Bladder diary patterns in detrusor overactivity and urodynamic stress incontinence

Area of Science:

• Urology
• Gynecology
• Continence Care

Background:

• Urodynamic stress incontinence (USI) and detrusor overactivity (DO) are distinct lower urinary tract conditions.
• Differentiating between USI and DO is crucial for effective treatment.
• Bladder diaries are essential tools for assessing urinary symptoms and patterns.

Purpose of the Study:

• To compare frequency-volume and incontinence episode patterns in patients with USI and DO using bladder diaries.
• To evaluate the effectiveness of raw versus adjusted diary measurements in differentiating between USI and DO.
• To identify distinct patient subgroups within USI based on bladder diary parameters.

Main Methods:

• Studied 58 patients with USI, 29 with DO, and 22 with both conditions.
• Utilized 3-day hand-written and computer-analyzed bladder diaries.
• Calculated voiding frequency, volume voided, average/maximum voided volume (Vol/Void), and incontinence episode characteristics.

Main Results:

• DO patients generally exhibited higher voiding frequency and lower Vol/Void compared to USI patients.
• DO patients had more urge-related leaks, while USI patients had more activity-related leaks.
• Age- and volume-adjusted percentiles provided better separation between USI and DO groups than raw measurements.
• A significant subgroup of USI patients presented with low Vol/Void, high frequency, and predominantly urge-related leaks, resembling an overactive bladder (OAB) clinical picture.

Conclusions:

• Reference population percentiles are superior to raw measurements for distinguishing frequency/volume patterns in USI and DO.
• A subset of USI patients displays an overactive bladder-like (OAB) clinical presentation.
• Bladder diary analysis, particularly with adjustments, aids in precise diagnosis and patient stratification.