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SURVEY OF URODYNAMIC
EXAMINATIONS: RESULTS OF A MULTICENTER STUDY ON 915 PTS
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Authors:
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G.Tuccitto1, E.Andretta2,
G.Signorelli2, G.Anselmo1, S.Callari4, G.Mazza4 C.Camuffo5, S. Guazzieri5,
A.D'Amico7, G.Mobilio7, G. Pezzotti6, S. Cosciani Cunico6, E. Mami3,
W. Artibani3, G.Olivo9, A. Lotto9, E. Ostardo8, A. Garbeglio8, G.
Giardiello10, D. Como10, F. De Seta10
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Institution:
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(1)"Osp. Ca' Foncello"
Treviso, (2) "Osp. Civile" Dolo, (3) Policlinico di Modena, (4)
"Osp. Civile" Gorizia, (5) "Osp. Civile" Belluno, (6) "Spedali Civili"
Brescia, (7) "Osp. Borgo Roma" Verona, (8) "A.O. S.Maria degli Angeli"
Pordenone, (9) Osp. di Legnago, (10) Medtronic Italia
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Aims of study:
To monitor the activities of urodynamic laboratories and assess the prevalence
of low urinary tract symptoms and disturbance in patients who undergo urodynamic
examination (UE).
Methods:
From June 1999 to February 2000 data of 915 consecutives patients (Male 31.7%,
female 68.3%, mean age 57.5±14.9 yrs, range 6-89) who underwent UE was collected
using a standardized form. The data collected concerned personal identification
data, referring physicians, date of appearance and type of urinary symptoms
and other pelvic symptoms, preliminary examinations, UE performed, urodynamic
findings, other test suggested.
Results:
The pts were referred to UE by: urologist 76%, gynaecologist 13.1%, general
practitioner 2.8%, neurologist 2.3%, physiatrician 2.3%, colorectal surgeon
1.2%, others 2.3%.
Prevalence of main symptoms
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Incontinence
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Urgency/Frequency
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Retention
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Prolapse
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Other
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Neurogenic
bladder
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%
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21
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10
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8
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3
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4
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4
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Prevalence
of associated symptoms
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Prolapse
and other symptom
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Incontinence
and other symptom
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Retention
and other symptom
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Urgency/frequency
and other symptoms
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Other
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%
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15
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12
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9
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8
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6
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Mean time between
appearance of symptoms and first visit was 2.7 yrs Correlated pelvic symptoms
were present in 171 out of 915 (18%) - fecal incontinence 44pts, constipation
71pts, pelvic pain 18pts, sexual dysfunction 38pts -. Preliminary evaluation:
864 pts (94%) underwent morfologic evaluation (xray, ultrasound), 431 (47%)
complete a micturition diary, 689 (75%) had had a recent urine analysis. UE
has been performed in 874pts (96.1%). In 41 pts the UE hasn't been performed:
in 23 for lack of preliminary exams, 12 refused the UE, 6 for other reasons.
Prevalence of urodinamics
findings (not mutually exclusive)
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Detrusor
Instability
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Sphincter
deficiency
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Transmission
defect
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Obstruction
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Other
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Detrusor
hypo/
acontractilty
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Hype-
reflexia
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Normal
Function
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Urgency
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Compliance
modification
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Detrusor
Hypo/
Areflexia
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N
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223
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188
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152
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140
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124
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97
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90
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82
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75
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70
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43
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Overall
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17,4%
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14,6%
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12%
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11%
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9,7%
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7,6%
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7%
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6,4%
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5,8%
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5,5%
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3%
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Male
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18%
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5%
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0%
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21%
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10%
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13%
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15%
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3%
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3%
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6%
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6%
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Female
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17%
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19%
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18%
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6%
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10%
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5%
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3%
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8%
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7%
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5%
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2%
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Conclusions:
This survey allowed us to estimate the prevalence of urinary disturbance in
the population who underwent UE. Only 41 pts did not undergo UE which shows
good patient selection. Apart from urologists and gynaecologists, few other
specialists are in the habit of referring patients to UE. The time gap of 2.7
yrs between symptoms onset and medical consultation could be explained by the
embarassement felt by patients when discussing bladder dysfunction symptoms.
We were disappointed that only 47% completed a micturition diary. The present
survey is a result of a collaborative multicenter study that will help lead
to a standardization in urodynamic evaluation and provide suggestions as ways
of improving quality and organizing of the urodynamic laboratory.