Can we predict detrusor overactivity in women with lower urinary tract symptoms? The King's Detrusor Overactivity Score (KiDOS).
OBJECTIVE
Traditionally, urodynamic studies (UDS) have been used to assess lower urinary tract symptoms (LUTS), but their routine use is now discouraged. While urodynamic stress incontinence is strongly associated with the symptom of stress urinary incontinence (SUI) and a positive cough test, there is a weak relationship between symptoms of overactive bladder and detrusor overactivity (DO). The aim of our study was to develop a model to predict DO in women with LUTS.


METHODS
This prospective study included consecutive women with LUTS attending a urodynamic clinic. All women underwent a comprehensive clinical and urodynamic assessment. The effect of each variable on the odds of DO was estimated both by univariate analysis and adjusted analysis using logistic regression.


RESULTS
1006 women with LUTS were included in the study with 374 patients (37%) diagnosed with DO. The factors considered to be the best predictors of DO were urgency urinary incontinence, urge rating/void and parity (p-value<0.01). The absence of SUI, vaginal bulging and previous continence surgery were also good predictors of DO (p-value<0.01). We have created a prediction model for DO based on our best predictors. In our scoring system, presence of UUI scores 5; mean urge rating/void≥3 scores 3; parity≥2 scores 2; previous continence surgery scores -1; presence of SUI scores -1; and the complaint of vaginal bulging scores -1. If a criterion is absent, then the score is 0 and the total score can vary from a value of -3 to +10. The Receiver Operating Characteristic (ROC) analysis for the overall cut-off points revealed an area under the curve of 0.748 (95%CI 0.741, 0.755).


CONCLUSIONS
This model is able to predict DO more accurately than a symptomatic diagnosis alone, in women with LUTS. The introduction of this scoring system as a screening tool into clinical practice may reduce the need for expensive and invasive tests to diagnose DO, but cannot replace UDS completely.
Department of Urogynaecology, King's College Hospital, London, UK. Electronic address: ilias.giarenis@nhs.net.
Ilias
I
Giarenis
School of Medicine, Health Policy & Practice, University of East Anglia, Norwich, UK; Centre for Infectious Diseases Research In Zambia (CIDRZ), Plot 1275 Lubuto Road, PO Box 34681, Lusaka, Zambia.
Patrick
P
Musonda
Department of Urogynaecology, King's College Hospital, London, UK.
Heleni
H
Mastoroudes
Department of Urogynaecology, King's College Hospital, London, UK.
Dudley
D
Robinson
Department of Urogynaecology, King's College Hospital, London, UK.
Linda
L
Cardozo
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000175:diagnosis* / Q000503:physiopathology; D008875:Middle Aged; D008962:Models, Theoretical; D011237:Predictive Value of Tests; D011446:Prospective Studies; D053201:Urinary Bladder, Overactive / Q000175:diagnosis* / Q000503:physiopathology; D014563:Urodynamics / Q000502:physiology*
Detrusor overactivity; Lower urinary tract symptoms; Prediction model; Urinary incontinence; Urodynamics