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2267 DETRUSOR OVERACTIVITY: DO THE DIFFERENT PATTERNS HAVE CHARACTERISTICS RELATED TO GENDER OR CLINICAL CONDITION?
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.
e930
THE JOURNAL OF UROLOGY姞
3) Between both genders, there was neither difference in characteristics of NIDC #1: volume of occurrence (148⫾103 vs. 186⫾122 mL), amplitude which was nearly significant (13.1⫾10.7 vs. 18.5⫾16.4 cmH2O; p⫽.0535), rise time (7.7⫾3.2 vs. 8.8⫾5.1s), nor in number of NIDC (3.2⫾1.7 vs. 3.8⫾3.1). There was a significant increase of NIDC amplitude during bladder filling whatever the gender and a significant difference of last NIDC amplitude between women and men: 27.8⫾21.5 vs. 44.5⫾33.8 cmH2O (p⫽.0056). 4) For women, NIDC #1 occurred at significantly smaller volume in non-neurological (125⫾89 vs. 185⫾116 mL, p⫽.0223); NIDC at bladder functional capacity was more frequent in older women (60.3⫾18.3 vs. 47.4⫾19.3 y, p⫽.0103). 5) In the whole population, there was no difference in volume of occurrence of DOT: 228⫾127 mL for women vs. 253⫾138 mL for men. 6) For women with DOT, NIDC occurred at larger volume in non-neurological (274⫾126 vs. 153⫾90 mL, p⫽.0001), no difference in men. CONCLUSIONS: The only difference between the patterns of DO is that DOP occurs in younger individuals. Except an expected higher detrusor pressure during the last NIDC in men with DOP, there is no significant difference between characteristics of each pattern whatever gender, complaint and neurological status. 1-NAU 2002; 21: 167-178 Source of Funding: None
2268 DETRUSOR AFTER-CONTRACTION. NEW INSIGHT Françoise Valentini*, Pierre Nelson, Paris, France INTRODUCTION AND OBJECTIVES: Detrusor after-contractions (DAC) are non common in adults (1). Both definition (nothing in ICS reports) and significance (artefact, link with detrusor overactivity (DO) or bladder outlet obstruction (BOO)) remain discussed. DAC are detected by all kind of pressure transducers. Our purpose was to make a VBN analysis of the voiding phase preceding DAC and to make simulations of pathophysiological conditions able to explain both voiding phase and DAC. METHODS: Our database consisted of 39 DAC observed during UDS in 39 patients (35 females and 4 males) who presented with voiding dysfunction. Cystometry was performed with a 7F triple lumen catheter allowing the recording of urethral pressure. Criteria for DAC were: post void residual ⬍30 mL and increase of detrusor pressure (pdet)⬎10cm H2O. We used the VBN mathematical micturition model (2) for analysis of recordings and simulations. RESULTS: 1-UDS Onset of DAC (ODAC) occurred during the end of voiding: QODAC⫽ 8.5⫾5.9 mL/s (Qmax⫽18.7⫾8.3 mL/s). There was a negative deflection of pdet at the onset of DAC in 18 patients. The bladder volume at ODAC⫽ 17.9⫾13.4mL (i.e. bladder collapse condition). The pressure amplitude of DAC (pDAC) was significantly higher than pdet.Qmax : 77.7⫾30.4 vs. 34.6⫾15.5 cm H2O (p⬍.0001). DO was found in 16/39 (41%) patients and BOO in 7/39 (18%). Urgency was the complaint for 25/39 (64%) patients. No change of activity of both urethra and rectum was observed during DAC. 2-VBN Neither hypothesis of a great (abnormal) detrusor force only effective after voiding nor that of abnormal nervous control of the end of voiding allowed restoring the recorded curves (pressure-flow and DAC). For 18/39 (50%) patients, the end of flow could not be explain without addition of an effective abdominal pressure (which only acted on the bladder). CONCLUSIONS: The onset of DAC is the more significant phenomenon. DAC is not associated with BOO but more probably with bladder overactivity. That latest phenomenon occurring with concomitant bladder wall collapse could lead to a concentration of stresses around the transducer similar to that observed at the tip of a nail. DAC appears as the result of local conditions in an almost empty bladder and thus of weak clinical significance.
