Presentation Authors: Natalie Swavely*, John Speich, Naveen Nandanan, Andrea Balthazar, Adam Klausner, Richmond, VA
Introduction: Multi-channel urodynamics is the gold standard for the diagnosis of lower urinary tract dysfunction. However, the study is invasive, non-physiologic, and prone to artifacts. These issues result in challenges in interpretation and clinical utility, even when following strict practice guidelines. Therefore, the purpose of this investigation was to examine urodynamics in normal, healthy volunteers in order to better define normal.
Methods: Healthy volunteers were recruited to undergo standard multi-channel urodyamic testing as part of a comparison group in a study evaluating novel urodynamic techniques. To be eligible, participants had to score â‰¤1 on all symptom questions of the ICIq-OAB survey, have no medical conditions or be on any medications that affect bladder function. The initial urodynamics fill was done according to ICS standards and used for evaluation. All tracings were evaluated twice by an expert neuro-urologist in a blinded fashion and discrepancies resolved. Data were analyzed categorically for the presence or absence of: 1) Low compliance ( < 30ml/cmH20) 2) Detrusor overactivity 3) Bladder outlet obstruction (BOOI < 40) 4) Weak contractility (BCI < 100) 5) Straining to void 6) Poorly sustained detrusor contraction 7) Uncoordinated EMG activity and 8) Intermittent flow.
Results: A total of 24 participants completed the study including 10 men and 14 women. The mean age of the participants was 28.83Â±11.45 with mean BMI of 26.46Â±6.23. ICIq-OAB scores for frequency, nocturia, urgency, and urge incontinence were (0.17Â±0.38, 0.33Â±0.48, 0Â±0, 0Â±0). All participants had at least 1 urodynamic abnormality (fig 1) with an average of 4.43Â±1.28 abnormalities/participant. The most common abnormalities included uncoordinated EMG activity (87.50%), straining to void (79.17%), and intermittent flow (70.83%). There were no significant differences for sex, age, BMI.
Conclusions: This study demonstrated that normal, healthy volunteers have high rates of abnormal urodynamic findings. All participants were completely asymptomatic, suggesting that artifacts and the non-physiologic nature of urodynamic testing present serious challenges in diagnostic interpretation and clinical utility. This data highlights the need to develop less invasive and more physiologic techniques to more accurately evaluate bladder function.
Source of Funding: NIH R01-DK101719