Sensory bladder disorders, characterized by symptoms like frequency and urgency, pose diagnostic challenges due to overlapping manifestations. This study aimed to assess autonomic function in female patients with detrusor overactivity (DO), hypersensitive bladder (HSB), and non-Hunner’s interstitial cystitis (NHIC) using a novel non-invasive neuECG method, evaluating whether autonomic parameters can discern these conditions.

In this prospective study, we enrolled 107 female participants presenting with symptoms of frequency and urgency, excluding those diagnosed with urinary tract infections. Autonomic function was assessed prior to diagnosis and treatment initiation using neuECG, a technique that simultaneously analyzes skin sympathetic nerve activity (SKNA) and heart rate variability (HRV). Diagnoses of DO and HSB were confirmed through urodynamic studies, while IC was diagnosed based on findings from cystoscopic hydrodistension.

The study comprised 32 participants with DO, 23 with HSB, and 52 with NHIC. Significant findings (Figure 1) revealed that DO had higher SKNA values during stress phases compared to NHIC (p=0.048), and HSB showed a higher stress-to-baseline SKNA ratio and elevated baseline LF/HF ratio versus NHIC (p=0.002 and 0.016, respectively). The SKNA stress-to-baseline ratio provided superior AUROC values for distinguishing between HSB and NHIC (AUROC = 0.755) and DO from HSB (AUROC = 0.711) compared to traditional HRV metrics (Figure 2).

These findings suggest that the stress-to-baseline phase ratio of SKNA serves as a promising non-invasive autonomic parameter for differentiating HSB from IC, as well as for distinguishing DO from HSB. This advancement not only has the potential to significantly enhance diagnostic accuracy for women experiencing frequency and urgency syndromes but also provide valuable insights into the underlying mechanisms of these disorders.