Maximum urethral closure pressure in women: normative data and evaluation as a diagnostic test.

Introduction And Hypothesis: Our goal was to identify correlates of maximum urethral closure pressure (MUCP) and MUCP as a diagnostic test for stress urinary incontinence (SUI).

Methods: This study was a retrospective review of women with non-neurological referrals for urinary incontinence between1995 and 2006.

Results: We studied the characteristics of 8,644 women who underwent urodynamics for non-neurological referrals.

The management of adolescents with neurogenic urinary tract and bowel dysfunction.

Most children with neurogenic bladder dysfunction arrive into adolescence with reasonably managed lower urinary tract function only to experience bladder and kidney function deterioration after puberty. The aim of this article is to identify issues that contribute to adverse changes in bladder and renal function during adolescence and to highlight strategies to preserve urinary tract integrity, social continence, patient autonomy, and independence. Surveillance of bladder function requires patient attendance at review appointments and compliance with treatment plans.

Defining achievable standards in urodynamics-a prospective study of initial resting pressures.

Aims: Establishing accurate initial resting pressures is an important step in quality control at the start of a urodynamics test. We therefore carried out a prospective study to establish the initial resting pressures achievable with careful quality control.

Methods: Consecutive patients undergoing urodynamics were recruited.

Increased patient information does not reduce patient anxiety regarding urodynamic studies.

Objective: To establish if patient anxiety pre-urodynamic investigation can be reduced by providing more information within the patient information sheet (PIS).

Patients And Methods: Two prospective cohorts of consecutive patients (round 1, n = 98 and round 2, n = 94) were asked to complete a visual analogue scale (VAS) quantifying their anxiety prior to urodynamics (UDS) and again after UDS quantifying their anxiety of potentially repeating UDS. Patients in round 1 received the standard hospital PIS.

Can maximum urethral closure pressure (MUCP) be used to predict outcome of surgical treatment of stress urinary incontinence?

Aims: The outcome of surgery for stress urinary incontinence (SUI) can be unpredictable. Urethral pressure measurements, including measurement of maximum urethral closure pressure (MUCP) can form part of the investigation of women prior to SUI surgery and some studies have suggested that women with higher MUCP may have a better surgical outcome. This study aims to determine whether outcome of SUI surgery is related to pre-operative MUCP.

The natural history of daytime urinary incontinence in children: a large British cohort.

Aim: Few studies have looked at the prevalence of daytime incontinence in a longitudinal cohort of children. This study set out to determine the prevalence of daytime incontinence and relationships between daytime incontinence and bedwetting, faecal incontinence and urgency in a large cohort of British children.

Methods: Parents of children taking part in the Avon Longitudinal Study of Parents and Children (ALSPAC) were asked questions concerning the child's daytime wetting, bedwetting and faecal incontinence at different time points, 4.

Assessment of non-neurogenic incontinence and lower urinary tract symptoms in adolescents and young adults.

Aims: The aim of this article is to provide insight to clinicians who principally treat adults, about non-neurogenic lower urinary tract symptoms (LUTS) either pre-dating or presenting in adolescence. Assessment fundamentals, diagnostic classification, and rationale behind the process of care are discussed.

Methods: Standardized terms are used to describe the current classification of symptoms of LUT dysfunction in young adults.

The long-term natural history of overactive bladder symptoms due to idiopathic detrusor overactivity in women.

Objectives: To assess the long-term natural history of overactive bladder (OAB) symptoms due to idiopathic detrusor overactivity (IDO) in women.

Patients And Methods: Original urodynamic traces were reviewed and women who were referred with OAB symptoms and found to have IDO on investigation in our urodynamic unit ≥10 years previously were invited for a repeat urodynamic and symptomatic assessment.

Results: In all, 174 women were identified and invited to participate; 53 had repeat urodynamics, another 32 attended the unit for symptom assessment and a further 23 completed postal questionnaires.

Trying to predict 'dangerous' bladders in children: the area under the curve concept.

Objective: Children with neurological and non-neurological lower urinary tract dysfunction normally undergo video urodynamics. One reason is to try to diagnose 'dangerous' bladders. Currently, bladder compliance is used to predict 'dangerous' bladders; however, in children there are no standardized methods of measurement and thus no 'cut-off' values.

Pediatric urodynamics: baseline audit and effect on management.