Vol. 189, No. 4S, Supplement, Wednesday, May 8, 2013
1-BJU Int 2002;90: 286-93; 2-NAU 2000; 19: 153-76 Source of Funding: None
2269 LOW BLADDER COMPLIANCE IS A RISK FACTOR IN NOCTURIA SEVERITY Johnson Tsui, Stephen Marshall*, Jeffrey Weiss, Patrick Samson, Brooklyn, NY; James Weinberger, New York, NY; Ksenia Roudakova, Brooklyn, NY; Jyoti Chouhan, Fort Worth, TX; Nicholas Kavoussi, Jerry Blaivas, Brooklyn, NY INTRODUCTION AND OBJECTIVES: The aim of this study is to report the relationship between bladder compliance and nocturia severity as measured by actual number of nightly voids (ANV) in men. METHODS: This is a retrospective study of men seen at a single center from 2009-2011 with lower urinary tract symptoms. All selected patients underwent urodynamic studies (UDS) and completed a 24-hour voiding diary within 1 month of their UDS. ANV was determined for each voiding diary. Bladder compliance was determined from the pressure-flow tracing by dividing the change in volume by the change in detrusor pressure at bladder capacity (prior to detrusor contraction). The population was separated into 3 cohorts based upon cutoff values of 20, 40, and 60 mL/cm H2O for bladder compliance. Student’s t-test was used to determine whether differences in the average ANV for each cohort were significantly different. RESULTS: There were 102 men, mean age of 68 (age range 27-89 years, SD 11). A total of 1082 voided volumes were recorded ranging from 10-800mL (mean 174, SD 115). ANV ranged from 0-10 (mean 2.8, SD 1.7). Bladder compliance ranged from 10-450 mL/cm H2O (mean 66, SD 61). Results are summarized in the Table. At all cutoff values, the differences in average ANV between those above and those below the cutoff value were found to be statistically significant. CONCLUSIONS: Bladder compliance appears to be inversely related to nocturia such that higher ANV (i.e., worse nocturia severity) is associated with lower bladder compliance, suggesting that in some patients, reduced bladder compliance is a risk factor accounting for nocturia severity. Cohort Based on Bladder Compliance (n) Bladder Compliance ⬍ or ⫽ 20 cm/H2O (15)
Average ANV
SD
P-value
Confidence Interval
0.0456
0.019-1.894
0.0015
0.433-1.764
0.0002
0.619-1.919
3.6
1.24
Bladder Compliance ⬎ 20 cm/H2O (87)
2.6
1.75
Bladder Compliance ⬍ or ⫽ 40 cm/H2O (38)
3.5
1.64
Bladder Compliance ⬎ 40 cm/H2O (64)
2.4
1.64
Bladder Compliance ⬍ or ⫽ 60 cm/H2O (63)
3.3
1.76
Bladder Compliance ⬎ 60 cm/H2O (39)
2.0
1.32
Source of Funding: Institute for Bladder and Prostate Research
2270 ADMINISTRATION OF FEDOVAPAGON CAUSES A DOSE-RESPONSIVE REDUCTION IN NOCTURNAL POLYURIA INDEX Georg Golor, Berlin, Germany; Hilary McElwaine-Johnn, Rachel Handy, Christopher Yea, Southampton, United Kingdom; John Lambert*, Harrow, United Kingdom INTRODUCTION AND OBJECTIVES: Nocturia, defined as waking to void at least once per night between periods of sleep, is a common complaint and shows an age-dependent increase in both prevalence and severity. It has been linked to age-dependent loss in
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.
e930
THE JOURNAL OF UROLOGY姞
3) Between both genders, there was neither difference in characteristics of NIDC #1: volume of occurrence (148⫾103 vs. 186⫾122 mL), amplitude which was nearly significant (13.1⫾10.7 vs. 18.5⫾16.4 cmH2O; p⫽.0535), rise time (7.7⫾3.2 vs. 8.8⫾5.1s), nor in number of NIDC (3.2⫾1.7 vs. 3.8⫾3.1). There was a significant increase of NIDC amplitude during bladder filling whatever the gender and a significant difference of last NIDC amplitude between women and men: 27.8⫾21.5 vs. 44.5⫾33.8 cmH2O (p⫽.0056). 4) For women, NIDC #1 occurred at significantly smaller volume in non-neurological (125⫾89 vs. 185⫾116 mL, p⫽.0223); NIDC at bladder functional capacity was more frequent in older women (60.3⫾18.3 vs. 47.4⫾19.3 y, p⫽.0103). 5) In the whole population, there was no difference in volume of occurrence of DOT: 228⫾127 mL for women vs. 253⫾138 mL for men. 6) For women with DOT, NIDC occurred at larger volume in non-neurological (274⫾126 vs. 153⫾90 mL, p⫽.0001), no difference in men. CONCLUSIONS: The only difference between the patterns of DO is that DOP occurs in younger individuals. Except an expected higher detrusor pressure during the last NIDC in men with DOP, there is no significant difference between characteristics of each pattern whatever gender, complaint and neurological status. 1-NAU 2002; 21: 167-178 Source of Funding: None
