Clinical and urodynamic presentations of young men with dysfunctional voiding

Abstract

Objective:To evaluate the urodynamic presentations of men <50 years of age with dysfunctional voiding (DV) and their presenting refractory lower urinary tract, bowel and sexual dysfunction symptoms. Patients and methods:We prospectively analysed the video-urodynamics and clinical data of 218 consecutive men <50 years of age without neurological disease who had a video cystometrogram. The patients were subdivided into three best-fit groups based on the pressure/flow relationship. Group 1; Low-pressure-low flow (BOOI < 20), Group 2: High-pressure-low flow; Bladder Outlet Obstruction Index (BOOI) > 20 from the ICS nomogram, Group 3; Patients with an interrupted flow secondary to intermittent sphincteric contractions. Bowel function was assessed using the patient assessment of constipation-symptoms (PAC-SYM) questionnaire. Sexual dysfunction was evaluated using the International Index of Erectile Function (IIEF) questionnaire. Results:The mean age of the cohort was 36.5 (range 18–50) years. 136/218 (62%) demonstrated voiding dysfunction (VD). 39% (n = 53) of the 136 men with VD were diagnosed with DV. 14, 19 and 20 men voided with low-pressure-low-flow, high-pressure-low flow and an intermittent pattern respectively. Patients in group 3 had significantly lower PVRs than patients in group 1 and 2 (mean ∼152 ml). Bowel symptoms and sexual function questionnaire results were available in 25 patients with DV. 15/25 patients reported bothersome bowel and/or sexual dysfunction. Conclusion:DV was observed in almost 14 of young men presenting with LUTS. The presenting LUTS, P/F patterns and association with bowel and sexual dysfunction is highly variable. This may suggest heterogeneity in aetiology and/or cross-sectional sampling of patients at different timelines on the natural history.