Clinical symptoms are not reliable in the diagnosis of lower urinary tract dysfunction in women

Abstract

The pathophysiology of female lower urinary tract symptoms (LUTS) may involve bladder, urethral, and pelvic floor dysfunctions. This study analyzed the relationship between clinical symptoms and lower urinary tract dysfunctions (LUTD) in women. A total of 1605 consecutive women were included. LUTS were classified as storage, voiding, pain, and postmicturition symptoms. All patients underwent videourodynamic study (VUDS) and the final diagnosis of LUTD was made based on VUDS findings. Patients were stratified into three major disorder groups: sensory, motor, and bladder outlet disorders. The main symptoms and associated symptoms were used for analysis in varying LUTD. Normal tracing was found in 272 patients (16.9%), sensory bladder disorders in 459 (28.6%), motor bladder disorders in 560 (34.9%), and bladder outlet disorders were found in 314 patients (19.6%). Frequent urination was the main symptom in patients with normal, bladder oversensitivity, interstitial cystitis, and idiopathic detrusor overactivity (DO). In patients with voiding dysfunction due to detrusor underactivity, bladder neck dysfunction and urethral stricture, dysuria was the most common symptom. However, 707 (44%) of overall women had both storage and voiding symptoms. DO was present in 533 women and in 149 (66%) of 212 with bladder outlet obstruction. However, DO was only found in 42.5% of women with urgency and in 69.4% of women with urgency incontinence based on reported LUTS. Storage and voiding symptoms are common in women with LUTD. The differential diagnosis of LUTD in women cannot be based on LUTS alone.