School of Psychology, Newcastle University, Newcastle upon Tyne, UK.
BJU Int. 2012 Dec;110(11):1756-61. doi: 10.1111/j.1464-410X.2012.11078.x. Epub 2012 May 29.
Study Type--Aetiology (case series) Level of Evidence 4. What's known on the subject? and What does the study add? The factors taken into consideration when determining when and where to void are poorly understood. Studies on bladder sensations, obtained during cystometry of from voiding diaries, are proving difficult to transfer to everyday experiences. There is therefore a need to explore what does influence when and where to void. This study, using focus groups, highlights the fact that many voids are driven by behavioural factors not by sensations of desire or need to void. It is further noted that a key factor in the final decision to void is an awareness of bladder volume. The concepts of 'cognitive voiding' informed by 'bladder awareness' are introduced and, if correct, will influence the way studies are devised and interpreted to explore lower urinary tract dysfunction and pharmacotherapy. OBJECTIVE • To investigate the inter-relationship between conscious decision-making processes and bladder sensation in determining the need, time and place to void
• The approach used interview focus groups and qualitative thematic analysis. In this preliminary study, 25 women were included (aged 21-90 years) meeting in groups of one to five on four occasions.
• The thematic analysis yielded six themes: temporal and cognitive maps, risk issues, habituation and opportunistic behaviour and awareness of the bladder. • For most voids, the decision to void was not based on sensation but determined by multiple factors: personal knowledge of time of last void, anticipated time to next void, proximity of toilets, a risk assessment or habituated behaviour. • As the bladder filled the subjects described an increasing awareness of their bladder. Such sensations were not immediately associated with desire to void. Rather, these sensations were described as influencing the cognitive processes of considering when and where to void. • A sub-group of subjects reported little awareness as their bladder filled, experiencing only sudden strong sensations that needed immediate action for fear of leakage.
• The decision to void is primarily a cognitive process influenced by multiple elements of which bladder awareness is only one. • Mechanisms generating awareness may be intensified or lost reflecting possible different pathological states. The importance of these observations in relation to current views of normal and abnormal voiding is discussed.
研究类型——病因学（病例系列）证据水平 4. 已知的主题是什么？这项研究增加了什么？在确定何时何地排尿时考虑的因素理解不佳。在膀胱感觉的研究中，这些感觉是在膀胱测压或从排尿日记中获得的，事实证明这些研究很难转化为日常经验。因此，有必要探索影响何时何地排尿的因素。这项研究使用焦点小组，强调了许多排尿是由行为因素驱动的，而不是由欲望或需要排尿的感觉驱动的。进一步指出，最终决定排尿的一个关键因素是对膀胱容量的意识。引入了“膀胱意识”告知的“认知排尿”的概念，如果正确的话，将影响探索下尿路功能障碍和药物治疗的研究设计和解释方式。
采用访谈焦点小组和定性主题分析。在这项初步研究中，纳入了 25 名女性（年龄 21-90 岁），她们分 4 次以 1-5 人的小组形式参加。
主题分析产生了 6 个主题：时间和认知地图、风险问题、习惯和机会行为以及对膀胱的意识。对于大多数排尿，排尿的决定不是基于感觉，而是由多种因素决定的：个人对最后一次排尿时间的了解、预计下一次排尿时间、厕所的远近、风险评估或习惯行为。随着膀胱充盈，受试者描述了对膀胱的越来越多的意识。这些感觉并不立即与排尿的欲望相关。相反，这些感觉被描述为影响考虑何时何地排尿的认知过程。一小部分受试者报告说，当他们的膀胱充盈时，他们几乎没有意识，只经历突然强烈的感觉，需要立即采取行动，以防漏尿。
排尿的决定主要是一个认知过程，受多种因素影响，其中膀胱意识只是其中之一。产生意识的机制可能会增强或丧失，反映出可能的不同病理状态。讨论了这些观察结果与正常和异常排尿的现有观点的重要性。
