Importance of urodynamic testing prior to treatment for overactive bladder in women

Abstract

Introduction. Overactive bladder (OAB) is a common and chronic complex of symptoms that increases in prevalence with advancing age and has a known adverse effect on the quality of life. OAB is a highly prevalent condition affecting 16.6% people from Europe. Women are more commonly affected, and there is an increased incidence with age. Studies in the United States suggest a prevalence of up to 43% in women. The use of urodynamics in the diagnosis of OAB remains controversial. Although it is a gold standard diagnostic test for detrusor overactivity, it is an invasive procedure and therefore should be limited to those with refractory OAB. Material and methods. A prospective and randomized study was performed in 60 patients with OAB symptoms who followed behavioral therapy without any effect. The study cohort was divided in two groups. 30 patients (group A) with the mean age of 40 years were treated without a prior urodynamic study, and 30 patients (group B) with a mean age of 41.5 years with overactive detrusor, underwent a urodynamic testing prior to pharmacotherapy based on EAU guidelines that recognize the benefit from addition of Mirabegron 50 mg/day to Solifenacin 5 mg/day, and on the AUA guidelines that recommends combination therapy in patients with OAB. The study was performed during 2019-2022, at the Department of Urology and Surgical Nephrology, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova. Results. The success rate (61%) in the group A of patients was lower than in group B (81%). The proportion of patients who had urge urinary incontinence (UUI) (OAB wet) rather than frequency-urgency (OAB dry) in this series was high (50%), and this may have been a significant factor in our success rate. According to the results of the questionnaire, the clinical manifestations have improved after treatment, however in 50% of cases of urinary frequency and in 20% of urinary urgency remained unchanged. The symptomatology and urodynamic did not display different behavior between the groups. The mean post-treatment score for group A was 11.7±3.27 and for group B was 15.32±2.14. Ten subjects (8 receiving pharmacotherapy from group A and 2 from group B) presented with adverse events. The most frequent reported adverse events were dry mouth (15%), dyspepsia (6%), and headache (9%). Other than dry mouth, no adverse event occurred in >10% of subjects. Conclusions. Urodynamics can influence the treatment decisions in determining treatment pathways in women presenting with OAB. Women treated based on UDS diagnoses appear to have greater reductions in symptoms than those who do not.