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Could a small bladder be predictive of detrusor overactivity in patients with overactive bladder symptoms?
IUGA Academy. Rajshekhar S. Jun 30, 2018; 212978
Topic: Overactive Bladder
Smita Rajshekhar
Smita Rajshekhar

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Could a small bladder be predictive of detrusor overactivity in patients with overactive bladder symptoms?

Rajshekhar, S1; Thiagamoorthy, G1; Flint, R1; Robinson, D1; Cardozo, L1

1: King's College Hospital, London

Introduction: Overactive bladder(OAB) affects 12.8%1 women and has a significant impact on quality of life, sleep, and mental health.Improved clinical evaluation could minimise inappropriate management.

Objective: To establish a relationship between reduced bladder capacity and detrusor overactivity(DO).

Methods: 740 women with OAB symptoms, were evaluated with a 3-day bladder diary, King’s Health Questionnaire and urodynamics (UDS). Bladder capacity of £ 300 ml was considered to be low. Incidence of DO was compared in patients with a low maximum functional capacity(MFC) recorded on the bladder diary and patients with a normal MFC. Similar analysis was performed for incidence of DO in patients with a low maximum cystometric capacity(MCC) during filling cystometry and a normal MCC.

Results: 26.7% of patients with a low MFC had DO, as compared to 19.4% patients with a normal MFC but this difference was not statistically significant (Chi Square test, p= .067). However, the incidence of DO was significantly higher in patients with a reduced MCC compared with a normal MCC (35.3% and 18.1% respectively, p= .00007). 30% of the patients with OAB symptoms were found to have urodynamic stress incontinence. Age, BMI, parity and menopausal status were similar in the compared groups.

Table 1. Bladder capacity and Urodynamic findings

Normal UDS

n(%)

DO

n(%)

Stress Incontinence

n(%)

Mixed Urinary Incontinence

n(%)

MFC £ 300 ml

40 (30.5)

35 (26.7)

34 (25.9)

22 (16.7)

MFC > 300 ml

165 (30.6)

105 (19.4)

162 (30.0)

107 (19.8)

MCC £ 300 ml

32 (32.2)

35 (35.3)

14 (14.1)

18 (18.1)

MCC > 300 ml

202 (31.5)

116 (18.1)

211 (32.9)

111 (17.3)

Conclusion: 1 in 4 patients with OAB symptoms and a reduced MFC on bladder diary will have DO. We would recommend urodynamics in all patients with OAB symptoms before commencing anticholinergics or expensive, invasive treatment.

References:

  1. Irwin DE, Milsom I, Hunskaar S. Population based survey of urinary incontinence, overactive bladder and other lower urinary tract symptoms in five countries: results of the EPIC study. Eur Urol 2006;50(6):1306-1315.

Disclosure:

Work supported by industry: no. A consultant, employee (part time or full time) or shareholder is among the authors (astellas allergan congenetix ferring boston ).

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