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MP77-20 IS DETRUSOR CONTRACTION REALLY NECESSARY FOR FEMALE MICTURITION?
THE JOURNAL OF UROLOGYâ
Vol. 195, No. 4S, Supplement, Monday, May 9, 2016
conditions and those who underwent surgical revisions were more likely to fail. Source of Funding: None
e1023
MP77-20 IS DETRUSOR CONTRACTION REALLY NECESSARY FOR FEMALE MICTURITION? satoru kira*, hideki kobayashi, yaburu haneda, norifumi sawada, takahiko mitsui, masayuki takeda, chuo, Japan
MP77-19 COMPREHENSION AND CONSTRUCT VALIDITY OF THE VISUAL PROSTATE SYMPTOM SCORE (VPSS) BY MEN WITH OBSTRUCTIVE LOWER URINARY TRACT SYMPTOMS (LUTS) IN RURAL UGANDA Lynn Stothers*, Andrew Macnab, Vancouver, Canada INTRODUCTION AND OBJECTIVES: The Visual Prostate Symptom Score (VPSS) is a pictorial version of 4 questions from the International Prostate Symptoms Score (IPSS) intended to quantify frequency, nocturia, weak stream and quality of life (QoL) regardless of ability to read or write. Successful correlation to IPSS and uroflow supports it as an alternative to word based questionnaires. Objectives: Develop VPSS construct and content validity by: (1) evaluating patient understanding of each pictogram (2) comparing VPSS pictogram description to IPSS responses (3) obtaining patient input to additions//improvements to enhance information capture (4) quantifying impressions of pictogram usefulness. METHODS: Men presenting with LUTS to a medical clinic in rural Uganda completed the VPSS and IPSS without and with assistance; described what they understood pictograms to represent; rated each for usefulness on a visual analogue scale and provided feedback for each image to enhance comprehension. Statistical analysis: Students t, Fishers exact, and Spearmans correlation tests. RESULTS: 136 scores were collected in men (mean age 69, range 45-93 yrs); school grade 8 to 12 (9%), grade 5 to 7 (9%), grade 1 to 4 21 62% and no schooling 20%. In total the IPSS was completed without assistance in only 2 subjects vs the VPSS in 94% (p ¼ <0.05). Comparing education: with no schooling the IPSS required assistance in 100% vs 6% with the VPSS (p¼<0.05); grade 1-4 100% vs 14% and higher grades 40% vs 0%. 94% independent of education had inherent recognition of the weak stream pictogram, 75 % for frequency and 42% for nocturia; dark background depicting night reduced visibility. Likert scale measures indicated the most helpful image was weak stream followed by daytime frequency with nocturia and QoL being less clear. Subjects valued the weak stream and QoL facial expressions the most after understanding that the QoL related to overall LUTS impact. VPSS and IPSS QoL measures correlated in 60% before verbal explanation. Improvements suggested: increased image size for frequency and nocturia pictograms and addition of urgency imagery. CONCLUSIONS: Construct validity related to immediate recognition is greatest for the slow stream pictogram. Comprehension and reporting would benefit from the addition of an urgency image, increased image size and contrast detail for frequency and nocturia, and a diagrammatic link between the QoL scale to these other constructs. Further development of the VPSS will add in the ability to measure men health on a global scale.
INTRODUCTION AND OBJECTIVES: Detrusor underactivity (DU) has been one of the most concerned issues of lower urinary tract dysfunction in recent years. Although DU focuses on detrusor contractility, the ultimate definition of DU has not been established yet. Particularly, significance of detrusor contraction during voiding remains unclear in females. In the present study, we investigated significance of detrusor contractility during voiding in females using urodynamic studies (UDS). METHODS: Fifty-eight women with non-neurogenic lower urinary tract symptoms, including 27 patients with pelvic organ prolapse (POP) and 19 patients with stress urinary incontinence, were enrolled in the present study. All patients underwent UDS from January 2010 to December 2014. UDS included pressure flow study (PFS), uroflowmetry for a maximum flow rate (Qmax) and mean flow rate, and post-void residuals (PVR). Existence of voluntary detrusor contraction was defined as a continuous and smooth increase of detrusor pressure (Pdet) (maximal Pdet: >5 cm water) after a command for micturition on PFS. Bladder contractility index (BCI) was calculated using the following formula: Pdet at Qmax + 5 Qmax. Statistical analyses were performed using Mann-Whitney U test and p<0.05 was considered statistically significant. RESULTS: PFS showed that 23 patients had detrusor contraction (Pdet+ group) and 35 patients had no detrusor contraction (Pdet- group) during voiding. There were no significant differences of urodynamic parameters except Pdet at Qmax and BCI between Pdet+ and Pdet- groups (Table). Of Pdet- group, 21 patients showed an increase of abdominal pressure during voiding (Pabd+ group), while the other 14 patients did not do it (Pabdgroup). There were no differences of urodynamic parameters between Pabd+ and Pabd- groups. CONCLUSIONS: Based on UDS, detrusor contraction or an increase of abdominal pressure is not always necessary in female micturition. The present study demonstrated that normal urethral sphincter function may be more important than detrusor contractility or an increase of abdominal pressure in female micturition.
