URODYNAMIC FINDINGS IN FEMALE PATIENTS REPORTING WITH LOWER URINARY TRACT SYMPTOMS
AbstractObjective: The study has been undertaken to determine the reproducibility of lower urinary tractsymptoms in female patients after urodynamic investigations. Design: A Descriptive study withretrospective analysis of data. Setting: Combined Military Hospital Rawalpindi and Armed ForcesInstitute of Urology, Rawalpindi. Methods: Fifty consecutive women with a primary history ofurinary incontinence were interviewed on a standard urinary incontinence questionnaire. Theyunderwent structured clinical pelvic examination, along with cough stress test. Post void residualurine was measured. This was followed by a urine routine examination to exclude any urinaryinfection. Later these patients underwent a combination of urodynamic tests to predict their finaldiagnosis. The tests performed were filling cystometry and leak point pressures. Results: Theclinical diagnosis was found to have a variable reproducibility on urodynamic investigations.Clinical stress incontinence translated as genuine stress incontinence in 61.5% of the cases.Patients with isolated symptoms of stress incontinence had an incidence of detrusor instability upto 33.3%. For the symptoms of urgency and urge incontinence, the diagnosis was reproducible inup to 50% of the cases. In cases of mixed symptoms, 20% patients were found to have stressincontinence and 33.3% cases were found to have an unstable bladder, whereas in 46.6% of thecases no objective abnormality was found on urodynamic investigations. Conclusion:Urodynamic investigations should be performed in female patients with lower urinary tractsymptoms, especially if irreversible procedure, e.g., surgery is being contemplated.Keywords: Urinary incontinence, stress incontinence, cystometry, leak point pressure, urinary tract
Lemack GE. Urodynamic assessment of patients with stress
incontinence: how effective are urethral pressure profilometry
and abdominal leak point pressures at case selection and
predicting outcomes? Curr Opin Urol 2004;14(6):307–11.
Fantl JA, Newman DK, Colling J, DeLancey JOL, Keeys C,
Loughery R, et al. Urinary incontinence in adults: acute and
chronic management. Clinical practice guideline, No. 2, 1996
Update. Rockville, MD: US Department of Health and Human
Services. Public Health Service, Agency for Health Care Policy
and Research. AHCPR publication No.96-0682 March 1996.
Handa VL, Jensen JK,Ostergard DR. Federal guideline for
management of urinary incontinence in United States: Which
patient should undergo urodynamic testing. Int Urogynecol J
Pelvic Floor Dysfunct 2001;12:31–7.
Moolgoaker AS, Ardran GM, Smith JC. The diagnosis and
management of urinary incontinence in the female. J Obstet
Gynaecol Br Commw 1972;79:481–97.
Richardson DA. Use of Vaginal pressure measurements in
urodynamic testing. Obstet Gynecol 1985;66:581–4.
AL-Taher H, Sutherst JR, Richmond DH. Vaginal pressure as
an index of intra abdominal pressure during urodynamic
evaluation. Br J Urol 1987;59:529–32.
Weld KJ, Dmochauski RR. Association of injury and bladder
behaviour in patients with post traumatic spinal cord injury.
Brown K, Hilton P. Ambulatory monitoring. Int Urologynaecol
Homma Y, Kondo Y, Takahashi S. Reproducibility of
cystometry in overactive detrusor. Eur Urol 2000;38:681–5.
Blairas JG, GroutzA, Verhaaren M. Does the method of
cystometrey affect the incidence of involuntary detrusor
contraction? A prospective randomized urodynamic study.
Neurourol Urodyn 2001;20:141–5.
Miklos Jr, Sze EH M, Karram MM. A critical appraisal of
methods of measuring leak-point pressure in women with stress
incontinence. Obstet Gynecol 1995;86:349–52.
11. Bump RC, Elser DM, Theofrastous JP. Valsalva leak point
pressures in women with genuine stress incontinence:
reproducibility, effect of catheter caliber and correlations with
other measures of urethral resistance. Am J Obstet Gynecol
Moore KH, Simonsa A, Mukerjee C. The relative incidence of
detrusor instability and bacterial cystitis detected on the
urodynamic test day. Br J Urol 2000;87:786–92.
Khan MS, Chaliha C, Leskova L, Khullar V. The relationship
between urinary symptoms questionnaire and urodynamic
diagnosis: an analysis of two methods of questionnaire
administration. BJOG 2004;111:468–74.
Swift SE, Ostrergard DR, Evaluation o0f current Urodynamic
testing methods in the diagnosis of genuine stress incontinence.
Obstet Gynecol 1995;86:85–91.
Clarke B. The role of Urodynamic assessment in the diagnosis
of lower urinary tract disorders. Int Urogynecol J Pelvic Floor
Roongruangslip U, Lertisithchai P, Kochakarn W, RatanaOlarn K. Correlation between symptoms and urodynamic
findings in Thai female patients with urinary incontinence.
Med Assoc Thai 2005;88:364–70.
Fukui J, Nakama M. The role of urodynamic study in female
patients with urinary incontinence. Hinyokika Kiyo
Lagro-Janssen AL, Debruyne FM, Vanweel C. Value of
patient’s case history in diagnosing urinary incontinence in
general practice. Br J Urol 1991;67:569–72.
Giner Santamaria C, Galiano Baena JF, Caballero Romeu JP,
Leivar Tamayo A, Belvis Esclapes V, Lobato Encinas JJ.
Urodynamic findings in patients older than 65 years:
experience in the department 19 of the health care area of
Valencia (HCAV). Arch Esp Urol 2007;60:656–63.
Barrero R, Mir P, Cavuela A, Campoy P, Pena JM, Alberca R.
Urinary symptoms and urodynamic findings in Parkinson’s
disease. Neurolgia 2007;22(2):93–8.