The use of voiding studies in the evaluation of women with overactive bladder syndrome

• Main Author: Basu, Maya
• Other Authors: Khullar, Vik; Rai, Raj
• Published: Imperial College London 2013
• Subjects: 618.1
• Online Access: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.650608

The aim of this study was to explore the relationship between voiding and overactive bladder (OAB) in women, in order to evaluate whether voiding assessment has any impact on management. This concept was explored within several clinical models. The first study assessed women with detrusor overactivity (DO) undergoing treatment with solifenacin, and identified that women who failed to respond to treatment had a significantly lower pre-treatment maximum flow rate (Qmax) than responders, indicating that urodynamic evidence of differences in voiding can be used to predict treatment response. Prolapse was used as a model of possible elevated urethral resistance. A retrospective analysis of women with OAB and prolapse identified a 53% cure rate for OAB following prolapse surgery, with cure being associated with a significant increase in Qmax and decrease in opening detrusor pressure (ODP). A powered prospective study in the prolapse and OAB population confirmed resolution of OAB symptoms to be associated with an increase in Qmax. Because the relationship between voiding and prolapse is imprecise, the final model used was women with confirmed voiding dysfunction and OAB undergoing urethral dilatation. A retrospective analysis confirmed urethral dilatation to lead to a significant increase in maximum flow rate (when corrected for voided volume), but with a poor cure rate for OAB of 19% at 6 months. Cure of OAB at 6 weeks was associated with a significant increase in Qmax and decrease in PdetQmax. This was followed up with a randomised trial of urethral dilatation and cystoscopy versus cystoscopy alone in women with OAB and voiding dysfunction, which showed urethral dilatation to lead to a higher cure rate for OAB at 6 weeks, but with no long term benefit, and no significant effect on health related quality of life even at 6 weeks. Collectively, these data do suggest an association between voiding parameters and OAB, although the mechanism of this association remains uncertain. Voiding may be a biomarker for another underlying process which affects OAB symptoms. Direct manipulation of the voiding axis in women is poorly defined and future work should focus on the aetiology of voiding differentials in selected women, and whether more targeted correction of these will be effective.