Objectives: To undertake a baseline audit of our pediatric urodynamic service, identifying areas for improvement, and to determine whether clinical management was affected by urodynamic results.

Patients And Methods: All pediatric urodynamic studies during one calendar year were reviewed to determine the quality of reports that were issued and to assess any problems encountered. A postal questionnaire was sent to all referring doctors to determine whether the urodynamic report had influenced management.

The impact of formal education and training on urodynamic practice in the United Kingdom: a survey.

Aim: A previous survey of personnel performing urodynamics had shown that half of the respondents thought that their training had been inadequate. In order to address this the outcome of a 4-day practical course for teaching urodynamics, which has been running since 1995 at the Bristol Urological Institute, was reviewed. We were not aware of any published studies that have assessed the impact of formal urodynamic training on clinical practice.

The effect of fluid intake on urinary symptoms in women.

Purpose: We determined the effect of caffeine restriction and fluid manipulation in the treatment of patients with urodynamic stress incontinence and detrusor overactivity.

Materials And Methods: This was a 4-week randomized, prospective, observational crossover study in 110 women with urodynamic stress incontinence (USI) or idiopathic detrusor overactivity (IDO) to determine the effect of caffeine restriction, and of increasing and decreasing fluid intake on urinary symptoms. Data were recorded in a urinary diary for the entire study period on urgency episodes, frequency, pad weight increase, wetting episodes and quality of life.

Addressing the needs of teenagers with continence problems.

Adolescence refers to the period of great physical and emotional change experienced by 11 to 19-year-olds. A recent report aims to raise the profile of adolescent health (British Medical Association, 2003), and it is important to understand the impact of continence problems at a time in life when self-image is so important and wetting and soiling are particularly distressing. This article considers the specific needs of teenagers and ways of encouraging them to seek treatment.

Nocturnal polyuria in community-dwelling women.

Objective: To determine the age prevalence of nocturnal polyuria among older women in the community, and to investigate the relationship between nocturnal polyuria and nocturia.

Patients And Methods: In all, 1183 women aged > or = 50 years, who were registered with a family doctor practice and who had taken part in a prevalence study, were sent brief questionnaires and a frequency/volume chart (FVC) to complete.

Results: There were 227 FVCs with adequate data and 264 completed questionnaires available for analysis.

Nocturnal incontinence in women: a hidden problem.

Purpose: We determined the prevalence of nocturnal incontinence and its association with other storage symptoms in a community population of women

Materials And Methods: We mailed the validated self-reporting Bristol female lower urinary tract symptom questionnaire to all 2,641 women 19 years old or older registered at a family physician practice in a major British city and analyzed the results. Main outcome measures were the prevalence of nocturnal incontinence and its correlation with other storage symptoms.

Results: A total of 2,075 completed questionnaires (80%) were returned.

Urinary symptoms and incontinence in women: relationships between occurrence, age, and perceived impact.

Background: The prevalence of urinary symptoms that impact on quality-of-life will be important in determining resource allocation in primary care groups.

Aim: To determine the prevalence of urinary symptoms and their perceived impact in a community population of women.

Method: A postal survey using a validated self-completed questionnaire among all women aged over 18 years and registered with one general practice in a major British city.

Role of ambulatory urodynamic monitoring in clinical urological practice.

A retrospective review was conducted of 125 ambulatory monitoring (AM) studies performed on 111 women and 11 men between 1992 and 1996. All patients had had conventional cystometry prior to AM. All tests were interpreted with the aid of event markers and urinary diaries.

The natural history of urinary symptoms during adolescence.

Objective: To determine the prevalence and natural history of urinary symptoms and incontinence among healthy adolescent schoolchildren.

Subjects And Methods: A prospective longitudinal study using a confidential questionnaire administered to an original cohort of 1176 local schoolchildren at 11-12 years and again at 15-16 years old.

Results: There was a decrease in the prevalence of urinary symptoms with age.

The Bristol Female Lower Urinary Tract Symptoms questionnaire: development and psychometric testing.

Objective: To develop a questionnaire that is sensitive to changes in the symptomatology of the female lower urinary tract, particularly urinary incontinence, providing an instrument that can characterize symptom severity, impact on quality of life and evaluate treatment outcome.

Patients, Subjects And Methods: Items covering as wide a range of urinary symptoms as possible were devised after consultation with clinicians and a health scientist, a literature review and discussion with patients. Additional items assessed the degree of 'bother' that symptoms were causing.