Relationship between urodynamic patterns and lower urinary tract symptoms in Chinese women with a non-neurogenic bladder

Objective:To investigate the urodynamic study(UDS)patterns,obstruction status,continence status,and their correlations among neurologically intact women with lower urinary tract symptoms(LUTS)through an epidemiological and logistic regression analyses.Methods:We retrospectively analyzed the UDS data of 3265 neurologically intact women with LUTS(2002e2014).Five UDS patterns were identified:normo-active detrusor/sphincter(NA,or DSI,detrusor/sphincter intact),idiopathic detrusor overactivity(IDO),idiopathic sphincter overactivity(ISO),IDO+ISO,and detrusor underactivity(DUA).Analyses of UDS pattern distribution and stratification were performed(based on a modification of the European Urological Association-Madersbacher classification system),and their correlations with bladder outlet obstruction(BOO)and stress urinary incontinence(SUI)status were evaluated via logistic regression analysis.Results:NA,IDO,IDO+ISO,ISO,and DUA were noted in 927(28.4%),678(20.8%),320(9.8%),689(21.1%),and 651(19.9%)cases,respectively.Moreover,storage,storage+voiding,and voiding symptoms were noted in 62.4%,21.1%,and 16.5% cases,respectively,whereas BOO and SUI were observed in 12.1%and 29.0%cases,respectively.The risk factors for BOO included NA,IDO,ISO,and IDO+ISO,whereas the protective factors against BOO included storage symptoms,SUI,storage+voiding symptoms,and complaint duration within 1e12 months.NA was the only risk factor for SUI,whereas BOO,storage+voiding symptoms,IDO,and storage symptoms were protective factors for SUI.Conclusion:Five UDS patterns were identified among neurologically intact women with LUTS.Functional abnormalities of the detrusor and/or sphincter were the main causes of LUTS,and were correlated with the BOO or SUI status.Thus,the UDS pattern can provide additional information regarding the risk factors for BOO or SUI status,as compared to symptomatic typing.

The role of botulinum toxin in the management of nonneurogenic overactive bladder in children:Highlights for clinical practice.A systematic review

Overactive bladder(OAB)is the most common voiding dysfunction in children;however,nonneurogenic or idiopathic OAB remains poorly studied.First-line treatment includes conservative measures;however,as many patients are refractory,have adverse effects,or are contraindicated for anticholinergics,new options must be explored.This review covers the use of intravesical botulinum toxin(BoNT)for idiopathic OAB treatment in children,emphasizing its efficacy,safety,differences between toxins,doses,and injection tech-niques.Clinical results were promising,with all 8 studies reporting good results.All authors used BoNT type A(BoNT-A),either onabotulinum or abobotulinum toxin A.Response rates were variable,with full-response percentages of 32%-60%.As proven by the full-response rates of 50%,repeated injections are as safe and effective as first injections.Only a few cases of urinary tract infection,transient urinary retention,and hematuria have been reported,with no major local or systemic adverse effects.Despite these limitations,evidence encourages and supports BoNT-A use as a safe and effective treatment modality for refractory idiopathic OAB in pediatric set-tings,regardless of dosage and target toxin.To the best of our knowledge,this is the first systematic review of the use of intravesical BoNT-A for idiopathic OAB treatment in children.