How should bladder sensation be measured?: ICI‐RS 2011

Abstract

AimsDisturbed bladder sensations, or in broader terms, sensory dysfunctions are increasingly recognized as key elements in the origin and manifestation of symptom syndromes of urinary dysfunction. Adequate assessment of bladder sensation is crucial to improve our understanding of the pathophysiology and treatment of urinary dysfunction. This manuscript summarizes the discussions of a think tank on “How to measure bladder sensation” held at the ICI‐RS meeting in 2011.MethodsBased upon literature reviews on bladder sensation presented at the think tank in the ICI‐RS meeting, discussions evolved which were summarized in the ICI‐RS report. Different physicians/researchers further elaborated on this report, which is presented in this manuscript.ResultsBladder sensations are not merely the result of bladder distension. Other factors inside the bladder or bladder wall: central processing and/or cognitive manipulation may play an important role. Current methods to measure sensations such as urodynamics, voiding diaries, forced diuresis, electrical stimulation and brain imaging are likely sub‐optimal as they only consider part of these factors in isolation.ConclusionsDifferent methods to measure bladder sensations have been described and are used in clinical practice. Current methods only address part of the parameters responsible for the generation and perception of urinary sensations. Further focused research is required, and several recommendations are provided. Neurourol. Urodynam. 31:370–374, 2012. © 2012 Wiley Periodicals, Inc.

Saccharin increases perception of bladder filling in a forced diuresis experiment

“…Bladder sensation can be generated by physiological (sensation of bladder filling, urge or the desire to void, and sensation during micturition), and pathologic (urgency and pain) processes . The current established description of three episodic sensations—(i) first sensation of filling; (ii) first desire to void described as a constant sensation gradually becoming more intense; and (iii) strong desire to void, a constant localized sensation to the perineal region or the urethra to void—does not reconcile with the theory that progressive increase in afferent information and constantly growing sensations occurs with progressive bladder filling at a constant rate . Further, these symptoms are poor discriminators of physiology versus pathology.…”

“…The bladder sensation‐logging tool used in this study employed a water loading protocol, which achieves a high diuresis with rapid, non‐invasive bladder filling . It is a simple and non‐invasive approach to identifying, recording, and quantifying sensation associated with bladder filling and voiding, based on subjective interpretation without relying on the use of pre‐determined terminology from the researcher.…”

“…Finding an effective objective way to measure perceived urinary sensation, is subjective and has been of great interest . The recently developed bladder sensation tool, is a simple approach to identify, record, and quantify sensations associated with bladder filling and voiding in an objective and reproducible way.…”

Quantification of bladder wall biomechanics during urodynamics: A methodologic investigation using ultrasound

“…Tension-sensitive afferent nerves in the bladder wall convey fullness sensation to the brain (Morrison, 1999), while bladder compliance affects the tension sensor load during filling (De Wachter et al, 2012). Bladder compliance has been shown to depend on shape (Damaser and Lehman, 1995).…”

Assessing multiple dimensions of urgency sensation: The University of South Australia Urinary Sensation Assessment (USA2)

“…In contrast, participants in a study by Heeringa et al reported sensation induced by forced diuresis (focal period “right now”). It is possible that sensation generated by rapid bladder filling differs from usual sensation . Furthermore, participants in the study by Heeringa et al were required to wait until their bladders were full before voiding and “tingling” described sensation experienced in the perineal region when the bladder was very full.…”