2268 DETRUSOR AFTER-CONTRACTION. NEW INSIGHT Françoise Valentini*, Pierre Nelson, Paris, France INTRODUCTION AND OBJECTIVES: Detrusor after-contractions (DAC) are non common in adults (1). Both definition (nothing in ICS reports) and significance (artefact, link with detrusor overactivity (DO) or bladder outlet obstruction (BOO)) remain discussed. DAC are detected by all kind of pressure transducers. Our purpose was to make a VBN analysis of the voiding phase preceding DAC and to make simulations of pathophysiological conditions able to explain both voiding phase and DAC. METHODS: Our database consisted of 39 DAC observed during UDS in 39 patients (35 females and 4 males) who presented with voiding dysfunction. Cystometry was performed with a 7F triple lumen catheter allowing the recording of urethral pressure. Criteria for DAC were: post void residual ⬍30 mL and increase of detrusor pressure (pdet)⬎10cm H2O. We used the VBN mathematical micturition model (2) for analysis of recordings and simulations. RESULTS: 1-UDS Onset of DAC (ODAC) occurred during the end of voiding: QODAC⫽ 8.5⫾5.9 mL/s (Qmax⫽18.7⫾8.3 mL/s). There was a negative deflection of pdet at the onset of DAC in 18 patients. The bladder volume at ODAC⫽ 17.9⫾13.4mL (i.e. bladder collapse condition). The pressure amplitude of DAC (pDAC) was significantly higher than pdet.Qmax : 77.7⫾30.4 vs. 34.6⫾15.5 cm H2O (p⬍.0001). DO was found in 16/39 (41%) patients and BOO in 7/39 (18%). Urgency was the complaint for 25/39 (64%) patients. No change of activity of both urethra and rectum was observed during DAC. 2-VBN Neither hypothesis of a great (abnormal) detrusor force only effective after voiding nor that of abnormal nervous control of the end of voiding allowed restoring the recorded curves (pressure-flow and DAC). For 18/39 (50%) patients, the end of flow could not be explain without addition of an effective abdominal pressure (which only acted on the bladder). CONCLUSIONS: The onset of DAC is the more significant phenomenon. DAC is not associated with BOO but more probably with bladder overactivity. That latest phenomenon occurring with concomitant bladder wall collapse could lead to a concentration of stresses around the transducer similar to that observed at the tip of a nail. DAC appears as the result of local conditions in an almost empty bladder and thus of weak clinical significance.
Vol. 189, No. 4S, Supplement, Wednesday, May 8, 2013
1-BJU Int 2002;90: 286-93; 2-NAU 2000; 19: 153-76 Source of Funding: None
2269 LOW BLADDER COMPLIANCE IS A RISK FACTOR IN NOCTURIA SEVERITY Johnson Tsui, Stephen Marshall*, Jeffrey Weiss, Patrick Samson, Brooklyn, NY; James Weinberger, New York, NY; Ksenia Roudakova, Brooklyn, NY; Jyoti Chouhan, Fort Worth, TX; Nicholas Kavoussi, Jerry Blaivas, Brooklyn, NY INTRODUCTION AND OBJECTIVES: The aim of this study is to report the relationship between bladder compliance and nocturia severity as measured by actual number of nightly voids (ANV) in men. METHODS: This is a retrospective study of men seen at a single center from 2009-2011 with lower urinary tract symptoms. All selected patients underwent urodynamic studies (UDS) and completed a 24-hour voiding diary within 1 month of their UDS. ANV was determined for each voiding diary. Bladder compliance was determined from the pressure-flow tracing by dividing the change in volume by the change in detrusor pressure at bladder capacity (prior to detrusor contraction). The population was separated into 3 cohorts based upon cutoff values of 20, 40, and 60 mL/cm H2O for bladder compliance. Student’s t-test was used to determine whether differences in the average ANV for each cohort were significantly different. RESULTS: There were 102 men, mean age of 68 (age range 27-89 years, SD 11). A total of 1082 voided volumes were recorded ranging from 10-800mL (mean 174, SD 115). ANV ranged from 0-10 (mean 2.8, SD 1.7). Bladder compliance ranged from 10-450 mL/cm H2O (mean 66, SD 61). Results are summarized in the Table. At all cutoff values, the differences in average ANV between those above and those below the cutoff value were found to be statistically significant. CONCLUSIONS: Bladder compliance appears to be inversely related to nocturia such that higher ANV (i.e., worse nocturia severity) is associated with lower bladder compliance, suggesting that in some patients, reduced bladder compliance is a risk factor accounting for nocturia severity. Cohort Based on Bladder Compliance (n) Bladder Compliance ⬍ or ⫽ 20 cm/H2O (15)
Average ANV
SD
P-value
Confidence Interval
0.0456
0.019-1.894
0.0015
0.433-1.764
0.0002
0.619-1.919
3.6
1.24
Bladder Compliance ⬎ 20 cm/H2O (87)
2.6
1.75
Bladder Compliance ⬍ or ⫽ 40 cm/H2O (38)
3.5
1.64
Bladder Compliance ⬎ 40 cm/H2O (64)
2.4
1.64
Bladder Compliance ⬍ or ⫽ 60 cm/H2O (63)
3.3
1.76
Bladder Compliance ⬎ 60 cm/H2O (39)
2.0
1.32
Source of Funding: Institute for Bladder and Prostate Research
2270 ADMINISTRATION OF FEDOVAPAGON CAUSES A DOSE-RESPONSIVE REDUCTION IN NOCTURNAL POLYURIA INDEX Georg Golor, Berlin, Germany; Hilary McElwaine-Johnn, Rachel Handy, Christopher Yea, Southampton, United Kingdom; John Lambert*, Harrow, United Kingdom INTRODUCTION AND OBJECTIVES: Nocturia, defined as waking to void at least once per night between periods of sleep, is a common complaint and shows an age-dependent increase in both prevalence and severity. It has been linked to age-dependent loss in