下泌尿症狀女性之年紀與影像尿路動力學檢查結果之關係

蔡仕傑¹、林志杰^{1, 2}、范玉華^{1, 2}、林登龍^{1, 2}、黃志賢^{1, 2}

¹臺北榮民總醫院泌尿部；²國立陽明交通大學醫學系泌尿學科及書田泌尿科學研究中心

Association of age with video-urodynamic studies findings

in women presenting weak steam symptoms

Shi-Jie Tsai¹, Chih-Chieh Lin^{1, 2}, Yu-Hua Fan^{1, 2}, Alex T.L. Lin^{1, 2}, William J.S. Huang^{1, 2}

¹ Department of Urology, Taipei Veterans General Hospital, Taiwan

²Department of Urology, School of Medicine, College of Medicine, Shu-Tien Urological Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan

Purpose:

Voiding symptom is one common bothering problem in women and can be caused by diverse contributing factors, such as an abnormality in detrusor muscle activity or bladder outlet obstruction. In this occasion, video-urodynamic study (VUDS) is one comprehensive diagnostic tool for investigating the exact cause of this manifestation. We aimed to evaluate the association among the parameters of VUDS and different age cohorts of female patients presenting weak steam symptom.

Materials and Methods:

We retrospectively reviewed video-urodynamic studies from January 2018 to August 2020 in our institute. A total of 179 neurologically intact female patients with “weak stream” subscore of International Prostate Symptom Score (IPSS) equal or greater than four points were enrolled. These patients were divided into three age groups: 18-54 years (A), 55-69 years (B), ≥ 70 years (C). All the video urodynamic parameters and diagnosis were recorded. The overall collected data were statistically analyzed with Brown-Forsythe and chi-square tests.

Results:

The overall numbers of recruited in each subgroup were 54 patients in group A, 81 patients in group B, and 44 patients in group C, respectively. The mean age of total recruited patients was 61.7 ± 12.5 years old. Although the maximum urinary flow rate (Qmax) by uroflowmetry was similar among three groups (15.1, 15.6, and 14.4 ml/sec in group A, B, C, respectively, p=0.67), the detrusor pressure at maximum flow (Pdet-Qmax) was significantly lower in the eldest age group (18.8 cmH₂O) compared to the youngest age group (34.3 cmH₂O pressure, p=0.001). Patients in group A had larger post-void residual volume (59.2ml) compared to group B (43.6ml) or group C (30.4ml), but without statistically difference (p=0.16). The results regarding bladder contractility were detrusor normoreflexia in 26 patients (14.5%), detrusor underactivity in 49 patients (27.3%), bladder neck obstruction in 27 patients (15.1%), and dysfunctional voiding in 33 patients (18.4%). The diagnosis of dysfunctional voiding was more dominant in the youngest age group (36.4%) than in the eldest age group (7.4%, p=0.001), while other diagnoses were similar between three groups. The total IPSS score and quality of life were not statistically different.

Conclusions:

For female patients bothered by weak stream symptoms, VUDS is a useful examination for establishing the diagnosis. Aging appears to have a negative effect on bladder detrusor function. In contrast, for young age patients, dysfunctional voiding is more likely the leading cause of weak stream symptoms.