Abstract
Voiding dysfunction can result from detrusor underactivity (DU), bladder outlet obstruction (BOO), or both. Conceptually, women with high-pressure low-flow urodynamic profiles are diagnosed with BOO without DU. However, the possibility of BOO is often neglected in women with DU-like (low-pressure low-flow) urodynamic (UDS) profiles. By reviewing the videourodynamic studies (VUDS) of 1678 women, our study identified the key factors suggesting urodynamic BOO (determined by radiographic evidence of obstruction) in women with DU-like UDS profiles (Pdet.Qmax < 20 cmH2O and Qmax < 15 mL/s). In 355 women with DU-like UDS profiles, there were 70 (19.7%) with BOO and 285 (80.3%) without BOO. The BOO group had predominantly obstructive symptoms. The BOO group showed significantly decreased bladder sensation, lower detrusor pressure (Pdet.Qmax), lower flow rate (Qmax), smaller voided volume, and larger post-voiding residual (PVR) compared to the non-BOO group. In multivariate analysis, volume at first sensation, Qmax, PVR, and detrusor overactivity (DO) remained independent factors for BOO. The receiver operating characteristic (ROC) areas for the parameters were largest for PVR (area = 0.786) and Qmax (area = 0.742). The best cut-off points were 220 mL for PVR and 4 mL/s for Qmax. Our findings provide simple indicators for BOO in women with DU.
Highlights
Voiding dysfunction can result from detrusor underactivity (DU), bladder outlet obstruction (BOO), or both[1]
DU has been defined by the International Continent Society (ICS) in 2002 as “a contraction of reduced strength and/or duration, resulting in prolonged bladder emptying and/or failure to achieve complete bladder emptying within a normal time span2.”
Women with high-pressure low-flow urodynamic profiles are diagnosed with BOO without DU
Summary
Voiding dysfunction can result from detrusor underactivity (DU), bladder outlet obstruction (BOO), or both. Either storage or voiding dysfunction may result in lower urinary tract symptoms (LUTS). In both men and women, storage symptoms include frequency, urgency, nocturia, and incontinence; and voiding symptoms include weak stream, intermittency, hesitancy, straining, and sensation of incomplete voiding. The consensus states that “UAB is characterized by a slow urinary stream, hesitancy, and straining to void, with or without a feeling of incomplete bladder emptying sometimes with storage symptoms3.”. This definition of UAB comprises the essential symptoms of BOO, making the two terms indistinguishable from each other. There are no standard urodynamic criteria for the diagnosis
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