Neurourology and urodynamics vol 30, issue 1 and 4 2011

Neurourology and urodynamics vol 30, issue 1 2011

Reference values for the nocturnal bladder capacity index – this paper adds to the complexity possible with measured voided volume diaries.  I highly recommend having patient measure volumes and calculating nocturnal polyuria or low bladder capacity if possible.

Protracted postpartum urinary retention – This is very important for the acute postpartum patient. Second stage of labor and vacuum were significant independent risk factors.  Complete resolution should occur within 28 days.

A pilot study of Botulinum toxin for IC/PBS – periurethral injection did not change symptoms of IC/PBS

The response of the abdominal muscles to pelvic floor muscle contraction in women with and without stress UI using ultrasound imaging – another study looking at the abdominal muscles and PFMs.  This study shows increased thickness of TrA and Internal Oblique during PFM contraction in patient with and without UI.   If both groups have similar abdominal muscle function then maybe we do not need to train the abdominals for SUI?

Neurourology and urodynamics vol 30, issue 4 2011

There are several outcomes measure studies in this issue

The correlation between clinical and urodynamic diagnosis in classifying the type of UI in women. A systematic review.  – this study reinforces the fact that history alone is not enough to reliably diagnosis type of UI.  “Level of agreement between clinical diagnosis and urodynamics is poor”.  Urodynamics has always been the gold standard, this paper calls this practice to question.  Either way it is wise to fully evaluate both PFM function and bladder function in all patients, and to treat any dysfunctions found regardless of diagnosis.   

Which single-item measure of OAB symptom treatment correlated best with patient satisfaction?  - Outcomes measures are helpful in documenting results however they do not always correlate with patient satisfaction.  This study notes the individuality of patients. 

Further validation of the short form versions of the PFDI and PFIQ – these are the two questionnaires I use in my practice – available on the SOWH CAPP web site.  I would recommend these to other PTs, they are easy and usually show good correlation with patient report of improvement. 

Validation of the Pelvic floor inventories Lieden in English – Bernie and I helped with this English validation of a questionnaire originally used in The Netherlands.  It is an intake history questionnaire and does not replace outcomes measures or QOL scores, although it does have some questions of overlap. 

Other interesting papers

Fall risk reduction and treatment of OAB symptoms with antimuscarinic agents – this review of literature aimed to answer the question” Can you decrease fall risk with OAB meds?”  Their conclusion is “no”.  Would be great to do a study where bladder training and PFM exercises where used instead of medications to treat OAB.

Coital incontinence: relation to detrusor overactivity sand stress incontinence – Many of the papers I have read in the past link UI during intercourse to OAB.  This study linked UI during intercourse to SUI and POP with sphincter incompetence as the mechanism.  Factors associated with UI during intercourse were SUI, POP and parity.

Association between urinary hesitancy symptoms and uroflowmetry measured urinary hesitancy time in men with LUTS – I think it is important for all pelvic PTs to have some experience with urodynamics.  This knowledge helps in understanding urinary dysfunction.  This study defines hesitancy as time to void of 11.5 seconds.  This also correlated with question #6 on the IPSS questionnaire.  I would not have guessed this long and am glad to have some clarification of the time.

How well informed are women who undergo urodynamic testing?  - This is another study pointing to the importance of pelvic PTs knowing the basics of urodynamics.  This study shows women are not well informed before they have the test.  PTs can provide some patient education before the test to alleviate this.