Cough associated detrusor overactivity in women with urinary incontinence

Abstract

Aims This is the first study that attempts to define different forms of cough associated detrusor overactivity (CADO). Current literature lacks clarity regarding the types of CADO and clinical epidemiology. Methods Retrospective review of all adult women who underwent urodynamics for urinary incontinence (UI) over 7 years. Patients were stratified into four types: I, leak with CADO; II, leak with cough; III, leak with both; IV, leak with neither. Cough spike immediately preceding detrusor overactivity was defined as index cough. Stress leak occurring with any cough was classified as type II, not limited to the index cough that triggered the CADO. Statistical analysis by R statistical program (version 3.1.3). Results Of 7009 studies, urodynamics was performed in 174, 290, and 874 women with clinical urgency, stress and mixed UI during the study period. CADO was noted in 29 (2.2%) (median 52 y; IQR 14 y) including six urgency UI, two stress UI, and 21 mixed UI (P = 0.102;n.s.). Types I–IV CADO was noted in 15, 5, 8, and 1 women, respectively. Type III was most bothersome (Patient Perception of Bladder Condition score 5; P = 0.049) and had the longest duration of CADO contraction (39.6 s IQR 20.3 s; P = 0.041). Types II (0.9 s) and III (2.0 s) had shorter latency of onset compared with type I (2.8 s, IQR 1.7 s; P = 0.038). Concluding Message CADO is a heterogeneous entity. Subtle differences in presentation suggest distinct mechanisms for different forms of CADO. Recognizing different types of CADO introduces a precision into the subject that could ultimately benefit both clinicians and researchers.

Effectiveness of onabotulinumtoxin A for refractory overactive bladder with cough‐associated detrusor overactivity

“…No standard treatment exists for CADO. Sinha et al 8 classified UDS results with CADO into four categories as incontinence associated with I: CADO (UUI), II: with cough (SUI), III: with both cough and CADO (mixed UI), and IV: with neither, and discussed the differences between them. For type II CADO associated with SUI, Koonings et al reported resolution of CADO after surgery for SUI.…”

“…For type II CADO associated with SUI, Koonings et al reported resolution of CADO after surgery for SUI. 7 For Type I cases, Sinha et al 8 stated that surgery for SUI is inappropriate and management with a refractory OAB regimen is logical, but there are no reports of actual treatment. Although our patient complained of incontinence during Pabd, UI due to type I CADO indicated UUI.…”

“…Although CADO is increasingly recognized, its characteristics remain unclear. One report of UDS in female patients with UI reported CADO prevalence of 2.2%, 8 whereas in another study of UDS in 1737 women with refractory OAB, 34.3% had a positive stress test and 38.7% had DO 9 . Those patients were tested for the diagnosis of refractory OAB, so a positive stress test may have indicated UI associated with CADO.…”

“…reported resolution of CADO after surgery for SUI 7 . For Type I cases, Sinha et al 8 . stated that surgery for SUI is inappropriate and management with a refractory OAB regimen is logical, but there are no reports of actual treatment.…”

Prevalência de incontinência urinária e fatores associados em mulheres internadas em uma unidade cirúrgica de hospital público

“…Quanto ao relato de rinite e sinusite, as mesmas apresentaram associação com os sintomas de bexiga hiperativa pelo ICIQ-OAB (p = 0,03). Isto pode ser ocasionado pela tosse ou espirros como resultado do aumento da pressão intra-abdominal e de uma contração do detrusor, o que leva a IU [32].…”