Study of Patients With Lower Urinary Tract Dysfunction Undergoing Urodynamic Examination for the Assessment of Quality, Cost and Treatment Success

Study Overview
=================
Brief Summary
-----------------
Lower urinary tract dysfunction (LUTD) is a very common complication of urological, gynecological, neurological, metabolic, inflammatory or tumor disease. LUTD is not an inevitable condition, the investigators can help in many ways. Modern clinical examinations like urodynamics allow for patient tailored treatment strategies. Urodynamics however, even if minimal invasive, may lead to urinary tract infections and are very expensive4. Aim of this study is to evaluate in the long-term perspective what patients profit of urodynamic examinations and in what patients the investigators could resign to perform urodynamics in the future and or in what patients the interval of urodynamics could be extended. Main objective is to follow in a long-term prospective cohort study, patients suffering of lower urinary tract dysfunction (LUTD). In this observational study the investigators will include all patient undergoing clinical routine urodynamic examination to better address what is the normal course of LUTD with and without Treatment. The aim is to have a prospective urodynamics database allowing to answer questions related to urodynamics.

Detailed Description
-----------------
Patients with a clinical indication for routine urodynamic assessment will be included in to this prospective cohort study. All standard urodynamic results as well as the treatment decision will be collected. Patients undergoing repeated urodynamic measurements i.e. spinal cord injured patients with yearly assessments will each time be included allowing for long-term and follow up analysis of both disease progress and therapy success. Bladder function is rather simple: storage and voiding of urine. The control of the urinary bladder on the other hand is very complex with many areas that still remain unclear, as for example the cross play of the central and and autonomous nervous system. Voiding of the bladder is an active process that is controlled by nervous impulses from the central nervous system. The detrusor muscle is contracted, and the urethral sphincter muscle is relaxed at the same time so that the urine can be drained off. Uroflow examination in combination with post-void residual assessment (by sonography or catheterization) are a simple but powerful screening tool to evaluate bladder function. Since both the uroflow as well as the post-void residual are dependent on the detrusor pressure and the infravesical resistance they do not allow for differentiation between hypocontractile detrusor muscle and infravesical obstruction or a combination of both. To do so, the minimal invasive Urodynamic examination is needed. Cystomanometry for the assessment of the bladder storage phase and a pressure-flow for the assessment of the voiding phase. By a thin transurethral catheter, body warm fluid is filled in to the bladder and at the same time is the intravesical and abdominal pressure traced with a computer system. The pelvic floor muscle activity (i.e. the urethral sphincter muscle) is assessed at the same time using EMG surface electrodes. For Video-Urodynamics, Contrast agent is mixed in to the body warm infusion solution allowing to judge bladder configuration (i.e. diverticula or trabeculation) and if there is vesico-uretero-renal reflux. Patients with a clinical indication for routine urodynamic assessment will be included in to this prospective cohort study. All standard urodynamic results as well as the treatment decision will be collected. Patients undergoing repeated urodynamic measurements i.e. spinal cord injured patients with yearly assessments will each time be included allowing for long-term and follow up analysis of both disease progress and therapy success. Except for urinary tract infections, are complications in urodynamic measurements very rare. The investigators estimate additional complications (like pain or autonomic dysreflexia) in about 1% of urodynamic examinations. To have a minimum of 50 complications, the investigators aim to include about 5000 urodynamic examinations for reliable numbers of each complication, ideally allowing for subgroup analysis. All patients undergoing clinical routine urodynamic examination will be included, i.e. per year approximately 500 urodynamic measurements and 450 patients (some patients will have multiple measurements per year). With the aim of 5000 included urodynamic examinations the investigators estimate a study duration of 10 years. This has the advantage that the investigators will also have a meaningful average follow-up of at least 5 years or more in patients undergoing annual urodynamic measurements (e.g. spinal cord injured patients). Descriptive statistics: Data will be presented on interval-scales with median and quartiles or with means and standard deviations summarized. Dichotomic variables will be presented as ratios and percentages. Univariate analysis: t-test will be used to compare means between groups and Chi-Square for the comparison of dichotomic variables. Multivariate analysis: To assess the distribution of initial parameters the investigators will use multivariate regression models.

Official Title
-----------------
Prospective Cohort Study of Patients With Lower Urinary Tract Dysfunction Undergoing Urodynamic Examination for the Assessment of Quality, Cost and Treatment Success

Conditions
-----------------
Urodynamics, Lower Urinary Tract Symptoms, Neurogenic Bladder

Intervention / Treatment
-----------------
* Diagnostic Test: Video-Urodynamics


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Participants fulfilling all of the following inclusion criteria are eligible for the study: Female and male patients, age >18 years Informed consent Lower urinary tract symptoms Planned clinical routine urodynamic examination Exclusion Criteria: The presence of any of the following exclusion criteria will lead to exclusion of the participant: Age <18 years Pregnancy or breast feeding Individuals especially in need of protection (according to Research with Human Subjects published by the Swiss Academy of Medical Sciences https://www.samw.ch/en/Publications/Medical-ethical-Guidelines.html) No informed consent Patients incapable to follow the trial, e.g. because of language problems, psychiatric disorders, dementia and so on.

