Is there a correlation between urodynamics findings and clinical outcomes in females with idiopathic overactive bladder syndrome (OAB)

Abstract

Introduction:

This study investigates the intricate relationship between urodynamic findings and clinical symptoms in females with overactive bladder (OAB).

Methods:

A retrospective cohort study, conducted at a tertiary university hospital, included female patients with positive detrusor overactivity (DO) OAB between November 2020 and November 2023. Patient demographics, OAB symptoms, and responses to anticholinergic treatment were recorded. Different Urodynamic features were analyzed.

Results:

A total of 92 female patients with positive detrusor overactivity (DO) and overactive bladder (OAB) were included. The median age was 49 years (IQR: 30.75–61.75). Among them, 16 (17.4%) were diabetic, 18 (19.6%) had hypertension, and 69 (75%) were regular coffee drinkers. Over half of the participants, 56 (60.9%), were overweight (BMI 25–29.9). The prevalence of key symptoms included frequency in 54 (58.7%), urgency in 73 (79.3%), urgency incontinence in 33 (35.9%), and nocturia in 44 (47.8%). Frequency of urination was more common among non-diabetic patients (41/54, 75.9%; p = 0.04), and urgency was significantly associated with non-smoking status (51/73, 69.9%; p = 0.025). Most patients (84, 91.3%) had phasic DO, with a median maximum detrusor pressure (Pdet DO) of 30 cmH₂O (IQR: 20.0–53.0) and a median cystometric capacity of 385.5 mL (IQR: 296.25–443.75). Frequency was significantly associated with higher maximum Pdet DO pressure (p = 0.049). In terms of treatment response, 81 patients (88.0%) demonstrated a good response to anticholinergic therapy. Non-responders had significantly higher maximum Pdet DO pressure (median 59.0 cmH₂O, IQR: 30.0–66.0) compared to responders (median 30.0 cmH₂O, IQR: 19.5–47.0; p = 0.013).

Conclusion:

The amplitude of DO in female with idiopathic OAB is theoretically and clinically correlated to symptomatology and response to anticholinergic treatment.

Keywords

OAB detrusor overactivity LUTS invasive urodynamic neurogenic bladder

Get full access to this article

View all access options for this article.

References

Haylen

de Ridder

Freeman

, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn 2010; 29(1): 4–20.

Lightner

Gomelsky

Souter

, et al. Diagnosis and Treatment of Overactive Bladder (Non-Neurogenic) in Adults: AUA/SUFU Guideline Amendment 2019. J Urol 2019; 202(3): 558–563.

Nambiar

Arlandis

Bø

, et al. European Association of urology guidelines on the diagnosis and management of female non-neurogenic lower urinary tract symptoms. Part 1: diagnostics, overactive bladder, stress urinary incontinence, and mixed urinary incontinence. Eur Urol. 2022; 82(1): 49–59.

Abrams

Cardozo

Fall

, et al. The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Urology 2003; 61(1): 37–49.

Drake

. Fundamentals of terminology in lower urinary tract function. Neurourol Urodyn 2018; 37(S6): S13–S19.

Abrams

. Describing bladder storage function: overactive bladder syndrome and detrusor overactivity. Urology 2003; 62(5 Suppl 2): 28–37; discussion 40–2.

Gormley

Lightner

Burgio

, et al. Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU guideline. J Urol 2012; 188(6 Suppl): 2455–2463.

Huang

Tseng

, et al. Correlation between overactive bladder and detrusor overactivity: a retrospective study. Int Urogynecol J. 2023;34(4):867–875.

Malone-Lee

Al-Buheissi

. Does urodynamic verification of overactive bladder determine treatment success? Results from a randomized placebo-controlled study. BJU Int. 2009;103(7):931–937.

10.

Rai

Cody

Alhasso

, et al. Anticholinergic drugs versus non-drug active therapies for non-neurogenic overactive bladder syndrome in adults. Cochrane Database Syst Rev 2012;12(12):Cd003193.

11.

Nager

Brubaker

Litman

, et al. A randomized trial of urodynamic testing before stress-incontinence surgery. N Engl J Med 2012;366(21):1987–1997.

12.

Nager

Sirls

Litman

, et al. Baseline urodynamic predictors of treatment failure 1 year after mid urethral sling surgery. J Urol 2011;186(2):597–603.

13.

Nitti

Rovner

Bavendam

. Response to fesoterodine in patients with an overactive bladder and urgency urinary incontinence is independent of the urodynamic finding of detrusor overactivity. BJU Int 2010;105(9):1268–1275.

