STANDARD AND EXTRAMURAL AMBULATORY URODYNAMIC INVESTIGATION FOR THE DIAGNOSIS OF DETRUSOR INSTABILITY-CORRELATED INCONTINENCE AND MICTURITION DISORDERS

Forty-six patients were evaluated for complaints of urinary incontinen ce or voiding disorders. Diagnostic testing included a detailed histor y, physical examination, urine analysis, and urodynamic studies consis ting of a conventional urodynamic test (S.I.) including provocative ma noeuvers and extramural ambulatory urodynamic monitoring (e.a.m.). We compared the pre-classification diagnoses obtained from the medical hi story with both urodynamic tests. Conventional cystometry detected det rusor instability in 8 patients out of 16 with a history of urgency, w hile a normal detrusor behaviour was observed in the other 8. ''Provoc ative'' manoeuvers yielded an additional 13.3%. Extramural ambulatory monitoring confirmed the diagnosis in the 8 patients with hyperactivit y and revealed detrusor instability in a further 7. E.a.m. proved adeq uate in 93.7% of patients with symptoms of detrusor instability. In th e group of patients with urinary stress incontinence (USI) e.a.m. reve aled detrusor instability in 18.7% of the patients, but did not signif icantly improved the diagnostic results obtained by S.I. Coughing was the most effective stimulus to objectify stress incontinence. The comp arison of the results obtained with S.I. and those obtained with home e.a.m. will probably lead to a more rational use of both methods. Our data confirm the promising impact of ambulatory urodynamic investigati on. (C) 1994 Wiley-Liss. Inc.