Urethral dilatation: Is there any benefit over cystoscopy and distension? A randomized trial in women with overactive bladder symptoms

Neurourol Urodyn. 2014 Mar;33(3):283-8. doi: 10.1002/nau.22411. Epub 2013 May 1.

Abstract

Aim: To evaluate the effect of urethral dilatation (UD) on urgency symptoms in women with overactive bladder (OAB) and voiding dysfunction.

Methods: Women with OAB symptoms and a maximum flow rate of less than 15 ml/sec on a volume voided of 200 ml were eligible for entry to the trial. Fifty women with OAB symptoms and a maximum flow rate of less than 15 ml/sec on a volume voided of over 200 ml were randomized to undergo UD plus cystoscopy or cystoscopy alone. All subjects underwent filling and voiding cystometry pre-operatively and at 6 weeks' post-operatively. Subjective outcomes were assessed using the Urgency Perception Scale (UPS) and King's Health Questionnaire at baseline, 6 weeks and 6 months. The primary outcome measure was cure of urgency, defined using the UPS.

Results: Urgency was cured in 10/22 (45%) patients in the UD group and 5/28 (18%) in the non-UD group at 6 weeks (Odds ratio 3.8, 95% confidence interval 1.1-13.8, P = 0.03). Cystometric flow data were available for all patients pre- and post-UD. UD was associated with a significant increase in the flow rate centile from 1.66 to 8.54 (P = 0.01). At 6 months there was no benefit from UD with 4/22 in the UD group cured of urgency and 4/28 in the non-UD group cured (Odds ratio 1.3, 95% confidence interval 0.3-6.1, P = 0.50).

Conclusion: UD confers a significant short-term benefit in cure of urgency over cystoscopy alone, but there is no significant benefit in symptom relief in the long term.

Trial registration: ClinicalTrials.gov NCT00839969.

Keywords: overactive bladder; urethral dilatation; voiding.

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Combined Modality Therapy
  • Cystoscopy* / adverse effects
  • Dilatation* / adverse effects
  • England
  • Female
  • Humans
  • Middle Aged
  • Recovery of Function
  • Surveys and Questionnaires
  • Time Factors
  • Treatment Outcome
  • Urethra / physiopathology*
  • Urinary Bladder / physiopathology*
  • Urinary Bladder, Overactive / diagnosis
  • Urinary Bladder, Overactive / physiopathology
  • Urinary Bladder, Overactive / therapy*
  • Urinary Incontinence, Urge / diagnosis
  • Urinary Incontinence, Urge / physiopathology
  • Urinary Incontinence, Urge / therapy*
  • Urodynamics

Associated data

  • ClinicalTrials.gov/NCT00839969