Reproducibility of same session repeated cystometry and pressure‐flow studies in women with symptoms of urinary incontinence

Broekhuis, Suzan R.; Kluivers, Kirsten B.; Hendriks, Jan C.M.; Massolt, Elske T.; Groen, Jan; Vierhout, Mark E.

doi:10.1002/nau.20783

Cited by 29 publications

(34 citation statements)

References 12 publications

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“…We disagree with the authors of earlier studies who did not recommend repeat urodynamic testing [25] because we consider the fluctuations in the functional behaviour of the bladder during the filling phase as a real influence on symptoms, especially in the nonneurological cases. In this respect, the documentation and reproduction of low-amplitude IDC, which might be associated with rUTI or symptoms of nonbacterial cystitis, may be difficult, and an increase in the amount of infusion fluid may be required to document bladder overactivity and to maximize its detection [27].…”

Section: Discussioncontrasting

confidence: 89%

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Involuntary Detrusor Contraction Is a Frequent Finding in Patients with Recurrent Urinary Tract Infections

Rodrigues

Hering²,

Campagnari³

2014

Urol Int

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Objective: To check whether subtle voiding dysfunction is related to recurrent urinary tract infection (rUTI). Methods: 254 consecutive patients with at least four episodes of urinary tract infection (UTI) were studied. At least three repeat urodynamic evaluations with an additional ice water test to maximize the detection of involuntary detrusor contraction (IDC) were used. Stress urinary incontinence cases were used as controls. Nonparametric univariate and multivariate analyses were used for statistics. Results: IDC was detected in 83.6% of patients in the rUTI group and in 31.7% in the control group. IDC was <15 cm H₂O in 54.7% whereas high-amplitude (>50 cm H₂O) IDC was observed in 6.8% in the rUTI group. Female urinary tract obstruction was diagnosed in 16.8% of patients in the rUTI group and in 7.9% in the control group. Residual volume, P_detQ_max and Q_max were not predictive of UTI recurrence. Symptoms were similar in both groups. Conclusions: Patients with rUTI present with covert bladder dysfunctions represented by detrusor overactivity.

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Section: Discussioncontrasting

confidence: 89%

“…As demonstrated by Broekhuis et al [25] and others [26], urodynamic testing has a good to excellent internal consistency for many studied parameters (internal consistency: 0.72-0.93); however, the volume and amplitude of IDC were poorly reproduced (0.18 and 0.25, respectively).…”

Section: Discussionmentioning

confidence: 85%

Involuntary Detrusor Contraction Is a Frequent Finding in Patients with Recurrent Urinary Tract Infections

Rodrigues

Hering²,

Campagnari³

2014

Urol Int

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“…105 When the accuracy of the reference standard is unknown, or known to be imperfect, estimates of the sensitivity and specificity or AUC for new diagnostic tests will be biased as misclassifications in the reference standard diagnosis will have been misattributed to errors made by the index test. 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.…”

Section: Concerns About the Reference Standardmentioning

confidence: 95%

“…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%

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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“…We excluded patients with neurologic diagnoses to minimize the risk of impaired perceptual processes contaminating the reliability of sensory volume thresholds. Both urodynamic results [19]and sensation reporting [20] show good reliability, and potential problems with inter-or intra-observer reliability were avoided by using only data obtained in the original history and interpretation of each urodynamic study.…”

Section: Pol Scientificmentioning

confidence: 99%

Underactive bladder and detrusor underactivity represent different facets of volume hyposensitivity and not impaired contractility

Smith

Pregenzer

Galffy

et al. 2015

Bladder

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OBJECTIVES:Underactive bladder (UAB) and detrusor underactivity (DU) are receiving increasing clinical and research attention. Although lacking a formalized definition, UAB is described as a symptom complex, while DU is a standardized statement of urodynamic function. Both terms nominally suggest impaired detrusor contractility leading to disordered emptying. We sought to evaluate the relationship between UAB, DU and detrusor contractility. METHODS:A chart review of 256 urodynamic records from clinical practice was conducted. Data about symptoms and urodynamic performance were extracted and analyzed, comparing measures of sensory and motor function among groups based on symptoms and urodynamic observations. RESULTS:One hundred and ninety eight complete urodynamic studies met ad hoc defined criteria for inclusion. UAB is specific (0.90) for, but not sensitive (0.22) to, DU. Increased post-void residual volume is common to both UAB and DU, but neither is associated with impaired contractility as measured by Watts factor. Patients with UAB and DU demonstrate higher sensation volume thresholds than do those without these symptoms or observations. CONCLUSIONS:The symptom complex of UAB is not a reliable predictor of the urodynamic observation of DU, and neither condition is associated with a diminished Watts factor. Our results suggest that UAB and DU are typically disorders of volume hyposensitivity rather than of impaired contractility, and may differ in their relationship to bladder perceptions. Thus, these terms should not be used interchangeably.

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Reproducibility of same session repeated cystometry and pressure‐flow studies in women with symptoms of urinary incontinence

Cited by 29 publications

References 12 publications

Involuntary Detrusor Contraction Is a Frequent Finding in Patients with Recurrent Urinary Tract Infections

Involuntary Detrusor Contraction Is a Frequent Finding in Patients with Recurrent Urinary Tract Infections

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

Underactive bladder and detrusor underactivity represent different facets of volume hyposensitivity and not impaired contractility

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