Cystodistension versus cystoscopy in patients with refractory detrusor overactivity: a randomized controlled trial

Cystodistension may be offered as a treatment for patients with refractory overactive bladder. The reported efficacy is based on a number of case series. This study was designed to evaluate the efficacy of cystodistension in a randomized trial.

This was a randomized study comparing cystoscopy combined with cystodistension with cystoscopy alone. The primary outcome was improvement in the Urgency Perception Scale (UPS) score. Symptoms were assessed using the ICIQ Female Lower Urinary Tract Symptoms (ICIQ-FLUTS). Quality of life was assessed using the Urinary Distress Inventory (UDI).

A total of 77 patients were recruited into the study with 42 randomized into the cystodistension arm and 35 into the cystoscopy-only arm. UPS scores had improved in both the cystodistension (41%) and cystoscopy (44%) arms at 6 weeks, but cystodistension provided no added benefit over cystoscopy alone. There was a significant improvement in ICIQ-FLUTS scores in the cystoscopy-only arm at 6 weeks (p = 0.01), but there was no significant improvement in the cystodistension arm (p = 0.09). At 6 weeks there were significant improvements in UDI scores in both arms (both p = 0.01). Despite statistical improvements at 6 weeks, no clinically therapeutic benefit was maintained by either procedure at 6 months.

Cystoscopy produces some short-term improvement in bladder symptoms, but cystodistension does not.