Cough induced detrusor overactivity (CIDO) – outcome after conservative and surgical treatment

Introduction CIDO is found in 2,2% of patients with/without urinary leakage. It's mostly found in patients with mixed urinary incontinence but generally classified as stress urinary incontinence (SUI). Both conservative and surgical management have been proposed, yet pharmacological treatment proved to be ineffective to date.

Bulking agents and midurethral slings are a treatment option for SUI.

Methods:

• 35 patients with CIDO, treated in a tertiary centre (2018-2021). Follow-Up was 6 months.

• Primary outcome: pad test before/after treatment.

• Secondary outcome: cured, improved no needing/needing further therapy, same or worse (patients’ rating).

• All patients received initially behavioural therapy and anticholingeric/betamimetic treatment. If leakage persisted, physiotherapy was advised. In case of non-success, bulking or midurethral sling was suggested.

• Statistics: students’ t-test.

Results All women had a positive pad test and showed after all treatments a significant improvement (no difference between bulking and midurethral sling).

22 patients underwent physiotherapy. 21 required surgery: 12 bulking and 9 midurethral sling. 13 were cured/needed no further treatment after conservative therapy.

Outcome was more favourable after bulking than midurethral sling: 7 patients were cured, 4 improved with no need for further therapy and 1 patient needed further therapy. After midurethral sling, 2 improved and needed no further therapy, 3 noticed no improvement and 4 worsened.

Conclusion 37% of patients had no need for further therapy after conservative treatment.

Bulking agents seem to be superior to physiotherapy and to midurethral sling and should be considered as treatment of choice for CIDO. Further larger studies are needed.

Publication History

Article published online:
11 October 2022