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Overactive bladder symptoms: do we need urodynamics?

G Alessandro Digesu1, Vik Khullar, Linda Cardozo

  • 1Department of Urogynaecology, King's College Hospital, London, United Kingdom. digesualex@hotmail.com

Neurourology and Urodynamics
|February 13, 2003
PubMed
Summary

Symptom-based overactive bladder (OAB) diagnosis in women does not reliably correlate with urodynamic findings. Urodynamic evaluation is essential for accurate diagnosis and management of detrusor instability in women with lower urinary tract symptoms.

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Area of Science:

  • Urogynecology
  • Urology
  • Female Lower Urinary Tract Symptoms

Background:

  • Overactive bladder (OAB) is characterized by urinary frequency, urgency, and/or urge incontinence.
  • Accurate diagnosis is crucial for effective management of lower urinary tract symptoms (LUTS).
  • The utility of urodynamic diagnosis in conjunction with symptom-based assessment for OAB requires clarification.

Purpose of the Study:

  • To investigate the correlation between symptomatic diagnosis of overactive bladder (OAB) and urodynamic findings in women.
  • To assess the diagnostic value of urodynamics in managing women presenting with symptoms suggestive of OAB.

Main Methods:

  • A cohort of 4,500 women with lower urinary tract symptoms attending a tertiary urogynaecology clinic were evaluated.
  • Comprehensive assessment included medical history, urinary symptom questionnaires, frequency-volume charts, vaginal examination, and videocystourethrography.

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  • Women with neurological disorders were excluded; symptomatic and urodynamic diagnoses were correlated based on International Continence Society criteria.

    • Main Results:

    • Only 18.7% (843/4,500) of women met the criteria for OAB based on symptoms.
    • Of those with OAB symptoms, 54.2% (457/843) demonstrated urodynamically proven detrusor instability.
    • A significant discrepancy was found: 36.5% (1,641/4,500) had urodynamic detrusor instability, but only 27.5% (457/1,641) of these were symptomatic for OAB.

    Conclusions:

    • Symptomatic diagnosis of OAB alone is insufficient and does not reliably correlate with urodynamic detrusor instability.
    • Symptom-based diagnosis underdiagnoses detrusor instability in women with lower urinary tract symptoms.
    • Urodynamic evaluation is deemed mandatory for the accurate diagnosis and effective management of women with symptoms suggestive of overactive bladder.