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Association of Bladder Sensation Measures and Bladder Diary in Patients with Urinary Incontinence
Ashley B King1, Jeffrey P. Wolters1, Adam P. Klausner1, David E. Rapp2
1Virginia Commonwealth University, Richmond, VA;2Virginia Urology Center for Incontinence and Pelvic Floor Reconstruction, Richmond, VA
Introduction: Investigation suggests the involvement of afferent actions in the pathophysiology of urinary incontinence. Current diagnostic modalities do not allow for the accurate identification of sensory dysfunction. We previously reported urodynamic derivatives that may be useful in assessing bladder sensation. This study further investigated these derivates by assessing for a relationship with 3-day bladder diary.
Methods: We performed a retrospective review of 120 women evaluated for urinary incontinence. Statistical analysis assessed for a relationship between bladder diary parameters and two previously reported urodynamic derivatives (First Sensation Ratio (FSR)(FS/Capacity), Bladder Urgency Velocity (BUV)(Capacity-FS)). Subset analysis was performed in patients without stress urinary incontinence (SUI) to isolate patients with urgency symptoms. Analysis was also performed to identify a possible relationship between these derivatives and the presence/absence of detrusor overactivity (DO).
Results: No association was demonstrated between bladder diary parameters and FSR/BUV. However, subset analysis demonstrated an association between DO and BUV, with a lower BUV identified in patients without DO (p<0.05). Subset analysis of patients without SUI demonstrated a weak association between voiding frequency and FSR (r=-0.39) and between daily incontinence episodes and BUV (r=-0.35). However, these failed to demonstrate statistical significance.
Conclusions: No association between bladder diary and FSR/BUV was seen. This is not unexpected since bladder diary may reflect numerous pathologies including not only sensory dysfunction but also SUI and DO. However, weak associations identified in patients without SUI suggest that further investigation is needed to assess the utility of FSR/BUV in characterizing sensory dysfunction in patients with urge-predominant symptoms
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