Videourodynamic Studies of Women with Voiding Dysfunction

Abstract

This retrospective study is aimed to present videourodynamic findings of women with symptoms of voiding dysfunction in a medical center. Of 1914 women, the diagnoses included bladder outlet obstruction (BOO, n = 810, 42.3%), bladder dysfunction (n = 1,048, 54.8%) and normal tracings (n = 56, 2.9%). Anatomic BOO (n = 49) included cystocele (n = 19) and urethral stricture (n = 30). Common functional BOOs included dysfunctional voiding (n = 325, 17.0%) and poor relaxation of the external sphincter (n = 336, 17.6%). Common bladder dysfunction subtypes included detrusor underactivity (n = 337, 17.6%), detrusor hyperactivity with impaired contractility (n = 231, 12.1%), and bladder oversensitivity (n = 325, 17.0%). Receiver operating characteristic (ROC) analysis were performed, and the following optimum cutoff values were determined: (1) voiding detrusor pressure at a maximum flow rate (Pdet.Qmax) = 30 cmH2O for differentiating BOO from bladder dysfunction and normal tracings, with an ROC area of 0.78; (2) the Abrams-Griffiths number = 30 for differentiating anatomic from functional BOO, with an ROC area of 0.66; (3) post-void residual = 200 mL for differentiating bladder neck dysfunction from the other BOOs, with an ROC area of 0.69; (4) Pdet.Qmax = 30 cmH2O for differentiating dysfunctional voiding from poor relaxation of the external sphincter with an ROC area of 0.93. The above findings can be used as initial guide for management of female BOO.

Can we improve our management of dysfunctional voiding in children and adults: International Consultation on Incontinence Research Society; ICI‐RS2018?

“…A postvoid residual of 200 ml could differentiate bladder neck dysfunction from DV and PRES with a receiver operating characteristic (ROC) area of 0.69 (95% CI = 0.63‐0.74; sensitivity = 52.0%, specificity = 74.1%). A pdetQmax value of 30 cmH2O was found to differentiate DV from PRES (mean 46 ± 18 vs 17 ± 12 cmH2O, respectively) with a ROC area of 0.93 (95% CI = 0.91‐0.95; sensitivity = 87.7%, specificity = 83.0%) …”

“…Despite the ICS definition, it also has been described as a ‘learned behavioral dysfunction’ characterized by increased activity of the external urethral sphincter (EUS) . DV has been differentiated from poor relaxation of the external sphincter (PRES) …”

“…In adults, symptoms and noninvasive evaluation alone may not be able to diagnose or differentiate DV from other causes of VD . Although voiding symptoms or even urinary retention may be expected in DV patients, storage symptoms, usually due to detrusor overactivity, can be quite common and a significant proportion of patients present with mixed LUTS …”

“…10,11 DV has been differentiated from poor relaxation of the external sphincter (PRES). 12 Whatever the muscle involved that increases urethral resistance, it would lower the urine flow rate. Such variability of definition may explain the wide prevalence range reported among men (14%-43%) [13][14][15][16] and women with lower urinary tract symptoms (LUTS) (10.5%-34.6%).…”

Pathophysiology of refractory overactive bladder

“…In women, the causes of OAB vary, with 6.5% of cases attributed to BOO . The percentage of BOO is even higher in women with dysfunctional voiding, where over half of all cases have BOO, including BND, poor relaxation of the external sphincter, and voiding dysfunction …”