Videourodynamic Studies of Women with Voiding Dysfunction

Sheng-Mou Hsiao,Hann-Chorng Kuo,Ho-Hsiung Lin

doi:10.1038/s41598-017-07163-2

Abstract

This retrospective study is aimed to present videourodynamic findings of women with symptoms of voiding dysfunction in a medical center. Of 1914 women, the diagnoses included bladder outlet obstruction (BOO, n = 810, 42.3%), bladder dysfunction (n = 1,048, 54.8%) and normal tracings (n = 56, 2.9%). Anatomic BOO (n = 49) included cystocele (n = 19) and urethral stricture (n = 30). Common functional BOOs included dysfunctional voiding (n = 325, 17.0%) and poor relaxation of the external sphincter (n = 336, 17.6%). Common bladder dysfunction subtypes included detrusor underactivity (n = 337, 17.6%), detrusor hyperactivity with impaired contractility (n = 231, 12.1%), and bladder oversensitivity (n = 325, 17.0%). Receiver operating characteristic (ROC) analysis were performed, and the following optimum cutoff values were determined: (1) voiding detrusor pressure at a maximum flow rate (Pdet.Qmax) = 30 cmH2O for differentiating BOO from bladder dysfunction and normal tracings, with an ROC area of 0.78; (2) the Abrams-Griffiths number = 30 for differentiating anatomic from functional BOO, with an ROC area of 0.66; (3) post-void residual = 200 mL for differentiating bladder neck dysfunction from the other BOOs, with an ROC area of 0.69; (4) Pdet.Qmax = 30 cmH2O for differentiating dysfunctional voiding from poor relaxation of the external sphincter with an ROC area of 0.93. The above findings can be used as initial guide for management of female BOO.

Highlights

Clinical lower urinary tract symptoms of women are not reliable for the diagnosis of lower urinary tract dysfunction1
We found that only 42.5% of women with symptoms of voiding dysfunction were proven to have anatomic or functional bladder outlet obstruction (BOO) (Table 1)
The incidences of moderate/severe voiding symptoms did not differ between women with BOO and bladder dysfunction (Table 1)

Summary

Introduction

Clinical lower urinary tract symptoms of women are not reliable for the diagnosis of lower urinary tract dysfunction. Pressure flow urodynamic studies can be used to diagnose bladder outlet obstruction (BOO). Videourodynamics can provide a definitive diagnosis for women with voiding symptoms. It is preferred to make a differential diagnosis in women with voiding symptoms using test without radiation, such as uroflowmetry or urodynamic studies, thereby avoiding radiation exposure. The main aim of this study is to determine if any parameters of urodynamic studies can be used as initial guide for the differential diagnosis of women with voiding dysfunction. The main cause of female BOO is controversial , we aim to present the videourodynamic findings in women with symptoms of voiding dysfunction

Objectives

Methods

Results

Conclusion