The peripheral nerve evaluation: determining which symptoms lead to a successful test

Abstract

Objective: To identify the symptom or set of symptoms most improved in patients undergoing a successful peripheral nerve evaluation (PNE) for refractory overactive bladder syndrome (OAB). Methods: An analysis was conducted on refractory OAB patients to determine which symptom (nocturia, daytime voids, urgency, leaks per day, pad use per day and time to reach the bathroom) most improved following a PNE. This was measured in two ways: 1) by patient responses to a questionnaire and 2) by determining changes in symptoms with use of a voiding diary. Patients completed a pre- and post-questionnaire by phone interview. Descriptive statistics were used to analyze demographic and baseline characteristics as well as responses to questionnaires. Changes in voiding patterns were analyzed using a paired-samples t-test. Results: Overall, 28 patients were included. Prior to their evaluation patients indicated they were most bothered by urgency (n=26, 92.8%), followed by number of leaks per 24 hours (n = 24, 85.7%). After their evaluation, symptom improvement was highest for number of voids at night (n = 20, 71.4%) followed by sense of urgency (n = 18, 64.3%). Paired-samples t-tests on pre- and post-PNE voiding diaries revealed significant improvements in number of daytime voids (p = 0.015), number of leaks per 24 hours (p = 0.001), and number of urges per 24 hours (p = 0.001). Conclusion: Voiding diaries alone cannot be used to accurately determine symptom improvement. Clinicians must take into account the degree to which their patients are bothered by their symptoms. In an elderly population, improvement in nocturia has important implications including decreased morbidity.