Videourodynamic Evaluation of the Pathophysiology of Lower Urinary Tract Symptoms in Neurologically Intact Women

Abstract

Objective: To determine the pathophysiology of voiding dysfunctions in women without neuropathy by videourodynamic study. Patients and Methods: From September, 1997 to October, 1998, 256 consecutive neurologically intact women were referred for videourodynamic study to define the pathophysiology of lower urinary tract symptoms (LUTS). Standard video-pressure-flow study was performed and the Valsalva leak point pressure was determined. Results: The patients ranged in age from 10 to 92 years (mean 56.1±13.9). Of the 256 women, 46 (18.0%) had a normal bladder and normal urethra, 102 (39.8%) had a hypersensitive bladder, 44 (17.2%) had detrusor instability, 77 (30.1%) had low detrusor contractility, and 76 (29.7%) had a poor relaxation of external sphincter. Genuine stress incontinence was found in 49 (19.1%), 47 of whom had an incompetent bladder neck and urethral incompetence with hypermobility, and 2 of whom did not have hypermobility. High pressure voiding was noted in 25 women, of whom 21 had bladder outlet obstruction and 12 had definite urethral stricture with detrusor instability. Of the 129 women with incontinence, detrusor instability was found in 30 (23.3%) and detrusor instability with inadequate contractility was found in 18 (14.0%). Among the 256 women studied, a total of 369 bladder and urethral abnormalities were found. Two hundreds and thirty-seven women (92.6%) had more than one LUTS and 157 women (61.3%) had more than one bladder and urethral abnormalities. Qmax and voided volume were not associated with the pathophysiology of LUTS. Conclusions: These findings show that videourodynamic study is helpful in the diagnosis of LUTS in women. Only with an accurate diagnosis based on the pathophysiology of the bladder and urethra can proper medical or surgical treatment e given and a good therapeutic outcome achieved.