Expanded Physiological Testing of the Lower Urinary Tract in Asymptomatic Women and Those With Urgency Urinary Incontinence: Findings From the LURN-Organ Study.

PURPOSE: To investigate sensory and motor function of the bladder and urethra in women with and without urgency urinary incontinence (UUI). MATERIALS AND METHODS: Treatment-seeking women with UUI and healthy, asymptomatic, nontreatment seeking controls enrolled in the Symptoms of Lower Urinary Tract Dysfunction Research Network Organ-Based study (LURN-Organ) and underwent a single session of physiological testing. Testing included rapid-fill cystometry before and after lidocaine administration, urethral pressure profiles, pelvic floor contraction (Kegel) testing, and tuning fork sensation testing at the urethral meatus. RESULTS: Data were collected from 31 asymptomatic controls and 56 women with UUI. Women with UUI were more likely to demonstrate detrusor overactivity (DO) (32% vs. 10% in controls, p = 0.019). In addition, women with UUI on average generated 25% lower active urethral closure pressures during maximal contraction (p = 0.0016) and reported sensations at lower volumes during cystometry (34% lower for first desire to void, p = 0.028; 34% lower for strong desire to void, p = 0.0017; and 32% lower for maximum cystometric capacity, p = 0.0047). Women with UUI demonstrated diminished urethral sensation on the tuning fork test (median of 7 vs. 8 in controls) though the difference was not significant (p = 0.054). Considerable overlap in all findings occurred between cases and controls in each parameter. While individual component comparisons revealed some differences, additional multivariable analysis demonstrated prominently the physiological heterogeneity of women with UUI. CONCLUSIONS: Women with UUI demonstrated varying amounts of bladder sensory dysfunction, urethral motor dysfunction and bladder motor dysfunction. Considering the function of lower urinary tract components in combination may reveal UUI phenotypes, highlighting the need to study UUI from a multifactorial perspective. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04557748.

Duke Scholars

Author Cindy Louise Amundsen Obstetrics and Gynecology, Urogynecology

Author Aaron Claude Lentz Urology

Author David Page Biostatistics & Bioinformatics, Division of Biostatistics

Author Michael R. Odom Urology

Author Nazema Y. Siddiqui Obstetrics and Gynecology, Urogynecology

Author John E Jelovsek Obstetrics and Gynecology, Urogynecology

Author Jordan Robert Foreman Urology

Author Kathryn Eve Flynn Population Health Sciences

Author Tara N Morgan Urology