Voiding dynamics in women with urinary incontinence but without voiding symptoms

Abstract

Aims: To describe the voiding pattern (VP) of women with urinary incontinence but without voiding symptoms and compare their clinical and urodynamic features between those voiding with and without a measurable detrusor contraction (DET-cont). Methods: Retrospective analysis of a prospectively built database of female urodynamic studies (UDS). Women with voiding symptoms and having medical history of different factors that could alter the lower urinary tract function were excluded. All UDS were performed following the ICS guidelines. DET-cont and abdominal straining (ABD-strain) were defined as an increase ≥10 cm H 2 O over the baseline for p det and p abd at Q max , respectively. Results: A total of 186 women were included in the analysis. Mean age was 58 ± 10.7 years (24-83). Most women showed a VP with DET-cont (77.4%), with or without ABD-strain. When compared to women voiding without DET-cont, those with DET-cont were younger (P = .004), more likely to have detrusor overactivity (P = .035) and better urinary sphincter competency in the UDS (P = .018). On multivariate analysis, the presence of DET-cont was associated with age ≤50 years (P = .004) and the absence of urodynamic stress urinary incontinence (SUI) or SUI with abdominal leak point pressure ≥100 cm H 2 O (P = .008). Conclusions: Most women without voiding symptoms show a VP characterized by a measurable detrusor contraction, with or without ABD-strain. The results suggest that the VP may vary independently with aging and with changes in the state of the urinary sphincter, emphasizing that for the interpretation of micturition in women different aspects must be considered.

ICS‐SUFU standard: Theory, terms, and recommendations for pressure‐flow studies performance, analysis, and reporting. Part 2: Analysis of PFS, reporting, and diagnosis

“…When straining occurs during the voiding however, this is considered relevant 72 as it will likely affect Q 73 although its effect on ICS‐DCI is little studied. The WG accepts that abdominal pressure may contribute to the driving force for voiding, especially and more often in women.…”

“Voiding dynamics in women with urinary incontinence but without voiding symptoms”

“…The fact is that women can urinate with a very low detrusor pressure increment and that this low pressure is accompanied by a high muscle shortening velocity = flowrate, as is also nicely demonstrated (uroflow rates) in this manuscript. 3 The detrusor contraction is, in women, not apparent by pressure only, but becomes especially evident through the flow rate. The women presented in this study with (very) low detrusor pressure during micturition did therefore not void without detrusor contraction.…”