Filling and Emptying Cystometries ("Backwards Cystometry"): a Feasibility and Validation Study
Filling and Emptying Cystometries ("Backwards Cystometry"): a Feasibility and Validation Study
This study evaluate the feasibility and the accuracy of an emptying cystometry in order to
 simplify the manometric follow-up of overactive detrusor in neurological patients under
 anticholinergic or botulinum toxin injections.
Bladder pressure assessment is necessary for the diagnosis, the prognostic assessment and the
 management of neurogenic bladder. High bladder pressures increase the rate of urological
 complications and mortality in patients with neurogenic bladder. Thus many treatments are
 proposed in order to improve bladder compliance and reduce uninhibited detrusor contractions
 (anticholinergic drugs, botulinum toxin injections, cystoplasty, sacral neuromodulation,
 beta-3-agonist, posterior tibial nerve stimulation).

 Clinical data, symptoms scales, quality of life questionnaires, renal ultrasound, biological
 tests of renal function and urodynamic studies are used to control the treatment efficacy of
 neurogenic lower urinary tract dysfunction. Filling cystometry is the usual way to record
 bladder pressure. Urodynamic techniques using external pressure transducers (microtip,
 air-filled or fluid-perfused catheters) connected to the patient with fluid-filled lines are
 recommended. This multichannel cystometry is performed in a specialized department with the
 inconvenience of delays for appointments and cost of the urodynamic assessment. Moreover,
 only some parameters are important and are taken in account in the follow-up of these
 neurogenic bladders: bladder capacity, bladder compliance and maximum detrusor pressure at
 the end of the filling phase. All these parameters can be recorded with a self-assessment of
 bladder pressure at home with a very simple device made of 1) a self-intermittent catheter;
 2) a three way stopcock; 3) a simple graduated tube. This device has in fact been used in the
 past to realize cystometries, in particular in the elderly subject. A such device should
 provide a monitoring in changes in bladder pressure in order to initiate adjustments in
 treatment sooner than would be achieved when patients are evaluated periodically but less
 frequently in the neurourology department. The early detection of high bladder pressures may
 avoid bladder deformation, reflux and upper tract deterioration. Moreover, the home control
 of appropriate bladder pressure may improve the patients' quality of live by reducing the
 constraint linked to the time-consuming specialized follow-up.

 In this study, the investigators will test a reverse single channel cystometry performed just
 after a classical filling cystometry during the usual emptying by means of a device allowing
 serial bladder pressure measurements during the bladder emptying. In case of such a
 feasibility and a good precision of the reverse cystometry, the manometric follow-up of
 overactive detrusor in neurological patients under anticholinergic or botulinum toxin
 injections could be simplified.

 The aim of this study is to assess the feasibility and the accuracy of sequential
 measurements of bladder pressure during the bladder emptying and to compare the evolution of
 bladder pressures during the emptying phase with the bladder pressures recorded during the
 filling phase.

 Patients over 18 years old, consulting for lower urinary tract symptoms and performing an
 urodynamic examination with a cystometry in a tertiary center are included.

 History, treatment and urodynamics data are recorded. Conventional supine multichannel
 cystometry with isotonic saline infused at 50ml/min (filling cystometry), conform to the
 International Continence Society (ICS) recommendations will be performed. At the end of the
 standard cystometry when the maximum cystometric capacity will be reached, if no micturition
 was obtained, urodynamic catheter was withdrawn and a CH12 urinary catheter will be
 introduced in the bladder according to the usual department procedure (usually, this catheter
 allows to empty the bladder). This catheter will be connected to a three-way stopcock. The
 second way of the stopcock will permit the emptying into a measuring container, graduated
 each 50ml. The third way of the stopcock will be connected via a tube extension to a rigid
 vertical 70cm tube (central venous pressure set) graduated each centimeter. The zero pressure
 of the vertical tube will be set at the upper edge of the symphysis pubis. For measuring the
 bladder pressure at the maximum cystometric capacity, the valve will be open between the
 bladder and the graduated tube, manometric data will be derived by observing the rise of the
 column of fluid in the centimeter scale tube. This procedure will be repeated every 50ml
 until bladder full emptying.

 The investigators will compared each bladder pressure measures every 50ml during the
 "backwards cystometry" with each bladder pressure measured every 50ml from the maximum
 capacity during the filling cystometry.

 Primary outcome is the agreement between the two cystometries evaluated using a kappa
 coefficient.

 Secondary outcome is the correlation between the pressures during the two cystometries.
Inclusion Criteria:

 -  Follow in neuro-urology for lower urinary tract symptoms

 -  Appointment for urodynamic assessment

 Exclusion Criteria:

 -  detrusor overactivity

 -  micturition during or at the end of the filling cystometry