Idiopathic and neurogenic detrusor overactivity: do the different patterns have urodynamic characteristics related to gender or neurological condition?

To evaluate the urodynamic characteristics of the two patterns (phasic, P and terminal, T) of detrusor overactivity (DO) according to gender and neurological condition.

Urodynamic characteristics of DO were analysed in a population with proven urodynamic DO (127 women and 76 men, respectively with 48 and 43 neurological diseases (encephalic, incomplete medullar lesion or peripheral)). Phasic DO is characterized by phasic waves with or without leakage while terminal DO is defined by a single non-inhibited contraction resulting in incontinence. Parameters analysed for both patterns of DO (among other parameters) included: volume and amplitude of the first non-inhibited detrusor contraction (NIDC#1), and for phasic DO: duration of pressure rise during NIDC#1 and number of NIDC.

Phasic DO was observed in younger patients in the whole population whatever the gender (women: 55.9 years vs. 64.7 years, p = 0.0052; men: 57.4 years vs. 67.8 years, p = 0.0038). Volume at NIDC#1 was greater for neurological PDO (significant in women: 185 vs. 125 mL, p = 0.0223). Other parameters were not significantly different whatever the gender. Amplitude of NIDC#1 during PDO was significantly lower than that of NIDC during terminal DO (TDO) in both genders whatever the neurological condition (p < 0.0001). Volume at NIDC#1 in both patterns was dependent on the level of neurological lesion.

The main difference between the patterns of DO is that PDO occurs in younger individuals. There is no significant difference between urodynamic characteristics of each pattern whatever gender or neurological status. Further studies will provide additional information on the impact of the level of neurological lesion on the pattern of DO.