Taking a Stand: A Prospective Study on the Influence of Posture on Urodynamic Studies in Older Patients

Abstract

Background and Objectives: Urinary incontinence (UI) is a prevalent issue among older adults and may require urodynamic studies (UDSs) for accurate diagnosis. However, these procedures can be uncomfortable and time-consuming, especially in a geriatric population, where certain practical restrictions may apply. This study examines whether posture of filling cystometry during UDSs in an older patient group affects diagnostic outcomes and whether a single UDS in one posture is sufficient for a reliable diagnosis or if multiple postures provide added value. Materials and Methods: This is a secondary analysis of the Think Dry: Optimalisation of Diagnostic Process of Urinary Incontinence in Older People study (NCT04094753), a prospective observational cohort study. Each patient underwent both sitting and standing filling cystometry during UDS. The final diagnosis was determined by the referring urologist by integrating results from both the sitting and standing groups alongside all available clinical data. Subsequently, each separate UDS was reviewed independently by a second, blinded, urologist, and a diagnosis was established based on a single UDS. The agreement between these independent diagnoses and the final diagnosis was then evaluated using Cohen's kappa coefficient (κ). Results: Results from the UDS with the standing filling cystometry had an almost perfect agreement (κ = 0.92) with the final diagnosis, compared to only a moderate agreement (κ = 0.42) while sitting. Conclusions: UDS with standing filling cystometry may be sufficient for an accurate diagnosis, potentially eliminating the need for additional filling cystometry in the sitting position. By streamlining the diagnostic process, this approach could enhance efficiency, reduce patient burden, and optimize resource utilization in older adults.

Keywords: adult; frail older; home; lower urinary tract symptoms; old age; posture; stress; urge; urinary incontinence.

Figure 1

Schematic overview of methods. (a). Diagnostic flowchart with both UDS and clinical parameters leading to final diagnosis by referring urologist. (b). Independent analysis of both UDS by a second blinded urologist, with comparison—concordance analysis—to the final diagnosis (made by the referring urologist. UDS: Urodynamic study.

Figure 2

Concordance analysis (Kappa Value and SE) comparing position and urodynamic diagnosis. (Left): Sitting vs. final diagnosis; (Right): Standing vs. final diagnosis. UDS: Urodynamic study, SUI: Stress urinary incontinence, UUI: Urgency urinary incontinence, MUI: Mixed urinary incontinence, SE: Standard error.