Moving Beyond the Bladder Diary: Does New Technology Now Allow Us to Take Investigation of LUTS Into the Community? ICI-RS 2024.

Context: Lower Urinary Tract Symptoms (LUTS) are defined by their distressing effect on patients' day-to-day life. Given the pressures on secondary care resources, LUTS may be overlooked or inadequately assessed and therefore patients may be burdened for an extended period before treatment.

Methods: In a debate held at the International Consultation on Incontinence Research Society (ICI-RS) meeting in Bristol in June 2024, we considered how new technologies might contribute to an expedited, dignified and effective investigation of LUTS.

Is the time right for a new initiative in mathematical modeling of the lower urinary tract? ICI-RS 2023.

Introduction: A session at the 2023 International Consultation on Incontinence - Research Society (ICI-RS) held in Bristol, UK, focused on the question: Is the time right for a new initiative in mathematical modeling of the lower urinary tract (LUT)? The LUT is a complex system, comprising various synergetic components (i.e., bladder, urethra, neural control), each with its own dynamic functioning and high interindividual variability.

Detrusor contractility in post-menopausal women: Impact of ageing, complaint and urodynamic diagnosis.

Introduction: Detrusor contractility (DC) can have a considerable impact on the management oflower urinary tract symptoms (LUTS). However, it is currently impossible to predict, based on clinical data alone, which woman has an impaired DC. Our aim was to determine if DC, assessed by projected isovolumetric pressure-1 (PIP1) and VBN contractility parameter k, was associated with age, main complaint, and urodynamic diagnosis in a population of older women.

Can we improve our diagnosis of impaired detrusor contractility in women? An ICI-RS 2019 proposal.

Introduction: Widely accepted consensus terminology and calculations of detrusor contractility in females do not exist but may be useful. We report the output of a proposal session at the International Consultation on Incontinence Research Society meeting 2019, addressing the title topic.

Methods: Three formal presentations and a lively discussion addressed several questions including: which is the optimal cutoff value of female bladder voiding efficiency during uroflow to suspect obstruction or detrusor underactivity? Is there a definition of pure underactive and pure obstructed voiding in females? Is there a place to distinguish those relatively obstructed from those relatively underactive females especially in those cases of equivocal obstruction? Current measures of contractility were reviewed for their usefulness in women.

Is the value of urodynamics undermined by poor technique?: ICI-RS 2018.

Introduction: The quality of urodynamic measurements in clinical practice has been debated as a matter of concern. It is considered plausible that this has a direct bearing on patient care and the perceived value of urodynamic testing.

Methods: This is a report of the proceedings of the Think Tank: "Is the value of urodynamics undermined by poor technique?" from the Annual International Consultation on Incontinence-Research Society, which took place in June 2018 in Bristol, UK.

Are there different patterns of detrusor overactivity which are clinically relevant? ICI-RS 2018.

Introduction: Different patterns of detrusor overactivity (DO) have been described and included in several standardization terminology documents. However, it is unclear if these different patterns have any clinical significance.

Methods: This is a report of the proceedings of Proposal 3: "Are there different patterns of detrusor overactivity which are clinically relevant?" from the annual International Consultation on Incontinence-Research Society (ICIRS) meeting, which took place from 14 to 16 June 2018, in Bristol, UK.

How can we better manage drug-resistant OAB/DO? ICI-RS 2018.

Aims: Botulinum toxin A (BTX-A), sacral nerve stimulation (SNM), and posterior tibial nerve stimulation (PTNS) are established treatments for idiopathic overactive bladder (OAB) refractory to oral drug therapy. At the ICI-RS meeting in Bristol in 2018 a think tank was convened to address the question of how to better manage drug-resistant OAB/DO (detrusor overactivity).

Methods: The think tank conducted a literature review and an expert consensus meeting focusing on the evidence for predicting response and adverse events (AEs) with the current therapies for drug-resistant idiopathic OAB.

Comparison of bladder voiding efficiency in women when calculated from a free flow versus an intubated flow.

Objectives: To assess the reproducibility of bladder voiding efficiency (BVE, Void%) between free flow (FF) and intubated flow (IF) and to correlate BVE measurements with urinary incontinence (UI) complaints and urodynamic (UDS) findings in women.

Methods: UDS recordings of women referred for LUTD evaluation to our UDS center were reviewed. Each file included FF at arrival, filling cystometry, and IF.

