Evaluating ambulatory urodynamics: a prospective study in asymptomatic women

Objective To identify abnormal detrusor contractions in asymptomatic women undergoing ambulatory urodynamics, to standardise the investigation techniq ue for women with urinary symptoms for clinical practice. Design Prospective observational study. Setting Two tertiary referral urogynaecology units: one in London, UK and o ne in Varese, Italy. Methods Women without urinary symptoms were recruited into the study. Ambul atory urodynamics was performed according to the King's College Hospital pr otocol. All the traces were analysed in four different ways: 1. without the second bladder transducer measurements displayed on the screen and without the diary; 2. as in 1, but with the diary, 3. with the second bladder sens or displayed on the screen but without the diary; 4. as in 3. but with the diary. The diary was always interpreted at the end of the test with the wom an present. For each method we reported the total number of detrusor contra ctions and whether the woman would have been diagnosed as having abnormal d etrusor contraction. Cochran's Q test was used for statistical analysis. Results Twenty-six women (mean age 31.7 years) were recruited. Ambulatory u rodynamic testing lasted an average of 3.57 hour. The diagnosis of abnormal detrusor contraction varied by 65.4% depending on the method of analysis u sed. The diary and the women's symptoms during the test were the most discr iminating factors. A significant difference between the diagnoses was obtai ned when comparing the four different ways of analysis, According to our pr otocol only three women (11.5%) had abnormal detrusor contractions. Conclusions Using our protocol almost 90% of asymptomatic women have a stab le bladder on ambulatory urodynamics, This is similar to the results of lab ouratory urodynamic testing of asymptomatic women but is in contrast to pre vious reports of ambulatory urodynamics of asymptomatic women. The techniqu e used during ambulatory urodynamics determines the tests ability to detect detrusor instability with an accurate symptom diary being the most importa nt.