The contribution of urethrocystoscopy to evaluation of lower urinary tract dysfunction in women

Abstract

The aim of this study was to determine whether the evaluation of lower urinary dysfunction with urodynamics and urethrocystoscopy provides unique information that is missed by urodynamics alone. Eighty-four women underwent multichannel urodynamics and urethrocystoscopy. Retrospective analysis included evaluation of the relationships between lower urinary tract lesions and risk factors using chi2 and Fisher's exact tests. Urethrocystoscopic findings changed the diagnosis and management in 6 patients. New urethrocystoscopic findings included papillary transitional-cell carcinoma, cystitis glandularis, an intravesical suture and a urethral diverticulum. Clinical parameters were not predictive of these findings. Urethrocystoscopic findings also contributed to the final diagnosis in 10 patients with intrinsic sphincter deficiency. Considered alone, maximum urethral closure pressure < or =20 cmH2O had a sensitivity of only 20% and a positive predictive value of 40% for this diagnosis. Urodynamics without urethrocystoscopy would have missed important diagnoses in 19% of women. Urethrocystoscopy and urodynamics complement one another, and both have a role in the evaluation of women with lower urinary tract dysfunction.

The tension-free vaginal tape in women with a non-hypermobile urethra and low maximum urethral closure pressure

“…Findings on history or physical exam associated with the diagnosis of ISD include age more than 50 [21], leaking urine with minimal effort, absence of urethral hypermobility, and a positive empty cough stress test [22]. Office tests used to diagnose ISD include a MUCP ≤20 cm H 2 O on urethral pressure profilometry [23,24], a Valsalva leak point pressure ≤60 cm H 2 O [25], and videofluoroscopy [25] or cystoscopy [26] to demonstrate an open or funneled proximal urethra. Bump et al recommended a MUCP ≤20 cm H 2 O, Valsalva LPP ≤50 cm H 2 O, and urethral axis <20°as the diagnostic criteria for ISD [27].…”

Bladder Wall Thickness on Ultrasonographic Cystourethrography

“…Cystourethroscopy is another option for detecting bladder wall lesions, but it is an invasive procedure. 11 Transvaginal ultrasonography provides serial noninvasive examinations for assessing the condition of the bladder wall, which is why we find it a useful method for examining the lower urinary tract in women with LUTS. The normal bladder wall is 3 to 6 mm thick, 12 although it may vary with intravesical volume.…”

Diagnosis of Ureteral Obstruction during Complex Urogynecologic Surgery

“…Routine preoperative cystoscopy has been advocated for women presenting with symptoms of lower urinary tract dysfunction [9]. This approach may identify preexisting ureteral obstruction.…”