Changes in bladder volumes with repetition of water cystometry

Sørensen, Steen; Nielsen, Jimmi; Nørgaard, Jens Peter; Knudsen, L.; Djurhuus, J. C.

doi:10.1007/bf00256804

Cited by 55 publications

(39 citation statements)

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“…Our reference standard, UDS, has been shown to have less than perfect reproducibility in previous studies in patients with OAB 106,107 and also in healthy women. 108,109 When estimating the test accuracy of BWT against an imperfect reference standard (UDS), the accuracy of BWT may have been biased to an unknown degree, or submerged in the 'noise' from the imperfect reference standard. However, the poor accuracy for BWT elicited in our study is unlikely to have been entirely caused by misclassifications made by UDS, as there was no significant relationship between BWT measurements and grades of DO severity or subsequent treatment responses (see Chapter 6).…”

Section: Concerns About the Reference Standardmentioning

confidence: 99%

“…Previous studies have described parasagittal measurements of BWT at three places on the bladder wall, with the calculation of an average BWT. 41,109 In one study, DWT instead of BWT was measured by transperineal scanning. 51 The rest of the studies have used transabdominal scanning at various bladder volumes, but we rejected this technique on account of the greater reported interobserver variation.…”

Section: Variation In Technique Of Transvaginal Bladder Wall Scanningmentioning

confidence: 99%

“…In previous urodynamic trials that evaluated the reproducibility of UDS in healthy patients and patients with OAB, inconsistency between serial urodynamic procedures were a common finding. [106][107][108][109] In a multicentre study with serial UDS in patients with OAB, there was increased variability in pressure measurements than volume measurements. 209 Using an imperfect test as a reference standard may underestimate the test accuracy of our index test, but not to the point of finding no relationship at all, as occurred in the BUS.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

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Bladder ultrasonography for diagnosing detrusor overactivity: test accuracy study and economic evaluation

Rachaneni

McCooty

Middleton

et al. 2016

Health Technol Assess

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BackgroundUrodynamics (UDS) has been considered the gold standard test for detrusor overactivity (DO) in women with an overactive bladder (OAB). Bladder ultrasonography to measure bladder wall thickness (BWT) is less invasive and has been proposed as an alternative test.ObjectivesTo estimate the reliability, reproducibility, accuracy and acceptability of BWT in women with OAB, measured by ultrasonography, in the diagnosis of DO; to explore the role of UDS and its impact on treatment outcomes; and to conduct an economic evaluation of alternative care pathways.DesignA cross-sectional test accuracy study.Setting22 UK hospitals.Participants687 women with OAB.MethodsBWT was measured using transvaginal ultrasonography, and DO was assessed using UDS, which was performed blind to ultrasonographic findings. Intraobserver and interobserver reproducibility were assessed by repeated measurements from scans in 37 and 57 women, respectively, and by repeated scans in 27 women. Sensitivity and specificity were computed at pre-specified thresholds. The smallest real differences detectable of BWT were estimated using one-way analysis of variance. The pain and acceptability of both tests were evaluated by a questionnaire. Patient symptoms were measured before testing and after 6 and 12 months using the International Consultation on Incontinence modular Questionnaire Overactive Bladder (short form) (ICIQ-OAB) questionnaire and a global impression of improvement elicited at 12 months. Interventions and patient outcomes were analysed according to urodynamic diagnoses and BWT measurements. A decision-analytic model compared the cost-effectiveness of care strategies using UDS, ultrasonography or clinical history, estimating the cost per woman successfully treated and the cost per quality-adjusted life-year (QALY).ResultsBWT showed very low sensitivity and specificity at all pre-specified cut-off points, and there was no evidence of discrimination at any threshold (p = 0.25). Extensive sensitivity and subgroup analyses did not alter the interpretation of these findings. The smallest detectable difference in BWT was estimated to be 2 mm. Pain levels following both tests appeared relatively low. The proportion of women who found the test ‘totally acceptable’ was significantly higher with ultrasonography than UDS (81% vs. 56%;p < 0.001). Overall, subsequent treatment was highly associated with urodynamic diagnosis (p < 0.0001). There was no evidence that BWT had any relationship with the global impression of improvement responses at 20 months (p = 0.4). Bladder ultrasonography was more costly and less effective than the other strategies. The incremental cost-effectiveness ratio (ICER) of basing treatment on the primary clinical presentation compared with UDS was £491,500 per woman successfully treated and £60,200 per QALY. Performing a UDS in those women with a clinical history of mixed urinary incontinence had an ICER of £19,500 per woman successfully treated and £12,700 per QALY compared with the provision of urodynamic to all women. For DO cases detected, UDS was the most cost-effective strategy.ConclusionThere was no evidence that BWT had any relationship with DO, regardless of the cut-off point, nor any relationship to symptoms as measured by the ICIQ-OAB. Bladder ultrasonography has no diagnostic or prognostic value as a test in this condition. Furthermore, despite its greater acceptability, BWT measurement was not sufficiently reliable or reproducible.Trial registrationCurrent Controlled Trials ISRCTN46820623.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 20, No. 7. See the NIHR Journals Library website for further project information.

