揭示女性功能性排尿障礙中逼尿肌低活動：症狀型態與影像尿動力學相關性

許淳淵、莊燿吉、李偉嘉、沈元琦

高雄長庚紀念醫院外科部泌尿科

Unveiling Detrusor Underactivity in Women with Dysfunctional Voiding: Symptom Patterns and Videourodynamic Correlates

Chun-Yuan Hsu, YAO-CHI CHUANG, WEI-CHIA LEE, YUAN-CHI SHEN

Kaohsiung Chang Gung Memorial Hospital, Urology

Purpose: Dysfunctional voiding (DV) is a functional form of female bladder outlet obstruction (fBOO) that occurs in the absence of neurological injury, such as prior surgery or spinal cord disease. DV is characterized by obstruction at the level of the striated urethral sphincter–pelvic floor complex (SUS-PFC), as demonstrated by fluoroscopy or electromyography (EMG). It is a less prevalent yet more complex subtype of fBOO. Although many patients with DV exhibit bladder overactivity, which is considered a compensatory response to detrusor–sphincter dyssynergia, a subset of patients present with detrusor underactivity (DU) and demonstrate distinct clinical features. This study aimed to analyze the symptom patterns and videourodynamic characteristics of DV in patients with DU.

Materials and Methods: Adult female patients diagnosed with DV at the Department of Urology of our medical center between July 2022 and May 2025 were retrospectively reviewed. Patients were categorized into two groups: DV with DU and DV without DU. Collected data included age, comorbidities, types and duration of lower urinary tract symptoms, uroflowmetry parameters, bladder ultrasound findings, videourodynamic study results, and prescribed treatments. Descriptive and inferential statistical analyses were performed to compare differences between the two groups.

Results: A total of 123 female patients with DV were included, among whom 40% were identified as having DU. The mean age was 59 years. There were no significant differences in presenting symptoms and signs between the two groups. However, patients with DU had a significantly shorter duration of symptoms compared to those without DU (36 vs. 109 months). They also demonstrated a significantly prolonged voiding time on uroflowmetry (94 vs. 55 seconds).Videourodynamic evaluation revealed that fluoroscopic evidence of SUS-PFC obstruction was less frequently observed in patients with DU (68% vs. 88%). In contrast, absence of spontaneous voiding (71% vs. 91%) and straining voiding patterns (49% vs. 26%) were more common in this group. Additionally, patients with DU had significantly lower Qmax (6.9 vs. 12 mL/sec), Qave (2.4 vs. 4.9 mL/sec), voided volume (150 vs. 257 mL), voiding efficiency (43% vs. 62%), bladder contractility index (BCI: 44 vs. 84), and fBOOI values

Conclusion: These findings highlight the heterogeneity of DV and underscore the importance of videourodynamic evaluation in identifying underlying detrusor dysfunction. Recognition of DU in patients with DV may have important implications for individualized management strategies.