EVALUATION OF RISK FACTORS FOR DETRUSSOR INSTABILITY

P.K. Tulikangas, C.L. LaSala, N.D.Goulet, D.M. O’Sullivan

Hartford Hospital, Hartford, CT

OBJECTIVE:  To determine historical risk factors for detrussor instability.

MATERIALS AND METHODS:  Retrospective review of 228 consecutive patients who presented to a referral urogynecology practice from 1/1/99 to 6/1/03 with symptoms of urinary incontinence and underwent multichannel urodynamic testing.  Detrussor instability was defined as any rise in detrussor pressure associated with urgency or urine loss.  Record review included patient questionnaires, physician notes and 24-hour voiding diaries.  Comparisons were made using a McNemar’s chi-square test; values at p<0.05 were considered statistically significant.  Risk factors analyzed included:  age, race, body mass index, caffeine use, history of prior pelvic surgery, history of hysterectomy, history of neurologic disease,  history of urge incontinence, history of stress incontinence, day time urine frequency, nocturia, 24 hour urine frequency, largest voided volume, and nocturnal enuresis.

RESULTS:  37/214 (17.3%) of women had detrussor instability documented on urodynamic testing.  Risk factors for detrussor instability included:  age greater than or equal to age 65 [X 2 (1)= 7.28, p<0.02];  greater then 2 episodes of nocturia [X 2 (1)= 19.98, p<0.001];  a history of urine loss in association with urgency [X 2 (1)= 12.35, p<0.001] (5.8%, 5/86, 12.35(1), p<0.001).  Women who had all three of these risk factors had a 50.0% chance of having detrussor instability vs. women who did not have all three [X 2 (1)= 17.93, p<0.001].

CONCLUSIONS:  Historical risk factors for detrussor instability in our population include:  history of urge incontinence, age greater than or equal to 65, and nocturia greater than two.  This information may be helpful to practitioners who treat women with urine incontinence who do not have access to urodynamic testing.

Key Words:  urine incontinence, overactive bladder, detrussor instability, urodynamic testing

Disclosure - Speakers Bureau: P.K. Tulikangas, Pfizer; CL LaSala, Pfizer.