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Section: Concerns About the Reference Standardmentioning

confidence: 99%

Section: Variation In Technique Of Transvaginal Bladder Wall Scanningmentioning

confidence: 99%

Section: Strengths and Limitationsmentioning

confidence: 99%

See 1 more Smart Citation

Bladder ultrasonography for diagnosing detrusor overactivity: test accuracy study and economic evaluation

Rachaneni

McCooty

Middleton

et al. 2016

Health Technol Assess

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“…The test is also included in outcome measures of clinical trials [6, 7, 8, 9]. Although cystometry has been documented to be reproducible in asymptomatic individuals [10, 11], this may not be the case in symptomatic patients [12, 13, 14, 15, 16]. …”

Section: Introductionmentioning

confidence: 99%

Reproducibility of Cystometry in Overactive Detrusor

Homma

Kondo²,

Takahashi³

et al. 2000

European Urology

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“…Este fato pode ter ocorrido, possivelmente, pela variação individual da sensibilidade vesical, uma vez que a infusão da solução fisioló-gica só era suspensa quando a paciente referisse desejo miccional imperioso ou dor. Sorensen et al 21 , em 1984, encontraram variações do volume tanto na primeira sensação vesical, quanto na capacidade vesical máxima em pacientes submetidos a quatro cistometrias realizadas em diferentes momentos, variando-se apenas a taxa de infusão ou a posição da paciente. Alterações dos parâmetros sensoriais vesicais podem acontecer por variações individuais e, entre outros motivos, pelo fato de que contrações involuntárias do detrusor são mais facilmente deflagradas com a paciente em posição ortostática que em decúbito dorsal 22 .…”

Section: Discussionunclassified

Urodinâmica convencional versus cistometria simplificada para caracterização da incontinência urinária feminina

Kawano¹,

Amaro²,

Silva³

et al. 2004

Rev. Bras. Ginecol. Obstet.

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RESUMO Objetivo: avaliar a concordância dos diferentes parâmetros urodinâmicos comparados à cistometria simplificada, permitindo uma diminuição na relação custo-benefício no diagnóstico da incontinência urinária de esforço (IUE) na mulher. Métodos: foram coletadas e avaliadas retrospectivamente as informações contidas dos prontuários de trinta pacientes acompanhadas, no período de janeiro de 2000 a março de 2001. Todas foram submetidas a exame físico geral e ginecológico. O estudo urodinâmico foi realizado pela técnica convencional, utilizando-se aparelho Dynograph Recorder R-611. A cistometria simplificada foi realizada com auxílio de um equipo em "Y" de PVC (pressão venosa central), conectado a um sonda de Foley 14 F, que permitia tanto a infusão de soro fisiológico como a captação da pressão intra-vesical. Foram analisados os parâmetros: volume residual, capacidade vesical, complacência, presença de contrações involuntárias do detrusor e perdas urinárias aos esforços. Para determinação da proporção de concordância entre os métodos foram utilizados o teste de concordância de Pearson e o teste de (p < 0,01). A média de capacidade vesical máxima no estudo urodinâmico foi de 440,5 ml, enquanto que, na cistometria simplificada, foi de 387 ml (p < 0,05 13,14 . Avaliações preliminares sugerem que a propedêutica uroginecológica, associada à cistometria, é opção a ser considerada na avaliação clínica e pré-operatória de pacientes com IUE em substituição à urodinâmica convencional, particularmente onde esta última não se encontra disponível. Trata-se de exame acessível e de considerável sensibilidade para a detecção de contrações vesicais involuntárias, além de proporcionar ao examinador noções fidedignas da complacência vesical e da atividade vesical 6,7 . Este trabalho tem por objetivo avaliar a concordância dos diferentes parâmetros urodinâmicos em relação à cistometria simplificada, bem como determinar suas limitações quando comparada à urodinâmica convencional. Pacientes e MétodosForam coletadas e avaliadas retrospectivamente as informações contidas dos prontuários de trinta pacientes acompanhadas no Serviço de Uroginecologia do Hospital das Clínicas da Faculdade de Medicina da Botucatu -UNESP, no perío-do de janeiro de 2000 a março de 2001. Tais pacientes eram portadoras de incontinência uriná-ria de esforço, caracterizada por perdas urinárias aos mínimos esforços como tossir, espirrar ou durante atividades físicas leves como subir escadas ou caminhar depressa. Tais queixas foram confirmadas pela demonstração objetiva da perda urinária durante o exame físico, solicitando-se à paciente que realizasse a manobra de Valsalva. Todas as pacientes foram submetidas a exame físi-co e ginecológico completos, estudos urodinâmicos e cistométricos. Nenhuma delas havia sido submetida à cirurgia prévia para tratamento de incontinência urinária.O estudo urodinâmico foi realizado pela téc-nica habitual, com a paciente em decúbio dorsal, empregando-se aparelho Dynograph Recorder R-611. Inicialmente foi realizada fluxometria obt...

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Changes in bladder volumes with repetition of water cystometry

Cited by 55 publications

References 4 publications

Bladder ultrasonography for diagnosing detrusor overactivity: test accuracy study and economic evaluation

Bladder ultrasonography for diagnosing detrusor overactivity: test accuracy study and economic evaluation

Reproducibility of Cystometry in Overactive Detrusor

Urodinâmica convencional versus cistometria simplificada para caracterização da incontinência urinária feminina

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