Urodynamic Classification of Patients With Symptoms of Overactive Bladder

Abstract

No AccessJournal of UrologyCLINICAL UROLOGY: Original Articles1 Feb 2003Urodynamic Classification of Patients With Symptoms of Overactive Bladder ADAM J. FLISSER, KONSTANTIN WALMSLEY, and JERRY G. BLAIVAS ADAM J. FLISSERADAM J. FLISSER , KONSTANTIN WALMSLEYKONSTANTIN WALMSLEY , and JERRY G. BLAIVASJERRY G. BLAIVAS View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)63948-1AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We describe a new classification of patients with overactive bladder symptoms. Materials and Methods: The office records of 132 patients who presented for evaluation of symptoms of urinary frequency, urinary urgency and/or urge incontinence, and who underwent videourodynamics were identified. All patients completed a 24-hour voiding diary and 24-hour pad test. Data collection included age, sex, hormone status, number of voids and incontinence episodes per 24 hours, functional bladder capacity, pad weight and associated genitourinary conditions. Videourodynamics were reviewed and patients were divided into 4 clinical categories, including type 1—no evidence of involuntary detrusor contractions on videourodynamics, type 2—involuntary detrusor contractions present, and patient aware and able to abort them, type 3—contractions present, patient aware and able to contract the sphincter but not abort contractions and type 4—contractions present and patient unaware but unable to contract the sphincter or abort contractions. Results: Average patient age ± SD was 64 years ± 13. There were an average of 13 ± 5 voids and 3 ± 5 incontinence episodes per 24 hours. Average functional bladder capacity was 306 ± 146 cc and average pad weight was 94 ± 165 gm. Associated diagnoses included benign prostatic hypertrophy in 28% of cases, sphincteric incontinence in 17%, idiopathic urge incontinence in 29% and uterovaginal or bladder prolapse in 17%. Another 11% of patients had bladder outlet obstruction, impaired detrusor contractility or neurogenic bladder conditions. Of the cases 72 (55%), 32 (25%), 23 (17%) and 5 (4%) were categorized as classes 1 to 4, respectively. ANOVA revealed no statistically significant differences in the number of voids or incontinence episodes, functional bladder capacity or pad test when individual categories were compared to each other. Conclusions: This overactive bladder classification stratifies patients according to degrees of awareness, and control of bladder and sphincter function. It may prove useful as a guide for prognosis and therapy. Patients can be stratified into clinical groups based on the presence or absence of involuntary detrusor contractions, the ability to abort contractions and the ability to contract the urinary sphincter in response to contractions. Limiting the definition of overactive bladder to apply only to patients with no proved infection or other pathological condition would have eliminated more than 75% of those in this sample with symptoms of urinary urgency, frequency and/or urge incontinence. References 1 : The standardisation of terminology of lower urinary tract function: report from the Standardisation Subcommittee of the International Continence Society. Neurourol Urodyn2002; 21: 167. Google Scholar 2 Flisser A.J., Blaivas J.G.: The role of cystometry in evaluating patients with overactive bladder. Unpublished data Google Scholar 3 : Involuntary detrusor contractions: correlation of urodynamic data to clinical categories. Neurourol Urodyn2001; 20: 249. 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A prospective randomized urodynamic study. Neurourol Urodyn2001; 20: 141. Google Scholar From the Departments of Obstetrics and Gynecology and Urology, Joan and Sanford Weill College of Medicine, Cornell University, Brady Department of Urology, New York Presbyterian Hospital, Weill Cornell Medical Center and Department of Urogynecology, Lenox Hill Hospital, New York, New York© 2003 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byBlaivas J, Marks B, Weiss J, Panagopoulos G and Somaroo C (2009) Differential Diagnosis of Overactive Bladder in MenJournal of Urology, VOL. 182, NO. 6, (2814-2818), Online publication date: 1-Dec-2009.ROSENBERG L, GRIFFITHS D and RESNICK N (2018) FACTORS THAT DISTINGUISH CONTINENT FROM INCONTINENT OLDER ADULTS WITH DETRUSOR OVERACTIVITYJournal of Urology, VOL. 174, NO. 5, (1868-1872), Online publication date: 1-Nov-2005.WYNDAELE J, VAN MEEL T and DE WACHTER S (2018) DETRUSOR OVERACTIVITY. DOES IT REPRESENT A DIFFERENCE IF PATIENTS FEEL THE INVOLUNTARY CONTRACTIONS?Journal of Urology, VOL. 172, NO. 5, (1915-1918), Online publication date: 1-Nov-2004.CHOU E, FLISSER A, PANAGOPOULOS G and BLAIVAS J (2018) Effective Treatment for Mixed Urinary Incontinence with a Pubovaginal SlingJournal of Urology, VOL. 170, NO. 2, (494-497), Online publication date: 1-Aug-2003. Volume 169Issue 2February 2003Page: 529-534 Advertisement Copyright & Permissions© 2003 by American Urological Association, Inc.Keywordsclassificationurination disordersurodynamicsbladderMetricsAuthor Information ADAM J. FLISSER More articles by this author KONSTANTIN WALMSLEY More articles by this author JERRY G. BLAIVAS Financial interest and/or other relationship with Eli Lilly, Pharmacia and Yamanovchi. More articles by this author Expand All Advertisement PDF downloadLoading ...