Hypothesis/Aim of study: It has been reported that multi-channel cystometry is not routinely recommended prior to continence surgery in women with a clinical diagnosis of “pure” stress urinary incontinence (SUI). However, the studies upon which these recommendations are based include 95% white women (1). Studies have shown that non-Caucasian origin women present more commonly with detrusor overactivity (DO) and are less likely to have urodynamic stress incontinence (USI) (2). This may lead to more false positive ‘stress tests’ in non-Caucasian women and inappropriate surgery. We therefore aimed to investigate the influence of ethnicity on urodynamic outcomes.
Study design, materials and methods: Women with lower urinary tract symptoms were recruited from clinic between April 2012 and March 2015. Women underwent urodynamics and self-reported ethnicity was grouped as ‘Caucasian’ or ‘Other’ (Asian, Black, Mixed, Middle Eastern). Relationship between ethnicity and urodynamic diagnosis was assessed using Chi square test and logistic regression.
Results: 1266 women were included (range 21–84 years), groups were matched for age, BMI and parity. Women of ‘Other’ ethnicity were more likely to have DO (OR 1.9 95%CI 1.5–2.5, p = 0.0001) and less likely to have USI (OR 0.59 95%CI 0.46–0.76, p = 0.0001). Diagnosis of mixed urodynamic incontinence (MUI) or Inconclusive results were not significantly different between ethnicities. In patients with predominantly stress incontinence symptoms, the equivalent of a positive stress test, (n = 111), ‘Other’ were more likely to have DO (Chi-squ, p = 0.02), there was no significant difference USI.
Conclusion: Our study shows that patients of ‘Other’ ethnicity who present with stress symptoms are more likely than not to have detrusor overactivity on urodynamics. Studies suggesting that the office ‘stress test’ and symptoms are sufficient to make a diagnosis of USI prior to continence surgery may not be valid in women of non Caucasian origin. Healthcare recommendations stratified by ethnicity should be further investigated in urogynaecology [
1
, 2
, 3
].References
- N Engl J Med. 2012; 366: 1987-1997
J Obstetr Gynaecol 34:2, 174-176.
- Obstet Gynecol. 1998 Jan; 91: 51-54
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