MP89-08 UNDERACTIVE BLADDER IS NOT A SYMPTOM COMPLEX

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Non-Neurogenic Voiding Dysfunction1 Apr 2015MP89-08 UNDERACTIVE BLADDER IS NOT A SYMPTOM COMPLEX Melissa Laudano, Matthew Benedon, Michael Stern, and Jerry Blaivas Melissa LaudanoMelissa Laudano More articles by this author , Matthew BenedonMatthew Benedon More articles by this author , Michael SternMichael Stern More articles by this author , and Jerry BlaivasJerry Blaivas More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1807AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Detrusor underactivity (DU) is defined by the ICS as a detrusor contraction of reduced strength and/or duration, resulting in prolonged bladder emptying and/or (residual urine), however they did not elaborate nor provide any metrics. The term “underactive bladder” has recently been suggested as the clinical correlate of DU. We sought to determine whether DU can be defined by a clinical symptom complex analogous to that for overactive bladder (OAB) symptoms. METHODS This is a retrospective, IRB-approved review of patients with a urodynamic diagnosis of DU defined by a bladder contractility index (BCI) < 100. Bladder outlet obstruction was defined by a bladder outlet obstruction index (BOOI) > 40. For patients with a urodynamic diagnosis of BOO we defined DU if the product of detrusor contraction time and Qavg of 12 mL/S was < 90% of bladder capacity; ie, the bladder did not contract long enough to empty. Patients with an acontractile detrusor (AD) during urodynamics were considered to possibly have underactive detrusor. The data was analyzed two ways – by both including and excluding patients with an AD to assess the minimum and maximum incidence of UAB in our cohort. Patient symptoms were characterized using the lower urinary tract symptom score (LUTSS) and its sub-scores. Urodynamic data, including detrusor pressure at maximum flow ([email protected]), maximum detrusor pressure (pdetmax), detrusor contraction duration, maximum flow (Qmax), and post void residual (PVR) were collected. The affected cohort of patients was compared to a control group consisting of patients with a urodynamic diagnosis of bladder outlet obstruction (BOO). The two groups were compared using a student t-test. RESULTS Of 4,272 consecutive patients the incidence of DU was 12%, AD 12%, and BOO 21%. The LUTSS questionnaires were completed in 392 patients. See table 1 for complete comparison data between both cohorts. In this cohort, the possible range of DU was 12% (DU alone) to 24% (DU + AD). Aside from urodynamic criteria and PVR, the only differences between DU and BOO was a higher incidence of OAB symptoms in the latter, however, both groups had a high incidence of OAB. CONCLUSIONS DU, unlike OAB, is a urodynamic diagnosis, not a clinical one. There is no symptom complex that correlates with UAB; rather, it should be based on urodynamics and PVR. Table 1. Characteristics of DU vs. BOO populations DU BOO P-Value Number (men/women) 120 (30/90) 152 (138/14) Age 69.86±11.45 68.10±12.55 0.22 LUTSS 25.47±9.02 22.90±11.46 0.94 Voiding Score 7.81±2.93 7.76±4.88 0.06 Storage Score 15.68±8.22 13.06±17.18 0.12 OABSS 13.48±6.37 11.75±5.90 0.02 Incontinence Score 3.81±3.47 2.39±2.93 0.18 Qmax (ml/s) 6.61±6.70 6.78±12.33 0.93 PVR (ml) 269.81±299.35 12.41±35.47 <0.0001 [email protected] (mm H2O) 11.37±19.41 42.42±35.00 <0.0001 © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e1102-e1103 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Melissa Laudano More articles by this author Matthew Benedon More articles by this author Michael Stern More articles by this author Jerry Blaivas More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Topic: Urinary Bladder and Prostate Research
Subfield: Urology
Field: Medicine
Domain: Health Sciences