女性原發性膀胱頸阻塞之不同亞型之臨床表現及嚴重度是否有差異?

陳子双¹、莊燿吉¹、沈元琦¹

¹高雄長庚紀念醫院 泌尿科

The presentation of two subtypes of primary bladder neck obstruction in female patients. Is it different in severity?

Tzu Shuang Chen¹, Yao Chi Chuang¹, Yuan Chi Shen¹

¹Department of Urology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taiwan

Purpose: Primary bladder neck obstruction (PBNO) is one of the functional causes of bladder outlet obstruction (BOO). There are two different subtypes of PBNO presentation including delay bladder neck opening and failure of funneling of bladder neck. We aim to evaluate the different presentation of the two subtypes.

Materials and Methods: Video-urodynamic study (VUDS) were performed for the confirmation of functional BOO in 133 women. from January 2016 and December 2022. Patients diagnosed with pure PBNO were identified and divided into two groups based on the presence or absence of lag time. The Qmax of uroflowmetry and pressure flow study was evaluated in each group. We used the Mann-Whitney U test to examine the relationship between lag time presentation and the female bladder outlet obstruction index (BOOIf) according to the Solomon-Greenwell (S-G) nomogram.

Results: The study included 16 patients diagnosed with female PBNO by VUDS, 12 of whom (75%) presented with lag time (≥ 5 seconds). We excluded patients who were unable to self-voiding, diagnosed with multiple sclerosis and other neurologic disease, mixed other types of bladder outlet obstruction, and incomplete pressure flow study. The average age of the patients was 47.4 years (range 16 to 66 years), and the mean Qmax was 12.0 ml/s (13.2ml/s in lag time group and 8.5 ml/s in the failure of funneling group, p=0.109). BOOIf was calculated and cutoff values were set at >5 (equivocal obstruction) and >18 (definite obstruction), as proposed by the original S-G nomogram. There were only 3 patients met the criteria of BOOIf > 18 and 9 patients met the criteria of BOOIf >5. No significant difference was found between the two groups (mean BOOIf: 3.3 ± 20 in lag time group and 3.9 ± 7 in failure of funneling group, p=0.956)

Conclusions: The definition of the SG nomogram appears to be less sensitive for female patients with PBNO. According to the presentation of maximal flow rate and BOOIf, there was no significant difference in the two subtypes of PBNO.