First symptom predicts urodynamic diagnosis in MUI

Researchers have found that the first or most bothersome symptom in women with mixed urinary incontinence (MUI) closely relates to the urodynamic diagnosis.

The team, led by G Alessandro Digesu (St Mary’s Hospital, London, UK), says the findings could help guide diagnosis and treatment when urodynamics are inconclusive or cannot be performed.

“[A]lthough we believe that urodynamic investigation is a useful tool in the assessment of patients with [lower urinary tract symptoms], it is a time-consuming and invasive test which requires expertise and dedicated personnel in order to be reliable,” they comment.

“Therefore, our symptom-guided approach may in some cases provide useful information directing the clinician towards a more appropriate therapy.”

The researchers prospectively studied 180 women with symptoms of MUI who were referred to a urodynamic clinic. Overall, 30% were diagnosed with detrusor overactivity, 23% with urodynamic stress incontinence, and 29% with both. The results were inconclusive in the remaining 18% of women.

A first occurring or most bothersome symptom of urge urinary incontinence (UUI) was predictive for detrusor overactivity with a specificity of 80–83% and a positive predictive value (PPV) of 72%. When UUI was both the first occurring and the most bothersome symptom, these values were 93% and 58%, respectively, with a negative predictive value (NPV) of 73%.

Meanwhile, stress urinary incontinence (SUI) as a first occurring or most bothersome symptom predicted urodynamic stress incontinence with a specificity of 70–78%, a PPV of 62–63%, and an NPV of 66–70%. These values rose to 91%, 70%, and 78%, respectively, when SUI was both the first occurring and most bothersome symptom.

The researchers found that using symptoms to predict mixed detrusor overactivity and urodynamic stress incontinence resulted in high specificities and NPVs but very poor sensitivities and PPVs.

Writing in the European Journal of Obstetrics & Gynecology and Reproductive Biology, Digesu and colleagues explain that the discrepancy between reported current symptoms and urodynamic diagnosis in women with MUI can make management of the condition difficult.

However, MUI is thought to stem from a progression of initial bladder dysfunction, with detrusor overactivity and urethral sphincter incompetence associated with UUI and SUI, respectively.

“These factors support and explain why asking about the onset and bother of SUI and UUI might be a helpful clinical tool in the assessment of women with MUI,” they conclude.

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