Identifying Occult Bladder Outlet Obstruction in Women with Detrusor-underactivity-like Urodynamic Profiles

Overview

Journal Sci Rep

Specialty Science

Date 2021 Dec 2

PMID 34853346

Citations 3

Authors

Po-Ming Chow

Sheng-Mou Hsiao

Hann-Chorng Kuo

Affiliations

Soon will be listed here.

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.

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References

King A, Goldman H . Bladder outlet obstruction in women: functional causes. Curr Urol Rep. 2014; 15(9):436. DOI: 10.1007/s11934-014-0436-z. View

Choi Y, Kim J, Lee K, Seo J, Kim H, Yoo T . Analysis of female voiding dysfunction: a prospective, multi-center study. Int Urol Nephrol. 2013; 45(4):989-94. DOI: 10.1007/s11255-013-0475-2. View

Resnick N, Yalla S, Laurino E . The pathophysiology of urinary incontinence among institutionalized elderly persons. N Engl J Med. 1989; 320(1):1-7. DOI: 10.1056/NEJM198901053200101. View

Boyd K, Hilas O . α-adrenergic blockers for the treatment of lower-urinary-tract symptoms and dysfunction in women. Ann Pharmacother. 2014; 48(6):711-22. DOI: 10.1177/1060028014524174. View

Nitti V, Tu L, Gitlin J . Diagnosing bladder outlet obstruction in women. J Urol. 1999; 161(5):1535-40. View

Abdelhakim M, Rammah A, Abozamel A, El-Sheikh M, Abdelazeem M, Abdallah S . Does detrusor underactivity affect the results of transurethral resection of prostate?. Int Urol Nephrol. 2020; 53(2):199-204. DOI: 10.1007/s11255-020-02669-7. View

Lemack G, Zimmern P . Pressure flow analysis may aid in identifying women with outflow obstruction. J Urol. 2000; 163(6):1823-8. View

Osman N, Chapple C, Abrams P, Dmochowski R, Haab F, Nitti V . Detrusor underactivity and the underactive bladder: a new clinical entity? A review of current terminology, definitions, epidemiology, aetiology, and diagnosis. Eur Urol. 2013; 65(2):389-98. DOI: 10.1016/j.eururo.2013.10.015. View

Solomon E, Yasmin H, Duffy M, Rashid T, Akinluyi E, Greenwell T . Developing and validating a new nomogram for diagnosing bladder outlet obstruction in women. Neurourol Urodyn. 2017; 37(1):368-378. DOI: 10.1002/nau.23307. View

10.

Uren A, Cotterill N, Harding C, Hillary C, Chapple C, Klaver M . Qualitative Exploration of the Patient Experience of Underactive Bladder. Eur Urol. 2017; 72(3):402-407. DOI: 10.1016/j.eururo.2017.03.045. View

11.

Chen C, Hsiao S, Chang T, Wu W, Lin H . Clinical and urodynamic effects of baclofen in women with functional bladder outlet obstruction: Preliminary report. J Obstet Gynaecol Res. 2016; 42(5):560-5. DOI: 10.1111/jog.12932. View

12.

Mitchell C, Mynderse L, Lightner D, Husmann D, Krambeck A . Efficacy of holmium laser enucleation of the prostate in patients with non-neurogenic impaired bladder contractility: results of a prospective trial. Urology. 2013; 83(2):428-32. DOI: 10.1016/j.urology.2013.09.035. View

13.

Chow P, Hsiao S, Kuo H . Obstructive patterns in videourodynamic studies predict responses of female dysfunctional voiding treated with or without urethral botulinum toxin injection: a long-term follow-up study. Int Urogynecol J. 2020; 31(12):2557-2564. DOI: 10.1007/s00192-020-04333-1. View

14.

DAncona C, Haylen B, Oelke M, Abranches-Monteiro L, Arnold E, Goldman H . The International Continence Society (ICS) report on the terminology for adult male lower urinary tract and pelvic floor symptoms and dysfunction. Neurourol Urodyn. 2019; 38(2):433-477. DOI: 10.1002/nau.23897. View

15.

Malde S, Solomon E, Spilotros M, Mukhtar B, Pakzad M, Hamid R . Female bladder outlet obstruction: Common symptoms masking an uncommon cause. Low Urin Tract Symptoms. 2017; 11(1):72-77. DOI: 10.1111/luts.12196. View

16.

Gammie A, Kaper M, Dorrepaal C, Kos T, Abrams P . Signs and Symptoms of Detrusor Underactivity: An Analysis of Clinical Presentation and Urodynamic Tests From a Large Group of Patients Undergoing Pressure Flow Studies. Eur Urol. 2015; 69(2):361-9. DOI: 10.1016/j.eururo.2015.08.014. View

17.

Chassagne S, Bernier P, Haab F, Roehrborn C, Reisch J, Zimmern P . Proposed cutoff values to define bladder outlet obstruction in women. Urology. 1998; 51(3):408-11. DOI: 10.1016/s0090-4295(97)00634-1. View

18.

Groutz A, Blaivas J . Non-neurogenic female voiding dysfunction. Curr Opin Urol. 2002; 12(4):311-6. DOI: 10.1097/00042307-200207000-00009. View

19.

Meier K, Padmanabhan P . Female bladder outlet obstruction: an update on diagnosis and management. Curr Opin Urol. 2016; 26(4):334-41. DOI: 10.1097/MOU.0000000000000303. View

20.

Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U . The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn. 2002; 21(2):167-78. DOI: 10.1002/nau.10052. View