Detrusor overactivity is missed by stopping urodynamic investigation at a bladder volume of 500 mL

Abstract

OBJECTIVES
To investigated whether detrusor overactivity is missed in a relevant percentage if the urodynamic investigation (UDI) is stopped at a filling volume of 500 mL due to the fear of bladder overdistention in patients with lower urinary tract symptoms and high bladder capacity.
PATIENTS & METHODS
A consecutive series of 1598 patients with a bladder capacity of >500 mL in the bladder diary undergoing UDI due to lower urinary tract dysfunction was prospectively investigated. UDI was performed according to Good Urodynamic Practices recommended by the International Continence Society. UDI was stopped at strong desire to void or in case of autonomic dysreflexia, vesico-uretero-renal reflux, bladder pain or discomfort.
RESULTS
Of the 1598 patients (594 women, 1004 men), 1282 (80%) and 316 (20%) suffered from neurogenic and non-neurogenic lower urinary tract dysfunction (LUTD), respectively. Overall, detrusor overactivity was detected in 66% (1048/1598), in 71% (910/1282) with neurogenic and in 44% (138/316) with non-neurogenic LUTD. Detrusor overactivity occurred in 16% (263/1598, 95% CI 14.7-18.4%) only at a bladder volume above 500 mL. This phenomenon was significantly (p<0.0001) more frequent in patients with neurogenic (18% (236/1282), 95% CI 16.4-20.6%) compared with non-neurogenic (9% (27/316), 95% CI 5.9-12.1%) LUTD.
CONCLUSIONS
In both neurological and non-neurological patients with high bladder capacity, we strongly recommend not to stop UDI at a bladder volume of 500 mL, since detrusor overactivity might be missed in a relevant percentage leading to inappropriate patient treatment. This article is protected by copyright. All rights reserved.