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Abstract
Introduction: Postural Orthostatic Tachycardia syndrome (POTS) is an autonomic nervous system disorder causing predominately cardio-vascular sequlae with bladder and bowel dysfunction. Cardio-vascular diagnostic criteria are established although diagnosis is often delayed due to lack of recognition of underlying abnormalities.
Methods: 21 patients referred to a neuro-urology service between February 2013 and June 2016 had confirmed diagnosis of POTS and urinary symptoms. Each had symptom evaluation, validated questionnaires and video-urodynamic studies performed and reported by a single operator.
Results: Patient age range was 16-56 years. 24% (9/21) had childhood voiding symptoms and 66% (14/21) recurrent UTI. 3 had over 1 litre retention with 1 established on clean intermittent self-catheterisation (CISC). 90% (19/21) had concurrent symptoms of poor bowel transit. On video-urodynamics reduced sensation of bladder filling was prevalent with average first sensation at 196mls (range 95-459mls) and cytometric capacity of 500mls (117-650mls). There was no significant bladder neck decent or stress urinary incontinence in any patients. In voiding studies 5 patients were unable to void with the lines in and one was already on CISC. 15 patients completed urodynamic flowometry with average pDet@Qmax 25cmH2O (5-48cmH2O.) 20/21 used abdominal straining during voiding. 19/21 patients had serial post void residual measurements with 32% (6/19) between 0-50mls, 36% (7/19) 50-100mls and 32% (6/19) greater than 100mls.
Conclusions: POTS can affect bladders. Our investigations suggest reduced sensation of filling, variable detrusor failure, incomplete emptying and recurrent UTI characterise this. Therefore, POTS should be considered in young women with these findings and either tachycardia or fainting.
Methods: 21 patients referred to a neuro-urology service between February 2013 and June 2016 had confirmed diagnosis of POTS and urinary symptoms. Each had symptom evaluation, validated questionnaires and video-urodynamic studies performed and reported by a single operator.
Results: Patient age range was 16-56 years. 24% (9/21) had childhood voiding symptoms and 66% (14/21) recurrent UTI. 3 had over 1 litre retention with 1 established on clean intermittent self-catheterisation (CISC). 90% (19/21) had concurrent symptoms of poor bowel transit. On video-urodynamics reduced sensation of bladder filling was prevalent with average first sensation at 196mls (range 95-459mls) and cytometric capacity of 500mls (117-650mls). There was no significant bladder neck decent or stress urinary incontinence in any patients. In voiding studies 5 patients were unable to void with the lines in and one was already on CISC. 15 patients completed urodynamic flowometry with average pDet@Qmax 25cmH2O (5-48cmH2O.) 20/21 used abdominal straining during voiding. 19/21 patients had serial post void residual measurements with 32% (6/19) between 0-50mls, 36% (7/19) 50-100mls and 32% (6/19) greater than 100mls.
Conclusions: POTS can affect bladders. Our investigations suggest reduced sensation of filling, variable detrusor failure, incomplete emptying and recurrent UTI characterise this. Therefore, POTS should be considered in young women with these findings and either tachycardia or fainting.
Introduction: Postural Orthostatic Tachycardia syndrome (POTS) is an autonomic nervous system disorder causing predominately cardio-vascular sequlae with bladder and bowel dysfunction. Cardio-vascular diagnostic criteria are established although diagnosis is often delayed due to lack of recognition of underlying abnormalities.
Methods: 21 patients referred to a neuro-urology service between February 2013 and June 2016 had confirmed diagnosis of POTS and urinary symptoms. Each had symptom evaluation, validated questionnaires and video-urodynamic studies performed and reported by a single operator.
Results: Patient age range was 16-56 years. 24% (9/21) had childhood voiding symptoms and 66% (14/21) recurrent UTI. 3 had over 1 litre retention with 1 established on clean intermittent self-catheterisation (CISC). 90% (19/21) had concurrent symptoms of poor bowel transit. On video-urodynamics reduced sensation of bladder filling was prevalent with average first sensation at 196mls (range 95-459mls) and cytometric capacity of 500mls (117-650mls). There was no significant bladder neck decent or stress urinary incontinence in any patients. In voiding studies 5 patients were unable to void with the lines in and one was already on CISC. 15 patients completed urodynamic flowometry with average pDet@Qmax 25cmH2O (5-48cmH2O.) 20/21 used abdominal straining during voiding. 19/21 patients had serial post void residual measurements with 32% (6/19) between 0-50mls, 36% (7/19) 50-100mls and 32% (6/19) greater than 100mls.
Conclusions: POTS can affect bladders. Our investigations suggest reduced sensation of filling, variable detrusor failure, incomplete emptying and recurrent UTI characterise this. Therefore, POTS should be considered in young women with these findings and either tachycardia or fainting.
Methods: 21 patients referred to a neuro-urology service between February 2013 and June 2016 had confirmed diagnosis of POTS and urinary symptoms. Each had symptom evaluation, validated questionnaires and video-urodynamic studies performed and reported by a single operator.
Results: Patient age range was 16-56 years. 24% (9/21) had childhood voiding symptoms and 66% (14/21) recurrent UTI. 3 had over 1 litre retention with 1 established on clean intermittent self-catheterisation (CISC). 90% (19/21) had concurrent symptoms of poor bowel transit. On video-urodynamics reduced sensation of bladder filling was prevalent with average first sensation at 196mls (range 95-459mls) and cytometric capacity of 500mls (117-650mls). There was no significant bladder neck decent or stress urinary incontinence in any patients. In voiding studies 5 patients were unable to void with the lines in and one was already on CISC. 15 patients completed urodynamic flowometry with average pDet@Qmax 25cmH2O (5-48cmH2O.) 20/21 used abdominal straining during voiding. 19/21 patients had serial post void residual measurements with 32% (6/19) between 0-50mls, 36% (7/19) 50-100mls and 32% (6/19) greater than 100mls.
Conclusions: POTS can affect bladders. Our investigations suggest reduced sensation of filling, variable detrusor failure, incomplete emptying and recurrent UTI characterise this. Therefore, POTS should be considered in young women with these findings and either tachycardia or fainting.
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