Voiding dynamics in women with stress urinary incontinence and high‐stage cystocele

Abstract

Objectives:The aim of this study was to identify the urodynamic features of women with stress urinary incontinence (SUI) or with high-stage (stage 3 or greater) cystocele (HSC) as compared with symptom-free women. Methods: Fifty-six neurologically intact women with SUI and 47 women with HSC but without SUI were prospectively evaluated. All patients underwent full urodynamics, in addition to basic clinical evaluations. The urodynamic parameters of SUI and HSC were compared to the ones obtained from 78 urologically symptom-free normal women over the same period. Results: Patients with HSC, after correction of cystocele using a temporary vaginal pessary, had consistently lower maximum urinary flow rate with a lower detrusor pressure during micturition than the controls or those with SUI. On the other hand , patients with SUI had an equivalent to higher maximum urinary flow rate, normal detrusor contraction strength with a lower detrusor pressure during micturition than the controls. Both maximum Watts factor and bladder contractility index were significantly lower in the whole HSC cohort in comparison to the controls and patients with SUI. The urodynamic characteristics observed among the three groups were all maintained even after adjusting for age. Conclusions: Women with SUI demonstrate voiding with low-pressure, normal contraction strength with an equivalent to high urinary flow rate. Women with HSC demonstrate voiding with low pressures with weak contraction strengths and low urinary flow rates, suggesting a higher prevalence of detrusor underactivity. Chronically decreased or increased urethral resistance might alter voiding dynamics and performance.Key words: cystocele, lower urinary tract symptoms, urinary incontinence, urodynamics. IntroductionStress urinary incontinence (SUI) and cystocele are representative disorders associated with lower urinary tract dysfunction in women. 1,2 High-stage cystocele (HSC) or SUI may change voiding dynamics and cause voiding dysfunction. 3,4 However, there is a paucity of published data outlining the existing dysfunction, especially for HSC, with the quantified parameters obtained from the voiding phase for cohorts involving women with lower urinary tract disorders.In the present study, we attempted to identify the urodynamic characteristics of the lower urinary tract in adult women with SUI or with HSC, by comparing strictly with selected cohorts of symptom-free women who had urologically normal voiding. The urodynamic characteristics were focused on detrusor contractility, urethral resistance and pressure flow relationships. The information regarding these particular voiding dynamics of either SUI or HSC may give a beneficial contribution in a clinical setting, especially in predicting the outcome of surgery. Methods Control patientsAfter obtaining the patient's informed consent, which was approved by the ethics committee of our institution, 86 patients for whom simple or radical hysterectomy was scheduled from January 1999 to December 2006 were prospectively included in...

Recommendations for future development of contractility and obstruction nomograms for women. ICI-RS 2014

“…Contractility indices such as W max and BCI seem to be influenced by the degree of outlet resistance both in males and females . Thus, it could be argued that abnormal post‐void residuals should be attributed to detrusor insufficiency after BOO has been excluded.…”

“…Thus, it could be argued that abnormal post‐void residuals should be attributed to detrusor insufficiency after BOO has been excluded. Unfortunately, there is no definitive urodynamic definition for female outflow obstruction . The limited articles proposing the use of p detQmax and Q max from PFS to define BOO have used quite different cut‐off values, as mentioned above …”

Bladder Emptying: Contractility

“…where V t = volume of noncontracting bladder wall tissue [7]. Although some studies report WF and WF max , no consensus has been made regarding normative values particularly in female patients [6,8,9]. A WF max of <12 μW/mm 2 for males and <5 μW/mm 2 for postmenopausal females has been used in some studies to define detrusor underactivity [8,10,11].…”

Bladder contractility and urethral resistance relation: What does a pressure flow study tell us?

“…It is suggested that a Pdet.qmax >20–25 cmH 2 O and Qmax <12–15 mL/s warrants the diagnosis of female BOO 67 . Recently, in some of the literature about PFS for POP, nomograms for BPO or BCI in men have been used to analyze PFS parameters for women 68,69 . However, BCI might largely overestimate Pdet.iso in female patients 24 .…”

“…67 Recently, in some of the literature about PFS for POP, nomograms for BPO or BCI in men have been used to analyze PFS parameters for women. 68,69 However, BCI might largely overestimate Pdet.iso in female patients. 24 It is urgently necessary to investigate whether nomograms or indicators for male BOO can be applied to female patients.…”