逼尿肌活性低下的婦女依據錄影尿路動力學檢查結果予以治療的預後

陳聖復、張嘉峰、江元宏、郭漢崇

花蓮慈濟醫院暨慈濟大學 泌尿部

Treatment Outcomes of Detrusor Underactivity in Women Based on Clinical and Videourodynamic Characteristics

Sheng-Fu Chen , Jia-Fong Jhang, Yuan-Hong Jiang, Hann-Chorng Kuo

Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University Hualien, Taiwan

Objective: Treatment of voiding dysfunction due to detrusor underactivity (DU) remains challenging. This study sought to determine the characteristics of video urodynamic study (VUDS) in female DU and outcomes after active treatment.
 

Materials and Methods: A total of 409 female patients with VUDS-proven DU were recruited. All patients received conservative bladder management, with others receiving active treatment, such as oral medication, transurethral incision of bladder neck (TUI-BN), surgery for prolapse, and urethral botulinum toxin A (BoNT-A) injection, according to their VUDS characteristics. Treatment outcomes were then analyzed by different VUDS characteristics.

Results: Satisfactory treatment outcomes were noted in 123 patients (30.0%), among whom 35 and 88 had a VE of > 90% and > 66.7%, respectively. A total of 165 patients (40.3%) had voiding efficiency (VE) of 33.3–66.7%, whereas 121 (29.6%) remained unable to void (12.5%) or had a VE of < 33.3% (17.1%). Conservative treatment had the worst outcome. Patients with normal or slightly reduced bladder sensation (49.3%) and those with a post-void residual (PVR) of < 250 mL (59.4%) displayed better satisfactory outcome after treatment; while TUI-BN and urethral BoNT-A injection promoted better treatment results. Patients with detrusor acontractility and a PVR of ≥ 500 mL still achieved high VE rates (> 66.7%) after TUI-BN. A 56.3% satisfactory outcome was achieved after TUI-BN, whereas 58.1% satisfactory outcome was noted in those with a tight external sphincter after medical treatment.

Conclusions: Female patients with DU exhibited VE improvement after active treatment. Patients with very low detrusor contractility and absent bladder sensation generally exhibited poor treatment outcomes.