0.7, P < 1e-5). CONCLUSION: FC connectivity analysis derived from an fMRI task-based study including repetitive voiding cycles is able to quantify the heterogeneity of connectivity patterns in the brain of MS patients. FC similarity decreased with maximum lesion size or the presence of enhancing lesions affecting the ability to void spontaneously.

Aims To assess the state of technologies for urodynamics that are less invasive than standard cystometry and pressure-flow studies and to suggest areas needing research to improve this. Methods A summary of a Think Tank debate held at the 2019 meeting of the International Consultation on Incontinence Research Society is provided, with subsequent analysis by the authors. Less-invasive techniques were summarized, classified by method, and possible developments considered. Discussions and recommendations were summarized by the co-chairs and edited into the form of this paper by all authors. Results There is a full spectrum of technologies available for less-invasive assessment, ranging from simple uroflowmetry through imaging techniques to emerging complex technologies. Less-invasive diagnostics will not necessarily need to replace diagnosis by, or even provide the same level of diagnostic accuracy as, invasive urodynamics. Rather than aiming for a technique that is merely less invasive, the priority is to develop methods that are either as accurate as current invasive methods, or spare patients from the necessity of invasive methods by improving early triaging. Conclusions Technologies offering less-invasive urodynamic measurement of specific elements of function can be potentially beneficial. Less-invasive techniques may sometimes be useful as an adjunct to invasive urodynamics. The potential for current less-invasive tests to completely replace invasive urodynamic testing is considered, however, to be low. Less-invasive techniques must, therefore, be tested as screening/triaging tools, with the aim to spare some patients from invasive urodynamics early in the treatment pathway.

INTRODUCTION The quality of urodynamic measurements in clinical practice has been debated as a matter of concern. It is considered plausible that this has a direct bearing on patient care and the perceived value of urodynamic testing. METHODS This is a report of the proceedings of the Think Tank: "Is the value of urodynamics undermined by poor technique?" from the Annual International Consultation on Incontinence-Research Society, which took place in June 2018 in Bristol, UK. The Think Tank discussed the evidence for deficiencies in urodynamic test quality and considered the implications of improvements for clinical diagnosis and practice. RESULTS There is evidence that technique affects urodynamic quality, and that urodynamic practice is variable. Factors such as team skill set, technologies used, and training received will also affect the quality of urodynamic service. Questions exist regarding the influence of technique on the utility and perceived value of urodynamics. CONCLUSIONS We suggest research questions that will provide the necessary evidence on the link between technique, reporting, and outcome, and clarify the role of good practice in the utility of urodynamic testing.

The cough stress test is a common and accepted tool to evaluate stress urinary incontinence but there is no agreement on how the test should be performed. We assessed the diagnostic ability of different cough stress tests performed when varying patient position and bladder volume using urodynamic stress urinary incontinence as the gold standard. The 24-hour pad test was also evaluated.We recruited women who presented to specialty outpatient clinics with the complaint of urinary incontinence and who were recommended to undergo urodynamic testing. A total of 140 patients were randomized to 4 cough stress test groups, including group 1-a comfortably full bladder, group 2-an empty bladder, group 3- a bladder infused with 200 cc saline and group 4-a bladder filled to half functional capacity. The sequence of standing and sitting was randomly assigned. The groups were compared by 1-way ANOVA or the generalized Fisher exact test. The κ statistic was used to evaluate agreement between the sitting and standing positions. The 95% CIs of sensitivity and specificity were calculated using the Wilson method. ROC analysis was done to evaluate the performance of the 24-hour pad test.The cough stress test performed with a bladder filled to half functional capacity was the best performing test with 83% sensitivity and 90% specificity. There was no statistically significant evidence that the sensitivity or specificity of 1 cough stress test differed from that of the others. The pad test had no significant predictive ability to diagnose urodynamic stress urinary incontinence (AUC 0.60, p = 0.08).Cough stress tests were accurate to diagnose urodynamic stress urinary incontinence. The 24-hour pad test was not predictive of urodynamic stress urinary incontinence and not helpful when used in conjunction with the cough stress test.