What research is needed to validate new urodynamic methods? ICI-RS2017.

Aims: In recent years urodynamic innovations, although well researched, have failed to follow a standardized development pathway specifically in terms of clinical trials undertaken to demonstrate efficacy. This was discussed at the International Consultation on Incontinence Research Society (ICI-RS) in Bristol, United Kingdom, 2017 with the aim of defining minimum standards for future urodynamic research.

Methods: The recent recommendations from the IDEAL (innovation, development, exploration, assessment, and long-term study) collaboration regarding surgical research were reviewed.

Are nomograms based on free uroflows helpful to evaluate urethral obstruction in men?

Aims: It was demonstrated earlier that reduced maximum flow-rate (Q ) during intubated flow (IF) in women may be the consequence of a urethral reflex. Over-estimation of outflow obstruction is the consequence. Our hypothesis, that a similar phenomenon could occur in men, is tested using results of a free uroflow (FF) preceding an IF to eventually correct the Abrams-Griffiths (AG) number.

Can we define and characterize the aging lower urinary tract?-ICI-RS 2015.

The prevalence of lower urinary tract (LUT) symptoms increases with age but the etiology is unknown. This article aims to identify research directions that clarify the basis of this association. The initial question is whether biological age is the variable of interest or a time-dependent accumulation of factors that impact on LUT function at rates that differ between individuals.

Recommendations for future development of contractility and obstruction nomograms for women. ICI-RS 2014.

Aims: At present, existing bladder outlet obstruction (BOO) nomograms for women are still not universally accepted. Moreover, only limited information is available regarding bladder contractility in women. The aim is to present the discussions and recommendations from the think tank session "Can we construct and validate contractility and obstruction nomograms for women?" held at the 2014 International Consultation on Incontinence-Research Society (ICI-RS) meeting in Bristol, UK.

VBN-based nomograms provide critical voiding parameters which can be used for invasive or non-invasive flow interpretation of women at risk of obstruction over time.

Aims: To design a simple office-based method to evaluate characteristic parameters from free uroflowmetries (FF) or pressure flow studies (PFs). This method can be applied by any physician to any recording, for instance in the follow-up of women at risk of developing outflow obstruction over time after surgical interventions.

Method: Using pressure-flow studies (PFs), a reliable evaluation of urethral obstruction (U) and detrusor contractility (k) parameters could be obtained from the maximum flow rate and detrusor pressure at maximum flow rate.

Detrusor after-contraction: a new insight.

Aims: Detrusor after-contractions (DAC) are non-common in adults. Both definition (nothing in ICS reports) and significance (artefact, link with detrusor overactivity (DO) or bladder outlet obstruction (BOO)) remain discussed. Our purpose was to carry out an analysis of the urodynamic parameters during voidings with DAC and, using the VBN model, to simulate pathophysiological conditions able to explain both voiding phase and DAC.

Contribution of behavioral and cognitive therapy to managing overactive bladder syndrome in women in the absence of contributive urodynamic diagnosis.

Overactive bladder (OAB) is a syndrome characterized by symptoms of urgency with or without incontinence, frequency, and nocturia. Pathophysiology of OAB is incompletely characterized. Therefore, there is great variability surrounding OAB evaluation.

Do patients with symptoms and signs of lower urinary tract dysfunction need a urodynamic diagnosis? ICI-RS 2013.

Aims: The ICI-RS Think Tank discussed the diagnostic process for patients who present with symptoms and signs of lower urinary tract (LUT) dysfunction. This manuscript reflects the Think Tank's summary and opinion.

Methods: An overview of the existing evidence and consensus regarding urodynamic testing was presented and discussed in relation to contemporary treatment strategies.

Idiopathic and neurogenic detrusor overactivity: do the different patterns have urodynamic characteristics related to gender or neurological condition?

Objectives: To evaluate the urodynamic characteristics of the two patterns (phasic, P and terminal, T) of detrusor overactivity (DO) according to gender and neurological condition.

Materials And Methods: Urodynamic characteristics of DO were analysed in a population with proven urodynamic DO (127 women and 76 men, respectively with 48 and 43 neurological diseases (encephalic, incomplete medullar lesion or peripheral)). Phasic DO is characterized by phasic waves with or without leakage while terminal DO is defined by a single non-inhibited contraction resulting in incontinence.