Near-Infrared Spectroscopy: A novel, Noninvasive, Diagnostic Method for Detrusor Overactivity in Patients with Overactive Bladder Symptoms-A Preliminary and Experimental Study.

Eur Urol. 2010 Dec 29;

Authors: Farag FF, Martens FM, D’Hauwers KW, Feitz WF, Heesakkers JP

BACKGROUND: Near-infrared spectroscopy (NIRS) is an optical technology. it detects the hemodynamic changes in tissues via noninvasive measurement of changes in the concentration of tissue chromophores such as oxyhemoglobin (O(2)Hb) and deoxyhemoglobin (HHb). Involuntary bladder contractions may cause changes detectable by NIRS. OBJECTIVE: To address the accuracy and reproducibility of NIRS to detect the hemodynamic effects of detrusor overactivity (DO). DESIGN, SETTING, AND PARTICIPANTS: A prospective cohort study was carried out on 41 patients with overactive bladder symptoms. MEASUREMENTS: Forty-one patients underwent one or more filling cystometries with simultaneous NIRS of the bladder. The separated graphs representing both tests were presented to three urodynamicists on two occasions, 3 wk apart. The graphs showed curves with and without DO episodes with the bladder sensations marked. Thirteen of 47 graphs (28%) with DO and 16 of 58 graphs (28%) without DO were excluded due to motion artifacts. The urodynamicists marked pressure changes suggestive of DO on the cystometry curves. for NIRS curves they marked definite deviations from baseline. The sensitivity and specificity of NIRS for DO were determined. The inter- and intraobserver agreements were determined. RESULTS AND LIMITATIONS: Valid data from 33 of 41 patients (80%) were included in the analysis. The interobserver agreement to trace the effect of DO on NIRS curves was “substantial” (?(f)>0.6). The sensitivity of the Hb(sum) (O(2)Hb+HHb) curves for DO was 62-97% with a specificity of 62-79% (area under the curve [AUC]: 0.80-0.82; p<0.001). O(2)Hb curves had 79-85% sensitivity and 82-91% specificity for DO (AUC: 0.80-0.85; p<0.001). The sensitivity and specificity of the HHb curves for DO were 71-82% and 77-82%, respectively (AUC: 0.73-0.84; p<0.001). these values represent the performance of NIRS in the data sample that is not contaminated with motion artifacts; they are not representative of a general clinical setting. CONCLUSION: NIRS is a potential noninvasive, reproducible, diagnostic method to detect DO.

PMID: 21216087 [PubMed - as supplied by publisher]

SaturdayNovember 6, 2010 2:00 pm

Several studies have already demonstrated that antichloinergic medications are safe to use in  men with bladder outflow obstruction.  Abrams et al performed urodynamics in men with bladder outflow obstruction before and after commencing anticholinergics (1).  there was no increased risk of urinary retention and no clinically significant change invoiding pressures or residual volumes.  a systematic review and meta-analysis by Blake-James et al confirmed these findings.

In this months BJU Int a futher paper adds evidence to the safety and efficacy of anticholinergics in men with residual overactive symptoms (urgency and frequency) already treated with an alpha blocker.  They also looked to see if Prostate Specific Antigen (PSA) influenced safety and efficacy.  They concluded that the addition of tolterodine-ER (anticholinergic) to alphablocker therapy improved key overactive bladder symptoms and appeared to be well tolerated regardless of subjects prostate size as judged by serum PSA concentrations (3).

(1)  Abrams P et Al.  Safety and tolerability of Tolterodine in the treatment of Overactive bladder in men with Bladder Outflow Obstruction.  J Urol 2006; 175:999-1004.

(2)  Blake-James et al.  the role of anticholinergics in men with LUTS suggestive of BPH: a systematic review and meta-analysis.  BJU Int 2006; 99:85-96.

(3)  Chapple et al.  Efficacy and safety of tolterodine-ER in men with overactive bladder symptoms treated with alpha-blocker:  effect of baseline PSA concentrstion.  BJU Int 2010; 106: 1332-1338.

Posted by: Andrew Sinclair | November 6, 2010 « Requesting a PSA test | News home | PCA3 test may predict prostate cancer occurring in the future »