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2265 URODYNAMIC PREDICTORS OF DE NOVO CLEAN INTERMITTENT CATHETERIZATION AFTER AUGMENTATION CYSTOPLASTY FOR REFRACTORY OVERACTIVE BLADDER
Vol. 189, No. 4S, Supplement, Wednesday, May 8, 2013
THE JOURNAL OF UROLOGY姞
CONCLUSIONS: Considering the high incidence of AD in almost 60% of our SCI patients with NLUTD and the potentially high risks involved with sudden hypertension, we strongly recommend continuous cardiovascular monitoring during urodynamic investigation in all SCI patients. Source of Funding: None
2265 URODYNAMIC PREDICTORS OF DE NOVO CLEAN INTERMITTENT CATHETERIZATION AFTER AUGMENTATION CYSTOPLASTY FOR REFRACTORY OVERACTIVE BLADDER Ahmed El-Azab*, Ahmed Moeen, Assiut, Egypt INTRODUCTION AND OBJECTIVES: In developed countries, numerous minimally invasive procedures are available for refractory Overactive bladder (OAB). Augmentation ileocystoplat (AC) remains an option for cultural and economic reasons in other countries. This study aimed to evaluate preoperative urodynamic variables that may predict subjects with refractory idiopathic OAB who may need CIC after AC. METHODS: Patients with refractory idiopathic urodynamically proven OAB completed UDI-6 and IIQ-7 questionnaires, urodynamics and post-void residual urine assessment before and 6 months after AC. Excluded from our study are subjects with suspected neurological deficit. RESULTS: 13 patients underwent augmentation cystoplasty for refractory OAB. Rate of De novo CIC after augmentation is 30% (n⫽4). Peak flow rate (Qmax) and detrusor pressure at Qmax were significantly higher among subjects who did not need CIC compared to those who needed CIC after augmentation (see table). In addition, the Qmax occurs during the down limb of the Pdet curve during voiding (see Figure). CONCLUSIONS: Qmax, Pdet at the Qmax and flow rate at the maximum detrusor pressure may ai to predict subjects who might require De novo CIC after AC for refractory idiopathic OAB.
e929
METHODS: We reviewed all stage 1 SNM procedures performed at our institution for medically refractory overactive bladder from 2000 to 2010. We examined demographic information, comorbidity, age, BMI, previous surgeries, and pre-operative urodynamics. We defined success as greater than 50% subjective improvement with a stage 1 device. RESULTS: 107 patients were identified that had undergone a stage 1 SNM trial. Patient demographic information, comorbidity, age, BMI, and history of previous surgeries did not predict success with InterStim. If present, successful patients had a statistically higher volume at urodynamic detrusor overactivity (VUDO) on filling. All failures had VUDO of 175 mL or less. CONCLUSIONS: In our cohort of patients with urodynamic detrusor overactivity, those with a successful stage 1 InterStim trial had a higher VUDO. This analysis suggests that preoperative urodynamic parameters may help predict patient outcomes after a stage 1 trial and may be used to counsel patients in this regard.
Source of Funding: None Comparison between subjects who needed De novo CIC vs those who did not need CIC after AC De novo CIC (n⫽4) No CIC (n⫽9) p value Age years (mean, SD) 32.5 (3.7) 28.1 (14.8) .583 Sex (Chi square)
1 male (33.3%)
2 males (30%)
.706
Qmax
20
28.5
.034
Qavr
7.1
10
.183
Pdet@Qmax
39.1
83.6
.077
Flow rate @ Max Pdet
4.7
11.4
.066
Max P det
51
121.1
.127
Urodynamic criteria
Source of Funding: None
2266 VOLUME AT URODYNAMIC DETRUSOR OVERACTIVITY PREDICTS SUCCESS WITH INTERSTIM Bhavin Patel*, Jay Choe, Una Lee, Alvaro Lucioni, Blair Washington, Fred Govier, Kathleen Kobashi, Seattle, WA INTRODUCTION AND OBJECTIVES: There are no consistent clinical preoperative predictors of stage 1 sacral neuromodulation (SNM) success. We reviewed our InterStim experience to evaluate for preoperative predictors of stage 1 success.
2267 DETRUSOR OVERACTIVITY: DO THE DIFFERENT PATTERNS HAVE CHARACTERISTICS RELATED TO GENDER OR CLINICAL CONDITION? Françoise Valentini*, Brigitte Marti, Gilberte Robain, Paris, France INTRODUCTION AND OBJECTIVES: Two patterns of detrusor overactivity (DO) are defined: phasic (DOP) and terminal (DOT) (1). Are there differences in pattern and characteristics according to age, gender, complaint and neurological status. In that last condition, are there differences according to the level of neurological injury? METHODS: Retrospectively, 203 files of DO patients have been analyzed (127 women and 76 men, respectively 48 and 43 had neurological disease). Each gender was separately analyzed. Studied parameters were pattern of DO and characteristics of non-inhibited detrusor contraction (NIDC). RESULTS: 1) DOP patients were significantly younger in the whole population (56⫾19 vs. 66⫾4 y; p⬍.0001) and whatever gender (56⫾19 vs. 65⫾15 y for women, p⫽.0052 and 57⫾18 vs. 68⫾12 for men, p⫽.0038). 2) Frequency of urgency was similar in DOP and DOT: 80.0 vs. 83.6% for women and 72.0 vs.79.5% for men.
