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.

Should we be revisiting LUT basic science and clinical measurement of LUT sensation to improve patient care? ICI-RS 2019.

Aims: This article reviews current knowledge of the underpinning mechanisms of how the bladder senses fullness locally and also revisits clinical measurements of lower urinary tract sensation. The former represents cellular sensing during bladder filling whereas the latter describes the sensations leading to conscious perception of bladder fullness.

Methods: The topic was discussed in a "think tank" session at the 2019 International Consultation on Incontinence-Research Symposium in Bristol, UK; summarized in the present review.

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.

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.

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.

Clinically relevant modeling of urodynamics function: the VBN model.

Background: For the past two decades, a mathematical model of micturition was built step by step. Fundamental studies, presentations of the model and several applications to various male and female lower urinary tract dysfunctions have been published. We expect now that other teams will be interested in using it.

Non-invasive evaluation of bladder outlet obstruction in men suspected of benign prostatic hyperplasia: usefulness of the d index.

Objective: To compare a new index of voiding dysfunction (D) based purely on free uroflow vs. Abrams-Griffiths (A-G) number obtained from intubated flow, for classification of bladder outlet obstruction in men.

Patients And Methods: Urodynamic tracings of 60 non-neurological patients (30 before transurethral resection of the prostate and of 30 men suspected of benign prostatic hyperplasia included in a medical therapy trial) were retrospectively analyzed.

Decreased maximum flow rate during intubated flow is not only due to urethral catheter in situ.

Introduction And Hypothesis: We used the Valentini-Besson-Nelson (VBN) mathematical micturition model to analyze the potential obstructive effect of a 7-F transurethral catheter on the voiding process during intubated flow (IF) in women. Our hypothesis was that incomplete sphincter relaxation leads to residual sphincter pressure.

Methods: We reviewed a urodynamic database of women referred for evaluation of lower urinary tract dysfunction.

Phasic or terminal detrusor overactivity in women: age, urodynamic findings and sphincter behavior relationships.

Objectives: To search for relationships between phasic (P) and terminal (T) DO with age, urodynamic findings and sphincter behavior during involuntary detrusor contraction in woman.

Materials And Methods: Urodynamic studies (triple lumen catheter 7F, seated position) of 164 successive women referred for LUTS with diagnosis of DO were reviewed. Patients were stratified in 4 sub-groups: pre- (18-44 y), peri- (45-54 y), post-menopause (55-74 y) and oldest old (= 75 y).

Urodynamics in a community-dwelling population of females 80 years or older. Which motive? Which diagnosis?

Purpose: To determine why community-dwelling women aged 80 years or over were referred for urodynamic evaluation despite their advanced age and which urodynamic diagnosis was made.

Materials And Methods: One hundred consecutive females (80-93 years) were referred to our urodynamics outpatient clinic for evaluation of lower urinary tract symptoms (LUTS) between 2005 and 2008. Clinical evaluation comprised of a previous history of LUTS, previous medical history of neurological disease or dementia, pelvic floor dysfunction or prior pelvic surgery.

Analysis of rhythmic rectal contractions during filling cystometry in women.

Purpose: Rhythmic or random rectal contractions independent of bladder activity are frequently observed during cystometry and usually attributed either to a neurological disease, or to ageing. The aim of our study was to search for an association of rhythmic rectal contractions (RRCs) with a specific lower urinary tract symptom or/and an urodynamic diagnosis.

Materials And Methods: The population consisted of 534 consecutive women with lower urinary tract symptoms and without specific gastro-intestinal disease referred for urodynamics; 382 (non-ND) had no history of neurological disease and 152 (ND) a history of neurological disease.

Differences between the data from free flow and intubated flow in women with urinary incontinence. What do they mean?

Aims: To assess the effects of a urethral catheter on the urodynamic data extracted from uroflow in women, and to interpret the differences from free uroflow using the VBN mathematical micturition model.

Methods: Urodynamic data of 217 consecutive (June 2002 to December 2004) women with urinary incontinence and without neurological disease or more than grade 2 prolapse were reviewed. Inclusion criteria were to perform one free flow (FF) and one intubated flow (IF) (voided volumes of at least 100 ml and continuous flow curves).