Relaxation During Bladder Filling Increases Diagnostic Yield.

SCOTTSDALE, ARIZ. -- There are new instructions for patients whose bladders are being filled for urodynamic testing: Instead of "Try to hold it in," tell them, "Relax."

In a prospective study of 42 patients with irritative lower urinary tract symptoms, the detection rate of involuntary detrusor contractions on cystometry increased from 48% when they tried to inhibit micturition to 64% when they tried neither to void nor inhibit micturition (Neurourol. Urodyn. 20[2]:141-45, 2001).

"I'm going to start changing the way I do urodynamics based on this," Dr. Steven P. Petrou said at a urogynecology conference sponsored by the Mayo Clinic Scottsdale. The message to patients during bladder filling should be, "Whatever happens, happens. If you gotta go, you gotta go," he said.

The change challenges part of the definition of bladder overactivity, which classically is defined as "involuntary detrusor contractions during the filling phase of the cystometrogram ...where the patient is attempting to inhibit the micturition," noted Dr. Petrou of the Mayo Clinic Jacksonville (Fla.).

Clinicians rely on cystometry to diagnose bladder overactivity and to assess the degree of pathology because symptoms of urge incontinence are only 78% sensitive and 35% specific for the diagnosis.

A simple cystometrogram (CMG), which ...