2 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.
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.