A longitudinal study over 5 to 10 years of clinical outcomes in women with idiopathic detrusor overactivity


Dr AR Morris, Department of Obstetrics and Gynaecology, Royal North Shore Hospital, St Leonards, New South Wales 2065, Australia. Email alastair.morris@btinternet.com


Objective  To evaluate the long-term clinical outcome in women with idiopathic detrusor overactivity (IDO) and to identify significant prognostic factors.

Design  Longitudinal study incorporating retrospective case note review and a postal questionnaire.

Setting  Tertiary referral urogynaecology clinic in Australia.

Population  Women with a sole urodynamic diagnosis of IDO.

Methods  Audit of urodynamic records and case notes. Postal questionnaire incorporating validated disease-specific quality-of-life (QoL) instruments.

Main outcome measure  Subjective assessment of overall improvement on a 4-point scale followed by scoring of short forms of the urogenital distress inventory and incontinence impact questionnaire.

Results  One hundred and thirty two women were identified following examination of 1975 consecutive records with 76 (67%) returning questionnaires. Median follow up was 8 years (6–9), and the duration of symptoms was 13 years (9–18). Improvement was achieved in 25 (35%) women. Disease symptoms fluctuated in severity and QoL were worse in nonresponders to therapy (P < 0.0001). Urge incontinence at presentation was associated with treatment failure (P= 0.001) as was nocturia (P= 0.04), but urodynamic variables were not associated with outcome. Only 3 of 46 (6.5%) women not responding to therapy thought that their symptoms would improve with time.

Conclusions  IDO seldom resolves and fluctuates in severity. Individual response is unpredictable, although the presence of urge incontinence is associated with a significantly worse prognosis.