Urodynamic verification of an overactive bladder is not a prerequisite for antimuscarinic treatment response
Article first published online: 21 AUG 2003
Volume 92, Issue 4, pages 415–417, September 2003
How to Cite
Malone-Lee, J., Henshaw, D.J.E. and Cummings, K. (2003), Urodynamic verification of an overactive bladder is not a prerequisite for antimuscarinic treatment response. BJU International, 92: 415–417. doi: 10.1046/j.1464-410X.2003.04351.x
- Issue published online: 21 AUG 2003
- Article first published online: 21 AUG 2003
- Accepted for publication 21 May 2003
- detrusor instability;
- overactive bladder;
- treatment outcome
To investigate the place of urodynamics in the evaluation of patients with symptoms of the overactive bladder by comparing the response to antimuscarinic therapy in those with and with no urodynamically verified symptoms.
PATIENTS AND METHODS
In a prospective observational study, 356 female patients with urinary frequency (≥ 8 voids/24 h) and urgency, with or without urge incontinence, underwent cystometry. Patients were diagnosed with detrusor instability if there were spontaneous, uninhibited increases in detrusor pressure during bladder filling. All patients, regardless of urodynamic findings, were subsequently treated with oxybutynin 2.5 mg twice daily and bladder retraining. The outcome was evaluated as the change in urinary frequency and incontinence episodes after 6–8 weeks of treatment.
Among 352 evaluable patients, 266 (76%) had detrusor instability on cystometry and the remainder did not. There was no significant between-group difference in mean age, urinary frequency or the number of incontinence episodes at presentation. Both groups improved equally well during oxybutynin and bladder retraining therapy; after 6–8 weeks there was no significant between-group difference for the mean change from baseline in urinary frequency or incontinence episodes. Tolerability profiles were comparable for the two groups.
Patients with symptoms of an overactive bladder, but apparently normal urodynamic findings, respond equally well to antimuscarinic therapy as those with urodynamically verified symptoms. Such findings cast further doubt on the clinical validity of using invasive urodynamic procedures to characterize patients with irritative lower urinary tract symptoms before starting antimuscarinic therapy.