Videourodynamic Studies of Women with Voiding Dysfunction

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

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.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Figure 1
Figure 1
Videourodynamic findings of the subtypes of bladder outlet obstruction: (A) urethral stricture, (B) bladder neck dysfunction, (C) dysfunctional voiding and (D) poor relaxation of the external sphincter.
Figure 2
Figure 2
The receiver operating characteristic (ROC) curve of using (A) the voiding detrusor pressure at maximum flow rate (Pdet.Qmax) to predict bladder outlet obstruction, (B) the Abrams-Griffiths number to predict anatomic bladder outlet obstruction, (C) the post-void residual to predict bladder neck dysfunction, (D) the Pdet.Qmax to predict dysfunctional voiding, and (E) the bladder contractility index to predict bladder dysfunction.

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