Source of Funding: Grand Challenges Canada
Source of Funding: none
Vol. 195, No. 4S, Supplement, Monday, May 9, 2016
conditions and those who underwent surgical revisions were more likely to fail. Source of Funding: None
e1023
MP77-20 IS DETRUSOR CONTRACTION REALLY NECESSARY FOR FEMALE MICTURITION? satoru kira*, hideki kobayashi, yaburu haneda, norifumi sawada, takahiko mitsui, masayuki takeda, chuo, Japan
MP77-19 COMPREHENSION AND CONSTRUCT VALIDITY OF THE VISUAL PROSTATE SYMPTOM SCORE (VPSS) BY MEN WITH OBSTRUCTIVE LOWER URINARY TRACT SYMPTOMS (LUTS) IN RURAL UGANDA Lynn Stothers*, Andrew Macnab, Vancouver, Canada INTRODUCTION AND OBJECTIVES: The Visual Prostate Symptom Score (VPSS) is a pictorial version of 4 questions from the International Prostate Symptoms Score (IPSS) intended to quantify frequency, nocturia, weak stream and quality of life (QoL) regardless of ability to read or write. Successful correlation to IPSS and uroflow supports it as an alternative to word based questionnaires. Objectives: Develop VPSS construct and content validity by: (1) evaluating patient understanding of each pictogram (2) comparing VPSS pictogram description to IPSS responses (3) obtaining patient input to additions//improvements to enhance information capture (4) quantifying impressions of pictogram usefulness. METHODS: Men presenting with LUTS to a medical clinic in rural Uganda completed the VPSS and IPSS without and with assistance; described what they understood pictograms to represent; rated each for usefulness on a visual analogue scale and provided feedback for each image to enhance comprehension. Statistical analysis: Students t, Fishers exact, and Spearmans correlation tests. RESULTS: 136 scores were collected in men (mean age 69, range 45-93 yrs); school grade 8 to 12 (9%), grade 5 to 7 (9%), grade 1 to 4 21 62% and no schooling 20%. In total the IPSS was completed without assistance in only 2 subjects vs the VPSS in 94% (p ¼ <0.05). Comparing education: with no schooling the IPSS required assistance in 100% vs 6% with the VPSS (p¼<0.05); grade 1-4 100% vs 14% and higher grades 40% vs 0%. 94% independent of education had inherent recognition of the weak stream pictogram, 75 % for frequency and 42% for nocturia; dark background depicting night reduced visibility. Likert scale measures indicated the most helpful image was weak stream followed by daytime frequency with nocturia and QoL being less clear. Subjects valued the weak stream and QoL facial expressions the most after understanding that the QoL related to overall LUTS impact. VPSS and IPSS QoL measures correlated in 60% before verbal explanation. Improvements suggested: increased image size for frequency and nocturia pictograms and addition of urgency imagery. CONCLUSIONS: Construct validity related to immediate recognition is greatest for the slow stream pictogram. Comprehension and reporting would benefit from the addition of an urgency image, increased image size and contrast detail for frequency and nocturia, and a diagrammatic link between the QoL scale to these other constructs. Further development of the VPSS will add in the ability to measure men health on a global scale.
INTRODUCTION AND OBJECTIVES: Detrusor underactivity (DU) has been one of the most concerned issues of lower urinary tract dysfunction in recent years. Although DU focuses on detrusor contractility, the ultimate definition of DU has not been established yet. Particularly, significance of detrusor contraction during voiding remains unclear in females. In the present study, we investigated significance of detrusor contractility during voiding in females using urodynamic studies (UDS). METHODS: Fifty-eight women with non-neurogenic lower urinary tract symptoms, including 27 patients with pelvic organ prolapse (POP) and 19 patients with stress urinary incontinence, were enrolled in the present study. All patients underwent UDS from January 2010 to December 2014. UDS included pressure flow study (PFS), uroflowmetry for a maximum flow rate (Qmax) and mean flow rate, and post-void residuals (PVR). Existence of voluntary detrusor contraction was defined as a continuous and smooth increase of detrusor pressure (Pdet) (maximal Pdet: >5 cm water) after a command for micturition on PFS. Bladder contractility index (BCI) was calculated using the following formula: Pdet at Qmax + 5 Qmax. Statistical analyses were performed using Mann-Whitney U test and p<0.05 was considered statistically significant. RESULTS: PFS showed that 23 patients had detrusor contraction (Pdet+ group) and 35 patients had no detrusor contraction (Pdet- group) during voiding. There were no significant differences of urodynamic parameters except Pdet at Qmax and BCI between Pdet+ and Pdet- groups (Table). Of Pdet- group, 21 patients showed an increase of abdominal pressure during voiding (Pabd+ group), while the other 14 patients did not do it (Pabdgroup). There were no differences of urodynamic parameters between Pabd+ and Pabd- groups. CONCLUSIONS: Based on UDS, detrusor contraction or an increase of abdominal pressure is not always necessary in female micturition. The present study demonstrated that normal urethral sphincter function may be more important than detrusor contractility or an increase of abdominal pressure in female micturition.
Source of Funding: Grand Challenges Canada
Source of Funding: none