女性功能障礙型排尿的臨床特徵和潛在相關病理生理學

李政霖 郭漢崇

花蓮慈濟醫院泌尿部

Clinical characteristics and underlying pathophysiology in women with mid-urethral dysfunctional voiding

Cheng-Ling Lee Hann-Chorng Kuo

Department of Urology Hualien Tzu Chi General Hospital

Abstract:

Aims: Voiding dysfunction due to dysfunctional voiding (DV) is commonly found among adult women with lower urinary tract symptoms (LUTS) during videourodynamic study (VUDS), nevertheless, it is not always easy to diagnose by clinical symptoms alone. This study analyzed the VUDS characteristics of DV in female voiding dysfunction and explored potential mechanism of action leading to this disease entity.

Methods: This retrospective study involved 205 women aged 18 to 80 years with refractory LUTS with urodynmically proven DV with a classic spastic mid-urethra. The medical records of co-morbidity and the VUDS parameters were reviewed. The VUDS characteristics were compared with those of urodynamically normal women.

Results: Clinically, women with mid-U DV had predominant storage lower urinary tract symptoms (LUTS) than voiding LUTS at presentation. Detrusor overactivity (DO) was noted in 64.4% of the subjects and in none of the control individuals (P < 0.05). Patients with DV had significantly increased bladder sensation, lower cystometric bladder capacity (CBC), lower bladder compliance, higher voiding detrusor pressure, smaller voided volume (VV), larger post-void residual volume (PVR), lower voiding efficiency (VE), and higher bladder outlet obstruction index (BOOI) than the controls. Among women with mid-U DV, hypertension, type 2 diabetes, and gynecological disorders are often coexisted. Women received pelvic surgery and with local bladder injury may contribute to higher provenance of DO (Table.1).

Conclusions: Mid-U DV women often presented with prominent storage LUTS, although mixed symptoms were not uncommon. Urodynamic characteristics resembles BOO with a high prevalence of DO. The underlying pathogeneses of DV may involve interplay of vasculogenic, neurogenic, hormonal and behavioral disturbances