Page 16 - Bladder Dysfunction in the Context of the Bladder-Brain Connection - Ilse Groenendijk.pdf

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Chapter 1
1.4 DIAGNOSTIC TOOLS IN FUNCTIONAL UROLOGY
Two different types of diagnostic measurements are often used within functional urol- ogy. Traditional measurements assess an objective outcome, such as number of voids per day, voided volume, pad weight or post-void residual. Patient reported outcome measurements (PROMS) are subjective outcomes and indicate a patient’s perception, usually obtained through a questionnaire.
A simple but important traditional diagnostic tool within functional urology is the bladder diary or voiding frequency chart. It gives information on the frequency of voiding per day and night, and on the average bladder capacity and fluid intake. In the outpatient clinic, a uroflowmetry can be performed after which the post void residual can be measured. The uroflowmetry measures the strength of the stream, which can provide information of the urethra and the tension of the pelvic floor muscles. A more invasive investigation is a urodynamic study, in which, using pressure sensors, the com- pliance and strength of the detrusor muscle can be measured. Detrusor overactivity and underactivity, which can occur in patients with OAB or UAB respectively, can be detected using a urodynamic study.18, 19 Because neuro-urology patients might be at risk for high pressure bladders, urodynamic studies in these patients are important investigations in the follow-up.1
The field of functional urology often uses PROMS, because the differences between objective and subjective outcomes are evident in this field. For instance, an individual might have a negatively affected quality of life (QoL) due to one incontinence episode per day, while the influence of this amount of UI would hardly affect another person’s QoL. With the use of PROMS, we can make these perceptions measurable and compa- rable between patients or within patients over time. Since the evolution of PROMS, many questionnaires have been developed measuring different aspect of different diseases. It is important that PROMS are phrased in line with the patient’s language and that questionnaires are validated in this language. Validation of a questionnaire ensures that the questionnaire actually measures what it is supposed to measure. In the Netherlands, some PROMS on diseases in the field of functional urology have been translated and validated in Dutch.21-29
As the pathophysiology of diseases in functional urology is still not completely known, tools to confirm or reject suspicion of a certain disease of a LUT disorder are still lacking. Dynamic brain imaging has been postulated as a possible future diagnostic tool in clinical practice. Some important issues need to be addressed, however, before this technique can be implemented in clinical practice. For example, how is the central innervation of the LUT organized and does the central innervation of the LUT differ between patients with LUT disorders and healthy subjects?