Ages Eligible for Study
-----------------
Minimum Age: 18 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Neurogenic lower urinary tract dysfunction<br>Lower urinary tract dysfunction due to any neurological condition like spinal cord injury, multiple sclerosis and others. | Diagnostic Test: Video-Urodynamics<br>* Minimal invasive Urodynamic examination: Cystomanometry for the assessment of the bladder storage phase and a pressure-flow for the assessment of the voiding phase. By a thin transurethral catheter, body warm fluid is filled in to the bladder and at the same time is the intravesical and abdominal pressure traced with a computer system. The pelvic floor muscle activity is assessed at the same time using EMG surface electrodes.<br>|
| Non-Neurogenic lower urinary tract dysfunction<br>Lower urinary tract dysfunction in absence of any neurological pathology. | Diagnostic Test: Video-Urodynamics<br>* Minimal invasive Urodynamic examination: Cystomanometry for the assessment of the bladder storage phase and a pressure-flow for the assessment of the voiding phase. By a thin transurethral catheter, body warm fluid is filled in to the bladder and at the same time is the intravesical and abdominal pressure traced with a computer system. The pelvic floor muscle activity is assessed at the same time using EMG surface electrodes.<br>|
| Chronic pelvic pain<br>Chronic pelvic pain as defined by the EAU guidelines. | Diagnostic Test: Video-Urodynamics<br>* Minimal invasive Urodynamic examination: Cystomanometry for the assessment of the bladder storage phase and a pressure-flow for the assessment of the voiding phase. By a thin transurethral catheter, body warm fluid is filled in to the bladder and at the same time is the intravesical and abdominal pressure traced with a computer system. The pelvic floor muscle activity is assessed at the same time using EMG surface electrodes.<br>|
| Urodynamic normal Bladder function<br>Normal urodynamic findings and absence of chronic pelvic pain. | Diagnostic Test: Video-Urodynamics<br>* Minimal invasive Urodynamic examination: Cystomanometry for the assessment of the bladder storage phase and a pressure-flow for the assessment of the voiding phase. By a thin transurethral catheter, body warm fluid is filled in to the bladder and at the same time is the intravesical and abdominal pressure traced with a computer system. The pelvic floor muscle activity is assessed at the same time using EMG surface electrodes.<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of voids per 24 hours | Number of voids per 24 hours | At the urodynamic assessment, up to 24 hours | 
| Number of leakages per 24 hours | Number of leakages per 24 hours | At the urodynamic assessment, up to 24 hours | 
| Number of used pads per 24 hours | Number of used pads per 24 hours | At the urodynamic assessment, up to 24 hours | 
| Post void residual (mL) | Residual urine remaining in the bladder after voiding. | At the urodynamic assessment, up to 10-30 minutes | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Cystometric capacity (mL) | Measured in mL in urodynamics | At the urodynamic assessment, up to 10-30 minutes | 
| Compliance (mL/cmH2O) | Measured in mL/cmH2O in urodynamics | At the urodynamic assessment, up to 10-30 minutes | 
| Bladder volume (mL) at detrusor overactivity | Measured in mL in urodynamics | At the urodynamic assessment, up to 10-30 minutes | 
| Maximum detrusor pressure amplitude (cmH2O) at detrusor overactivity | Measured in cmH2O in urodynamics | At the urodynamic assessment, up to 10-30 minutes | 
| Detrusor leak point pressure (cmH2O) | Measured in cmH2O in urodynamics | At the urodynamic assessment, up to 10-30 minutes | 
| Maximum detrusor pressure (cmH2O) during storage phase | Measured in cmH2O in urodynamics | At the urodynamic assessment, up to 10-30 minutes | 
| Maximum detrusor pressure (cmH2O) during voiding phase | Measured in cmH2O in urodynamics | At the urodynamic assessment, up to 10-30 minutes | 
| Detrusor pressure at maximum flow | Measured in urodynamics | At the urodynamic assessment, up to 10-30 minutes | 
| Scores in Qualiveen & International Prostate Symptom Score (IPSS) |  | At the urodynamic assessment, up to 10-30 minutes | 
| Scores in Female Sexual Function Index (FSFI) or International Index of Erectile Function (IIEF) |  | At the urodynamic assessment, up to 10-30 minutes | 
| Number of patients with adverse events grade 1 bis 5 following the National Cancer Institute terminology Vers. 4 (Common Terminology Criteria for Adverse Events (CTCAE) |  | At the urodynamic assessment, up to 10-30 minutes | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
Urodynamics, Lower Urinary Tract Symptoms, Neurogenic Bladder