膀胱壁厚度與逼尿肌低活動性、逼尿肌活動過度合併收縮功能缺損之女性病人的臨床表現之相關性
余秉軒、林志杰、范玉華、盧星華、林登龍
台北榮民總醫院 泌尿部
The Correlation between Bladder Wall Thickness and Clinical Manifestation among Female Patients with Detrusor Underactivity and Detrusor Hyperactivity with Impaired Contractility
Ping-Hsuan Yu, Chih-Chieh Lin, Yu-Hua Fan, Shing-Hwa Lu, Alex Tong-Long Lin
Department of Urology, Taipei Veteran General Hospital, Taiwan
Purpose: Among female patients with symptoms of incomplete emptying and difficult voiding, the possible diagnoses of urodynamic study are detrusor underactivity (DU) and detrusor hyperactivity with impaired contractile function (DHIC). Although DU and DHIC are both characterized on urodynamic by impaired detrusor contractility, the presentation of DHIC is more complicated than DU. These symptoms hypothetically resulting from the pathological changes of the bladder wall were reported in some literatures. In this research, we investigate the correlation between the bladder radiological findings and clinical symptoms in female patients with DU or DHIC.
Materials and Methods: DU was defined as follows: maximum free flow rate (Qmax) ≦15cc/s, detrusor pressure at maximum flow (Pdet Qmax) ≦20cmH2O, and bladder capacity＞150cc. DHIC was defined as follows: maximum free flow rate (Qmax) ≦15cc/s, detrusor pressure at maximum flow (Pdet Qmax) ≦20cmH2O, and bladder capacity ≦150cc. From the year of 2011 to 2016, female patients with the diagnoses of DU or DHIC by the video urodynamic study at Taipei Veterans General Hospital were recruited. We analyzed all the urodynamic parameters and collected the questionnaires, including IPSS, UDI-6, and OABSS. Under radiological exam, such as ultrasonography and CT scan, the bladder wall thickness and the proportion of bladder wall thickness to the whole bladder diameter were recorded. In the statistical analysis, The Mann-Whitney U test was applied to compare the bladder wall thickness between these two diagnostic subgroups, and the Spearman's rank correlation coefficient was applied to correlate the bladder wall thickness and the proportion of bladder wall thickness to the whole bladder diameter, with the IPSS, UDI-6, and OABSS questionnaires.
Results: There were 48 female DU patients with mean age 63.92 years old (SD=11.80) and 13 DHIC patients with mean age 55.37 years old (SD=20.55) recruited in this research. The mean patients’ age between these two subgroups revealed no significant difference (p=0.449). The mean measured bladder wall thickness of DHIC patients (4.11mm) is significantly larger than that of DU patients (3.42 mm) (p=0.001). In DHIC subgroup, it showed strong correlation between bladder wall thickness and some questions of UDI-6 questionnaires (to urgency: r=0.831, p=0.006; to activity: r=0.884, p=0.002; small amounts of leakage: r=0.809, p=0.008; and total score: r=0.69, p=0.04). In addition, the bladder wall thickness of DHIC patients also has significant correlation with urge incontinence of the OABSS questionnaire (r=0.679, p=0.044). Nevertheless, there was no correlation between bladder wall thickness and IPSS questionnaire items.
Conclusions: The bladder walls of female DHIC patients are significantly thicker than those of female DU patients. Furthermore, DHIC patients with higher UDI-6 questionnaire scores have the thicker bladder wall. However, either DU or DHIC patients have no correlation between bladder wall thickness and IPSS.