There is growing debate about when and if urodynamic testing is necessary for patients with Overactive Bladder (OAB), especially patients with uncomplicated symptoms. Urodynamic tests are used to measure and evaluate bladder function and efficiency. Some of the tests are simple and may be performed in a doctor’s office, but some urodynamic testing can be invasive, time-consuming and expensive.
In addition, an increasing number of studies question the efficacy of urodynamic testing for patients who have not yet exhausted the various forms of treatment for OAB, and suggest this type of testing may not be necessary for the initial diagnosis. However, a recent study examining the role of urodynamics in OAB care suggests that urodynamic testing of refractory cases can better diagnose the cause of the incontinence and better identify candidates for percutaneous tibial nerve stimulation (PTNS) delivered by the Urgent PC Neuromodulation System.
Guideline for OAB Diagnosis & Treatment
Urodynamic testing is a management and diagnostic tool. During testing, patients arrive for the appointment with a full bladder and are then instructed to urinate so the volume can be measured. After the insertion of a thin flexible tube (catheter) into the bladder through the urethra, the remaining urine is measured. Additional fluid may be introduced into the bladder through the catheter and measured in stages, until involuntary urination occurs. It’s something of a stress test for the bladder to check whether function is normal.
The American Urological Association (AUA) and the Society for Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction released a guideline for the Diagnosis and Treatment of Overactive Bladder (Non-Neurogenic) in Adults. Their findings indicate urodynamics, cystoscopy and diagnostic renal and bladder ultrasound should not be used in the initial workup of the uncomplicated patient.
However, urodynamics may provide some additional benefits when:
- Patients are refractory to drugs therapy.
- The patient has moderate to severe involuntary release of urine.
- Other tests do not determine the cause of incontinence.
- The doctor suspects there is more than one cause for the incontinence.
- Surgery is being considered
Study of Urodynamic Testing and Urgent PC Treatment
A poster presented recently at the annual meeting of the United Kingdom Continence Society (p. 56) looked at how urodynamics may be able to provide some guidance on patient selection for Urgent PC.
The study included 112 patients who underwent a 12-week course of Urgent PC therapy.
Patients completed a validated standardized questionnaire (OAB-q) at four intervals: Week 1, 6, 12 and 16. At week 16, patients were also asked if they felt they benefitted from the treatment, with the following results:
- 68% of patients with pure OAB demonstrated improvement after 12 PTNS treatment sessions.
- 62% of patients with with pure OAB and mixed incontinence showed improvement.
- Only 21% improved if there were only irritable bladder symptoms demonstrated, without urodynamic diagnosed OAB.
The results indicate that Urgent PC does quite well in treating OAB, especially pure OAB at rates (68%) similar to previous studies. The results also show that if urodynamics does not demonstrate OAB (pure or mixed), then the treatment is less effective.
The study also showed that a significant number of patients (25%) were misdiagnosed as having OAB, and that urodynamics can identify these patients – alerting physicians to move them onto other, more appropriate therapies. Urodynamics may also be helpful in setting expectations for the patients with mixed incontinence (OAB and SUI) about the limitations of Urgent PC in resolving all their incontinence issues.
As a result, the authors concluded that, “Appropriate patient selection for this treatment (PTNS) should include a urodynamic diagnosis of overactive bladder syndrome and the exclusion of other pathology causing irritable bladder symptoms.”
The bottom line is that urodynamic testing provides a more accurate diagnosis of difficult incontinence cases, and a better diagnosis of true OAB can help health care practitioners and patients achieve better results.
Urgent PC is indicated for the treatment of Overactive Bladder and associated symptoms of urinary urgency, urinary frequency and urge incontinence. Treatment with Urgent PC is contraindicated for patients with pacemakers or implantable defibrillators, patients prone to excessive bleeding, patients with nerve damage that could impact either percutaneous tibial nerve or pelvic floor function or patients who are pregnant or planning to become pregnant during the duration of the treatment. Most patients don't experience side-effects. If side-effects occur, they are typically temporary and include mild pain and skin inflammation at or near the stimulation site. Caution: Federal law (USA) restricts this device to sale by or on the order of a physician. For complete instructions for use, storage, warnings, indications, contraindications, precautions, adverse reactions and disclaimer of warranties, please refer to the insert accompanying each product or online at www.cogentixmedical.com. Urgent PC is a registered trademark of Cogentix Medical © 2015 Cogentix Medical. All rights reserved.