Cough associated detrusor overactivity in women with urinary incontinence

This is the first study that attempts to define different forms of cough associated detrusor overactivity (CADO). Current literature lacks clarity regarding the types of CADO and clinical epidemiology.

Retrospective review of all adult women who underwent urodynamics for urinary incontinence (UI) over 7 years. Patients were stratified into four types: I, leak with CADO; II, leak with cough; III, leak with both; IV, leak with neither. Cough spike immediately preceding detrusor overactivity was defined as index cough. Stress leak occurring with any cough was classified as type II, not limited to the index cough that triggered the CADO. Statistical analysis by R statistical program (version 3.1.3).

Of 7009 studies, urodynamics was performed in 174, 290, and 874 women with clinical urgency, stress and mixed UI during the study period. CADO was noted in 29 (2.2%) (median 52 y; IQR 14 y) including six urgency UI, two stress UI, and 21 mixed UI (P = 0.102;n.s.). Types I-IV CADO was noted in 15, 5, 8, and 1 women, respectively. Type III was most bothersome (Patient Perception of Bladder Condition score 5; P = 0.049) and had the longest duration of CADO contraction (39.6 s IQR 20.3 s; P = 0.041). Types II (0.9 s) and III (2.0 s) had shorter latency of onset compared with type I (2.8 s, IQR 1.7 s; P = 0.038).

CADO is a heterogeneous entity. Subtle differences in presentation suggest distinct mechanisms for different forms of CADO. Recognizing different types of CADO introduces a precision into the subject that could ultimately benefit both clinicians and researchers.