abstract405 - DYNAMIC CYSTOSCOPY FOR THE DIAGNOSIS OF URINARY INCONTINENCE
DYNAMIC CYSTOSCOPY FOR THE DIAGNOSISOF URINARY INCONTINENCE
D. GLOBERMAN1, L.GAGNON 2, E. A. BRENNAND 3, S. G. KIM-FINE 4,M. ROBERT 5;
1Univ. of Calgary, Calgary,Canada, 2Univ. of Calgary, Toronto, Canada, 3Departmentof Obstetrics & Gynecology, Univ. of Calgary, Calgary, Canada,4Obstetrics and Gynecology, Univ. of Calgary, Calgary,Canada, 5ob/gyn, Univ. of Calgary, Calgary, Canada.
Introduction: Patient history isoften insufficient to identify type of urinary incontinence,requiring further testing. Multichannel urodynamic testing (UDS) isoften used to clarify the diagnosis. The utility of UDs continues tobe examined. Dynamic cystoscopy (DC) is a novel approach for testingbladder function. During direct observed bladder filling, the womanis asked about filling sensations and the detrusor muscle isinspected to observe changes. Stress incontinence is then tested atthe completion of the procedure. DC gathers the same information asUDs, with the exception of urethral pressures. DC has the advantageof being able to directly visualize for bladder pathology.
Objective:The objective was to compare UDS to DC for evaluation of womenpresenting with mixed urinary incontinence.
Methods: Womenpresenting with mixed urinary incontinence and requiringinvestigations were approached for enrollment. The Questionnaire forUrinary Incontinence Diagnosis (QUID) score was used to evaluateurinary incontinence. The Subjective Unit of Distress (SUDS) was usedto measure patient experience with both tests. Multichannel UDS wasperformed according to international standards (Gammie, InternationalSociety Guidelines) using a Triton Laborie system. Cystoscopy wasperformed in a standardized fashion, using a 300 Storzcystoscope with infusion of sterile water at 60 mL/min. Theinvestigators were blinded to history and comparative test result.Stress incontinence (SI) was defined as any leakage with cough orValsalva. Urinary urge incontinence (UUI) and urgency (UU) was anyof: first filling sensation <150 mL, strong desire to void <250cc,maximum capacity <300cc and/or a bladder contraction (on DC:directly visualized or blanching of trabeculation; on UDS: isolatedrise in vesical pressure >5cmH20). McNemar’s Kappa wascalculated for agreement of the tests. T-test was used for comparisonof continuous variables. ROC analysis was used to identify the bestpossible filling sensations for cystoscopy.
Results: 60women were included of which 4 were excluded for protocol violation.The mean age was 56.8 (+/- 13.2), mean BMI 32.7 (+/- 7.2), mean QUIDurge score 8.7 (+/- 3.1), mean QUID stress score of 9.8 (+/- 4).Comparison of UDS and DC results agreed in 44/56 of SUI cases (79%)with a κ= 0.55, and in 43/56 of UUI cases (77%) with a κ= 0.55Table1: Diagnosis
First urge to void at DC was amedian volume of 160cc (+/- 68.5cc) vs. 207cc (+/-195cc) at UDS(p=0.005). Strong desire during DC was reported at an average of259cc (+/-96cc) vs. 301cc (+/-111cc) at UDS (p=0.01). The mediancystoscopic maximum capacity was 322.5cc (+/-143.5cc) compared with390cc (+/-189cc) at UDS (p<0.001).
ROC analysis identified thebest prediction of cystoscopic first urge to void was at 148 mL,strong urge at 215 mL and maximum capacity at 246 mL. Using theseparameters to compare UDS UUI to DC UUI resulted in a κ= 0.61,p=0.37. During DC, three bladder biopsies were done revealing:polypoid cystitis, papilloma and cystitis cystica. Average time forcystoscopy was 7 minutes compared to 21.5 min for UDS. The SUDSacceptance mean score was 20 (range 32.5) with DC and 20 (range 30)for UDS (p=0.7).
Conclusions: Dynamic cystoscopy showsmoderate agreement with UDS (an imperfect gold standard) for stressincontinence, κ= 0.55. Sensations to void were earlier oncystoscopy. When this was adjusted using ROC analysis then DI showedsubstantial agreement, κ= 0.61, when compared to UDS. DC had theadvantage of allowing direct visualization of the bladder and shortertesting time. Patients equally accepted both procedures, thereforedynamic cystoscopy is a promising test for evaluation of mixedurinary incontinence.