THE JOURNAL OF UROLOGY姞
CONCLUSIONS: Considering the high incidence of AD in almost 60% of our SCI patients with NLUTD and the potentially high risks involved with sudden hypertension, we strongly recommend continuous cardiovascular monitoring during urodynamic investigation in all SCI patients. Source of Funding: None
2265 URODYNAMIC PREDICTORS OF DE NOVO CLEAN INTERMITTENT CATHETERIZATION AFTER AUGMENTATION CYSTOPLASTY FOR REFRACTORY OVERACTIVE BLADDER Ahmed El-Azab*, Ahmed Moeen, Assiut, Egypt INTRODUCTION AND OBJECTIVES: In developed countries, numerous minimally invasive procedures are available for refractory Overactive bladder (OAB). Augmentation ileocystoplat (AC) remains an option for cultural and economic reasons in other countries. This study aimed to evaluate preoperative urodynamic variables that may predict subjects with refractory idiopathic OAB who may need CIC after AC. METHODS: Patients with refractory idiopathic urodynamically proven OAB completed UDI-6 and IIQ-7 questionnaires, urodynamics and post-void residual urine assessment before and 6 months after AC. Excluded from our study are subjects with suspected neurological deficit. RESULTS: 13 patients underwent augmentation cystoplasty for refractory OAB. Rate of De novo CIC after augmentation is 30% (n⫽4). Peak flow rate (Qmax) and detrusor pressure at Qmax were significantly higher among subjects who did not need CIC compared to those who needed CIC after augmentation (see table). In addition, the Qmax occurs during the down limb of the Pdet curve during voiding (see Figure). CONCLUSIONS: Qmax, Pdet at the Qmax and flow rate at the maximum detrusor pressure may ai to predict subjects who might require De novo CIC after AC for refractory idiopathic OAB.
e929
METHODS: We reviewed all stage 1 SNM procedures performed at our institution for medically refractory overactive bladder from 2000 to 2010. We examined demographic information, comorbidity, age, BMI, previous surgeries, and pre-operative urodynamics. We defined success as greater than 50% subjective improvement with a stage 1 device. RESULTS: 107 patients were identified that had undergone a stage 1 SNM trial. Patient demographic information, comorbidity, age, BMI, and history of previous surgeries did not predict success with InterStim. If present, successful patients had a statistically higher volume at urodynamic detrusor overactivity (VUDO) on filling. All failures had VUDO of 175 mL or less. CONCLUSIONS: In our cohort of patients with urodynamic detrusor overactivity, those with a successful stage 1 InterStim trial had a higher VUDO. This analysis suggests that preoperative urodynamic parameters may help predict patient outcomes after a stage 1 trial and may be used to counsel patients in this regard.
Source of Funding: None Comparison between subjects who needed De novo CIC vs those who did not need CIC after AC De novo CIC (n⫽4) No CIC (n⫽9) p value Age years (mean, SD) 32.5 (3.7) 28.1 (14.8) .583 Sex (Chi square)
1 male (33.3%)
2 males (30%)
.706
Qmax
20
28.5
.034
Qavr
7.1
10
.183
Pdet@Qmax
39.1
83.6
.077
Flow rate @ Max Pdet
4.7
11.4
.066
Max P det
51
121.1
.127
Urodynamic criteria
Source of Funding: None
2266 VOLUME AT URODYNAMIC DETRUSOR OVERACTIVITY PREDICTS SUCCESS WITH INTERSTIM Bhavin Patel*, Jay Choe, Una Lee, Alvaro Lucioni, Blair Washington, Fred Govier, Kathleen Kobashi, Seattle, WA INTRODUCTION AND OBJECTIVES: There are no consistent clinical preoperative predictors of stage 1 sacral neuromodulation (SNM) success. We reviewed our InterStim experience to evaluate for preoperative predictors of stage 1 success.
2267 DETRUSOR OVERACTIVITY: DO THE DIFFERENT PATTERNS HAVE CHARACTERISTICS RELATED TO GENDER OR CLINICAL CONDITION? Françoise Valentini*, Brigitte Marti, Gilberte Robain, Paris, France INTRODUCTION AND OBJECTIVES: Two patterns of detrusor overactivity (DO) are defined: phasic (DOP) and terminal (DOT) (1). Are there differences in pattern and characteristics according to age, gender, complaint and neurological status. In that last condition, are there differences according to the level of neurological injury? METHODS: Retrospectively, 203 files of DO patients have been analyzed (127 women and 76 men, respectively 48 and 43 had neurological disease). Each gender was separately analyzed. Studied parameters were pattern of DO and characteristics of non-inhibited detrusor contraction (NIDC). RESULTS: 1) DOP patients were significantly younger in the whole population (56⫾19 vs. 66⫾4 y; p⬍.0001) and whatever gender (56⫾19 vs. 65⫾15 y for women, p⫽.0052 and 57⫾18 vs. 68⫾12 for men, p⫽.0038). 2) Frequency of urgency was similar in DOP and DOT: 80.0 vs. 83.6% for women and 72.0 vs.79.5% for men.