14.

Rovner

Kennelly

Schulte-Baukloh

, et al. Urodynamic results and clinical outcomes with intradetrusor injections of onabotulinumtoxina in a randomized, placebo-controlled dose-finding study in idiopathic overactive bladder. Neurourol Urodyn 2011;30(4):556–562.

15.

Koldewijn

Rosier

PFWM

Meuleman

EJH

, et al. Predictors of success with neuromodulation in lower urinary tract dysfunction: results of trial stimulation in 100 patients. J Urol 1994;152(6 Part 1):2071–2075.

16.

South

MMT

Romero

Jamison

, et al. Detrusor overactivity does not predict outcome of sacral neuromodulation test stimulation. Int Urogynecol J 2007;18(12):1395-1398.

17.

Giannitsas

Perimenis

Athanasopoulos

, et al. Comparison of the efficacy of tolterodine and oxybutynin in different urodynamic severity grades of idiopathic detrusor overactivity. Eur Urol 2004;46(6):776–782; discussion 82-3.

18.

Jonas

Höfner

Madersbacher

, et al. Efficacy and safety of two doses of tolterodine versus placebo in patients with detrusor overactivity and symptoms of frequency, urge incontinence, and urgency: urodynamic evaluation. The International Study Group. World J Urol 1997;15(2):144–151.

19.

Goode

Burgio

Locher

, et al. Urodynamic changes associated with behavioral and drug treatment of urge incontinence in older women. J Am Geriatr Soc 2002;50(5):808–816.

20.

Qasrawi

Tabouni

Almansour

, et al. An evaluation of lower urinary tract symptoms in diabetic patients: a cross-sectional study. BMC Urol 2022;22(1):178.

21.

Abushamma

Nassar

Najjar

, et al. Lower urinary tract symptoms among females with rheumatoid arthritis: a prospective cross-sectional study. Int J Gen Med 2021;14:8427–8435.

22.

Saffarini

Ahmad

Samara

, et al. Assessment of lower urinary tract symptoms during pregnancy: an observational cross-sectional study from Palestine. BMC Pregnancy Childbirth 2021; 21(1): 84.

23.

Ahmad

Saffarini

Samara

, et al. The impact of lower urinary tract symptoms on the quality of life during pregnancy: a cross-sectional study from Palestine. BMC Urol 2020; 20(1): 191.

24.

Abushamma

Abu Alwafa

Shbaita

, et al. The correlation between academic stress, overactive bladder syndrome (OAB) and quality of life among healthy university students: a cross-sectional study. Urologia 2024; 91(2): 426–434.

25.

Valentini

Marti

Robain

, et al. Phasic or terminal detrusor overactivity in women: age, urodynamic findings and sphincter behavior relationships. Int Braz J Urol. 2011; 37(6): 773–780.

26.

López-Fando Lavalle

Calleja Hermosa

Velasco Balanza

, et al. Bladder capacity in women with overactive bladder syndrome: a cross-sectional study. Urology 2023; 179: 44–49.

27.

Yao

Simoes

. Urodynamic Testing and Interpretation. StatPearls. Treasure Island (FL): StatPearls Publishing LLC; 2024.

28.

Al-Ghazo

Ghalayini

Al-Azab

, et al. Urodynamic detrusor overactivity in patients with overactive bladder symptoms. Int Neurourol J. 2011; 15(1): 48–54.

29.

Hashim

Abrams

. Is the bladder a reliable witness for predicting detrusor overactivity? J Urol. 2006; 175(1): 191–194; discussion 4-5.

30.

Scarneciu

Lupu

Bratu

, et al. Overactive bladder: a review and update. Exp Ther Med 2021; 22(6): 1444.

31.

Digesu

Khullar

Cardozo

Salvatore

. Overactive bladder symptoms: do we need urodynamics? Neurourol Urodyn 2003; 22(2): 105–108.

32.

Rovner

Goudelocke

. Urodynamics in the evaluation of overactive bladder. Curr Urol Rep 2010; 11(5): 343–347.

33.

Foon

Drake

. The overactive bladder. Ther Adv Urol 2010; 2(4): 147–155.

34.

Herschorn

Chapple

Abrams

, et al. Efficacy and safety of combinations of mirabegron and solifenacin compared with monotherapy and placebo in patients with overactive bladder (SYNERGY study). BJU Int 2017; 120(4): 562–575.