Assessment of lower urinary tract function in women with urodynamic stress incontinence with and without detrusor overactivity

There are many diagnostic tests available to help evaluate urethral sphincter and bladder dysfunction in patients with urinary incontinence. The most commonly used tests are multichannel cystometry, urethral pressure profilometry, leak point pressure, bladder diaries, pad tests and quality of life questionnaires. More recently, measurements of opening detrusor pressure obtained during pressure f1ow urodynamic studies have claimed to offer a suitable alternative to tests predicting urethral sphincter insufficiency. There have been very few studies evaluating the validity and reliability of these investigations in assessing lower urinary tract in women. The initial part of this thesis provides a review of the normal and abnormal bladder and urethral function. It also presents an overview of the investigation and management of women with lower urinary tract dysfunction. The remainder of this thesis aims to determine the reliability of the various tests currently available. This is done by assessing their reproducibility using test re-test analysis, on the same subject, in two different visits. The different tests are compared in a larger number of subjects, to establish any correlation that may be evident between them. Furthermore, I have compared different subgroups of patients with urodynamic stress incontinence, with or without detrusor overactivity, and assessed the effect they have on the reproducibility of urodynamic studies, urethral function tests and other commonly used bladder investigations. In the last section, the relevance of the study findings are discussed, final conclusions are made and suggestions for future research considered.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Reliability testing of urodynamics, pressure flow studies and cough leak point pressure in women with urodynamic stress incontinence with and without detrusor overactivity

Urodynamic studies which included cough leak point pressure (CLPP) and pressure flow studies were performed at two visits 2 weeks apart. Reproducibility between the two visits and also between the two diagnostic groups, urodynamic stress incontinence (USI) and urodynamic mixed incontinence (UMI) were analysed. Thirty-one women completed both visits, of those 14 had USI in both sets of urodynamic studies, 11 had UMI on both visits, six had USI on one visit and UMI in the other. The urodynamic variables of maximum cystometric capacity and CLPP have the most repeatability. Analysis in women with USI alone compared to USI with detrusor overactivity (DOA) showed that the repeatability for pressure flow parameters and CLPP was better in women without DOA, of which the CLPP was significantly different (p?=?0.036). Urodynamic variables are inconsistent. This may reflect variations in urinary tract behaviour