Dysfunctional Voiding in Women with Lower Urinary tract Symptoms

Abstract

Objective: Dysfunctional voiding is an abnormaility of the external urethral sphincter or pelvic floor muscles during voiding. Dysfunctional voiding can cause lower urinary tract symptoms (LUTS), recurrent urinary tract infection, and incontinence in children and women. This study retrospectively investigates the characteristics of dysfunctional voiding in Taiwanese women as well as the clinical symptoms and urodynamic findings. Patients and Methods: In total, 34 women with dysfunctional voiding were identified by a videourodynamic study was performed as a standard procedure, and the urodynamic parameter and voiding cystourethrographic results were analyzed; the clinical characteristics are discussed. Results: Clinically, 32 patients complained of frequency and nocturia (94%); 22 patients had hesitancy, dysuria, or residual urine sensation (64.7%); and 14 patients had occasional urgency and/or urge incontinence (41.2%). The mean Pdet at Qmax was 47.2±17.3 cmH2O, them mean Qmax was 45.6±47.1 mL. Detrusor instability was found in 16 patients (47.1%). External sphincter electromyographic (EMG) activity was noted to be poorly relaxed during the voiding phase in 21 patints (62%), with increased EMG activity in the other 13 patients (38%). Voiding cystourethrography revealed an open bladder neck and dilated proximal urethra with a spinning top distalurethra in all patients. Two patients were found to have bilateral grade 2 vesicoureteral reflux during the voiding phase. Conclusions: The result of this retrospective study reveals that dysfunctional voiding is not uncommon in Taiwanese women with LUTS. Videourodynamic study is the best tool for the diagnosis of this functional bladder outlet obstruction.