==inizio objective==

To investigate the role of urodynamic study in female patients with non-neurogenic overactive bladder (OAB), correlation between overactive bladder symptoms and urodynamic findings and its influence on conservative therapy.

==fine objective==

==inizio methodsresults==

A retrospective study, performed at Urological Division of Istituto Clinico Città Studi in Milan, included female (mean 53,7) subjects with overactive bladder symptoms who underwent urodynamic evaluation by a single urologist between October 2012 and October 2017. Patients with previous anti-incontinence surgery, anatomic or neurogenic bladder were excluded. We analyzed the urodynamic data of 205 women with OAB symptoms. OAB symptoms were divided in two groups, dry and wet. Urodynamic results were comparated between patients with dry and wet symptoms. After urodynamic tests, all patients were treated with antimuscarinic drugs (fesoterodin). We have ruled out a bladder outlet obstruction by uroflowmetry with post voiding residual.

==fine methodsresults==

==inizio results==

A total of 205 patients with OAB were included in this study. Patients with OAB and wet symptoms was 170 and subjects with OAB dry was 35. In our experience, the detrusor overactivity (DO) were detected in 123 patients of 205 (60%); patients with OAB “wet” and DO were 100 (81,5%); patients with “dry symptoms” and DO were 18,8 % (23 patients). The prevalence of DO in patients with OAB “wet” were 100/170 (64.8%); the percentage of DO in patients with “dry symptoms” were 65.7% (23/35 patients). Low compliance bladder (LCB) was found in 15 patients without DO and urge incontinence and 5 patients without DO and dry symptoms. 65% of the women (all groups) considered their bladder problems to have improved regardless of urodynamic findings or choice of antimuscarinic drug.

==fine results==

==inizio discussions==

Overactive bladder (OAB) is a common problem. It is reported that a significant percentage of patients with symptoms not have unstable bladder contractions on provocative cystometry. It has been well documented that only 30-60% of patients with symptoms of OAB are found to have detrusor overactivity at cystometric exam. In our study, the detrusor instability is detected in 81.5% of women with urge incontinence with conventional cystometry. In women for whom local and system pathologies can be ruled out by the initial diagnostic procedure for LUTS, it is common practice to administer conservative treatment and oral pharmacotherapy for OAB without further investigation using urodynamics. This is because the response to antimuscarinic therapy does not differ between OAB patients, with and without urodynamic diagnosis. (1) NICE guidelines do not recommend performing urodynamics to commence conservative measures. (2) TS Verghese et al. demonstrated that urodynamic diagnoses appear to have greater reductions in symptoms than who do not (3) Instead, Nitti et al. showed that the response to antimuscarinic therapy in patients with OAB symptoms was independent of the urodynamic diagnosis of DO. (4) Our study confirms last hypothesis.
Limitations of our study is reduced number of patients.

==fine discussions==

==inizio conclusion==

Conventional cystometry showed not complete co-relation with lower urinary tract symptoms and, in our experience, its finding does not alter the treatment (conservative measures) outcome of the patients with symptoms of overactive bladder. Cystometry should only be reserved for confuse clinical diagnosis, conservative treatment failed and before surgery.

==fine conclusion==

==inizio reference==

(1) Malone-Lee J, Henshaw DJ, Cummings K. Urodynamic verification of an overactive bladder is not a prerequisite for antimuscarinic treatment response. BJU Int. 2003 Sep;92(4):415-7).

(2) (NICE) NIfHaCE. Urinary incontinence: The management of urinary incontinence in women. 2013 (Clinical Guideline 171).

(3) TS Verghese, LJ Middleton, JP Daniels, JJ Deeks, PM Latthe. The impact of urodynamics on treatment and outcomes in womwn with an overactive bladder: a longitudinal prospective follow-up study. Int Urogynecol J. 2017

(4) Nitti VW, Rovner ES, Bavendam T. Response to fesoterodine in patients with an overactive bladder and urgency urinary incontinence is indipendent of the urodynamic finding of detrusor overactivity. BJU Int. 2010; 105: 1268-75.

==fine reference==