gms | German Medical Science

35. Kongress der Deutschen Kontinenz Gesellschaft

Deutsche Kontinenz Gesellschaft e. V.

22.11. - 23.11.2024, Essen

Urodynamics: Imposition or not as bad as it seems? Secondary analyses from a randomized controlled trial

Meeting Abstract

  • author presenting/speaker Madlen Kasten - Klinik für Neuro-Urologie, Universitätsklinik Balgrist, Universität Zürich, Zürich, Switzerland
  • Oliver Gross - Klinik für Neuro-Urologie, Universitätsklinik Balgrist, Universität Zürich, Zürich, Switzerland
  • Marian Wettstein - Division of Urology, Department of Surgery, University of Toronto, Toronto, Canada
  • Collene E. Anderson - Klinik für Neuro-Urologie, Universitätsklinik Balgrist, Universität Zürich, Zürich, Switzerland
  • Veronika Birkhäuser - Klinik für Neuro-Urologie, Universitätsklinik Balgrist, Universität Zürich, Zürich, Switzerland
  • Joël Borer - Klinik für Neuro-Urologie, Universitätsklinik Balgrist, Universität Zürich, Zürich, Switzerland
  • Martina D. Liechti - Klinik für Neuro-Urologie, Universitätsklinik Balgrist, Universität Zürich, Zürich, Switzerland
  • Ulrich Mehnert - Klinik für Neuro-Urologie, Universitätsklinik Balgrist, Universität Zürich, Zürich, Switzerland
  • Raphael Röthlisberger - Klinik für Neuro-Urologie, Universitätsklinik Balgrist, Universität Zürich, Zürich, Switzerland
  • Helen Sadri - Klinik für Neuro-Urologie, Universitätsklinik Balgrist, Universität Zürich, Zürich, Switzerland
  • Lara Stächele - Klinik für Neuro-Urologie, Universitätsklinik Balgrist, Universität Zürich, Zürich, Switzerland
  • Stephanie van der Lely - Klinik für Neuro-Urologie, Universitätsklinik Balgrist, Universität Zürich, Zürich, Switzerland
  • Thomas M. Kessler - Klinik für Neuro-Urologie, Universitätsklinik Balgrist, Universität Zürich, Zürich, Switzerland
  • corresponding author Lorenz Leitner - Klinik für Neuro-Urologie, Universitätsklinik Balgrist, Universität Zürich, Zürich, Switzerland

Deutsche Kontinenz Gesellschaft e.V.. 35. Kongress der Deutschen Kontinenz Gesellschaft. Essen, 22.-23.11.2024. Düsseldorf: German Medical Science GMS Publishing House; 2024. Doc06

doi: 10.3205/24dkg06, urn:nbn:de:0183-24dkg062

Published: November 20, 2024

© 2024 Kasten et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Introduction: Urodynamic investigation (UDI) is the gold standard for evaluating refractory lower urinary tract symptoms. However, its invasive nature, involving bladder and rectal catheterization, can cause emotional and physical discomfort and side effects. The aim of these secondary analyses from a randomized controlled trial (RCT) assessing artifact susceptibility of water- and air-filled urodynamic systems was to assess discomfort and adverse events (e.g. urinary tract infections (UTI)) of UDI.

Methods: From 04/2021-01/2022, 490 patients (40% females) participated in the RCT and underwent UDI. In case of asymptomatic bacteriuria, no antibiotic prophylaxis was given. After removal of the catheters, patients were asked to rate their emotional perception and pain on a numerical rating scale from 0-10, with lower values indicating less discomfort/pain. A follow-up telephone interview was conducted 7-14 days later to assess examination-related adverse events. Chi-square test and logistic regression were used to evaluate associations.

Results: Median overall emotional discomfort and pain were 2 (Q1-Q3: 0-5) and 2 (Q1-Q3: 0-4). Female patients reported stronger emotional discomfort (p=0.004). Pain ratings did not differ significantly between sex (p=0.112). In the follow-up interview, 30% (146/490) reported self-limiting pain with a median intensity of 5 (Q1-Q3: 3.5-6) and a duration of ≤72h in 81% (118/146) and >72h in 19% (28/146) of cases. Increased urgency was found in 18% (90/490) (≤72h: 70% (63/90); >72h: 30% (27/90)). 6% (28/490) of patients developed a UTI. UTI was significantly associated with UTI within the past 12 months (odds ratio (OR) 3.01 95% confidence interval (CI) 1.38-6.58, p=0.006)), asymptomatic bacteriuria at UDI (OR 4.54, 95% CI 1.54-13.41, p=0.006) and higher Charlson-Comorbidity-Index (OR 1.22, 95% CI 1.06-1.4, p=0.005). However, the number of positive urine cultures needed to treat to prevent one UTI was 16 (95% CI 9.6-38.6). Gross hematuria was present in 8% of patients, with 34% of these patients taking anticoagulants or platelet aggregation inhibitors. Severe adverse events requiring hospitalization were seen in 1% (5/490) with 3 of them being examination related (UTIs) and 2 not examination related.

Conclusion: UDI is a well-tolerated examination with an acceptable rate of short- and medium-term adverse events. Prophylactic antibiotics to reduce post-UDI UTIs do not seem justified.