Bladder Sensations During Filling Cystometry Are Different According To Urodynamic Diagnosis

Main Category: Urology / Nephrology
Article Date: 08 Dec 2008 - 3:00 PDT

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UroToday.com - The role of bladder sensation has recently been highlighted as a way of understanding the sensory pathophysiology of lower urinary tract dysfunction.

Sensation depends on neurophysiologic mechanisms involving nerves, receptors, and transmitters. Bladder sensation is a prerequisite for conscious bladder control and understanding them is important in the management of LUT dysfunction. Indeed, reduced or absent bladder sensation function will lead to urinary problems.

Sensory information is carried in all peripheral nerves of the LUT via parasympathetic, sympathetic and somatic pudendal nerves. Therefore alteration of sensory functions may be related to lesions of one or more of these nerves.

In the urinary bladder of humans and animals, sensory nerves have been identified suburothelially, as well as in the detrusor muscle. Suburothelially, the nerves form a plexus that lies immediately beneath the epithelial lining. This location makes them extremely sensitive to changes in urine composition, especially if the epithelial barrier is disrupted. Therefore, the urothelium with its sensory nerves may serve as a mechanosensor, which, by producing mediators, such as ATP, nitric oxide and acetylcholine can control, either directly or indirectly, the activity in afferent nerves, and thereby alter bladder sensation as the bladder fills.

Several sensations have been described in the LUT. They can be classified as physiological (sensations of bladder filling and sensation during micturition), pathological (urgency and pain), and externally induced (sensation of touch, temperature and sensation due to electrical stimulation). Results from this study suggest that women's bladder sensations vary in relation to their bladder condition. The assessment of these sensations during filling cystometry may provide clinicians with important information about bladder function.

Urgency is a common symptom reported by women with bladder dysfunction. The site, character and duration of urgency as well as the other bladder sensations have yet to be considered by the ICS.

Very few studies have investigated the location of urgency in patients with LUTS. However the conclusions and their implications in the clinical practice are still contradictory. Therefore we studied a total of 95 women between October 2005 and December 2007 to determine the site and character of bladder filling sensations in women undergoing urodynamic investigations for lower urinary tract symptoms.

Our study showed that there is a strong relationship between the site of the sensation of urgency and the urodynamic diagnosis.

The study results show that the feeling of needing to micturate is felt in different places with different pathologies. Women with stress urinary incontinence experience bladder sensations during filling mainly as suprapubic sensation compared with women with detrusor overactivity who experience these as a perineal or vaginal in origin. The perineal origin of urgency may explain why woman with OAB who have never leaked use pads as they feel urgency as a sensation that urine leakage might occur. Most women described the bladder sensations during filling as "constant pressure." Very few women described a sensation as a "sharp pain". The majority of women reported a "cold sensation in the bladder" during filling whereas very few reported filling as "hot". In the majority of the cases the sensations started as "weak" but became "strong" with increasing bladder distension. The character of sensations was not significantly different between the diagnostic groups (Chi square, p  0.05); however the intensity of the sensation did increase with increased bladder volume in all groups.

The feeling of "urgency" was reported during the test by 41 (100%), 8 (35%) and 18 (100%) women with detrusor overactivity, urodynamic stress incontinence and mixed urodynamic diagnosis respectively. Women with detrusor overactivity and mixed urodynamic diagnoses predominantly described the sensation of urgency as perineal or vaginal in origin (66% and 72%, respectively). Women with urodynamic stress incontinence described the site of bladder sensation as suprapubic (88%) (Chi square, p < 0.05).

The duration that voiding could be delayed during filling cystometry was significantly different according to urodynamic diagnosis at each sensation, with the exception of the "first sensation".

To define the location, character and duration of urgency and other bladder sensations during filling cystometry may help the clinician's assessment of women with LUTS. This providing additional information allows greater understanding of LUTS since different sensory pathways are related to different urodynamic diagnoses. Bladder sensations may provide a good clinical and research tool to differentiate between different lower urinary tract pathophysiologies.

Written by Alessandro DiGesu, MD, as part of Beyond the Abstract on UroToday.com.

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