3 articles
Detrusor overactivity has been detected in approximately 50% of women with overactive bladder symptoms. According to the NICE guidelines, urodynamic testing is mandatory confirm the diagnosis of detrusor overactivity before performing minimally invasive treatment.
This study retrospectively analyzes 76 women, categorized into two groups based on age: reproductive age (n = 49) and climacteric period (n = 27), referred to the Timofei Moșneaga Republican Clinical Hospital between 2022 and 2024 for symptoms of overactive bladder. The research focused on physical examination, questionnaires, bladder diary, urinalysis, and urodynamic measurements before and after botulinum toxin type A injections in 30 patients with overactive bladder refractory to first-line therapy.
In women with overactive bladder, the reproductive group was as follows: moderate problems (51%) > very severe problems (31%), severe problems (18%) (p = 0.02); in the group of women in the climacteric period: severe problems (48%) > very severe problems (37%) > moderate problems (15%) (p = 0.10). Based on urodynamics data, the diagnosis of overactive bladder with detrusor overactivity was confirmed by establishing the presence of phasic contractions of the detrusor (3.9 ± 1.15), increased values of detrusor pressure (45.9 ± 23.9 cmH2O) and reduced bladder compliance (10.4 ± 11.4 ml/cmH2O). In 100% of cases, these findings predicted an effective botulinum toxin type A injection. Daytime urinary frequency, nocturia, and urinary urgency scores improved significantly after botulinum toxin type A injection by 41.7%, 26.1% and 34.1%, respectively.
The study revealed age differences in overactive bladder symptom severity between the women in both groups. The reproductive period group experienced moderate complications, while the climacteric period group had more severe complications. Administration of botulinum toxin type A through detrusor injection has been shown to be efficacious in the management of overactive bladder.
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.
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.
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.
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.
The aim of study was to establish if the treatment of overactive bladder in women and its result reported by patients were different depending on the findings of urodynamics, performed before botulinum toxin injection. We obtained clinical data based on the necessity and importance of performing urodynamic tests up to surgical treatment with botulinum toxin A injection in detrusor muscle, at patients diagnosed with idiopathic overactive bladder and detrusor overactivity, offering a guarantee of an effective and long-lasting treatment and assure with predictive parameters for some postoperative complications.
The research was carried out at the Department of Urology and Surgical Nephrology, during the years 2019 – 2022. After applying the inclusion and exclusion criteria, 36 women diagnosed with overactive bladder were enrolled in the prospective pilot study, aged between 18 and 70 years, refractory to drug treatment and investigated urodynamic by excluding/including the presence of detrusor overactivity and clinically using voiding diary/24h, bladder symptoms and Quality of Life questionnaires before and after botulinum toxin A injection. The primary data were analyzed and presented as a mean and standard deviation.
All women involved in the study were diagnosed clinically and urodynamic with overactive bladder, of which 55.5% of cases were associated with detrusor overactivity and subsequently received BTX-A injectable surgical treatment with a dose of 100U. At urodynamics, the low values of the indices obtained at cystometry were established: first sensation of bladder filling (79.8±56.3 ml), first desire to void (117.8±103.2 ml), strong desire to void (162±125 ml) and maximal cystometric capacity (183.4±139.8 ml), which correlated in 100% cases with OAB symptoms (urinary urgency, frequency and nocturia) from the OABSS validated questionnaire. The capacity of the bladder at each sensation was lower, being inversely proportional to the detrusor overactivity present in women with OAB. Based on UDS data, the diagnosis of OABi with detrusor overactivity was confirmed by establishing the presence of phasic detrusor contractions (3.9±1.1), increased values of detrusor pressure (45.9±23.9 cmH2O) and the presence of bladder hypocompliance (10.6±11.5 ml/cmH2O), these data in 100% of cases predicted an effective BTX-A injection. Daily activity and psychosocial behavior improved after intradetrusor botulinum injections toxin was influenced by reducing daytime urination from 28% to 40% and urinary urgency from 30 to 69%.
This study identified a number of statistically significant urodynamic variables associated with objective clinical data, which confirm the impact of severity of idiopathic overactive bladder symptoms and the subsequent effect of botulinum toxin type A injections in case of urodynamic confirmation of detrusor overactivity presence.