在女性膀胱過動症患者中，膀胱過敏感是否和尿路動力學證實的逼尿肌過動有所不同？
蕭其航1、陳順郎1,2、陳進典2,3
1中山醫學大學附設醫院泌尿科; 2中山醫學大學醫學院醫學系; 3中山醫學大學附設醫院婦產科
Are patients with bladder oversensitivity different from urodynamically proven detrusor overactivity in female overactive bladder syndrome?
Chi-Hang Hsiao1, Sung-Lang Chen1,2, Gin-Den Chen2,3
1Department of Urology, Chung Shan University Hospital, Taichung, Taiwan
2Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
3Department of Obstetrics and gynecology, Chung Shan University Hospital, Taichung, Taiwan
Abstract
Background: To determine if there are clinical and urodynamic (UD) differences between female overactive bladder (OAB) patients with bladder oversensitivity (BO) and detrusor overactivity (DO) via a much lower filling rate.
Methods: In total, 205 patients with OAB symptoms were recruited for this study. During filling cystometry, the bladder was filled at a more “physiological” rate of 20 ml/min. All patients underwent a complete urogynecological evaluation including detailed history, physical examination, urinalysis, pad test for quantification of urine leakage, 3-day frequency-volume chart (FVC) documentation, and completion of a UD study.
Results: The overall incidence of BO was 34.2% and DO was 65.8%. The first desire to void (FDV) in patients with BO and DO was at 117.47 ±21.68 ml and 135.23 ±22.88 ml, respectively (p<0.05). Maximal cystometric capacity (MCC) in patients with BO and DO was recorded at 259.44 ±33.87 ml and 265.32 ±44.05 ml (p>0.05). A receiver operating characteristic (ROC) was used to find the cut-off value of FDV for sensitivity and specificity in patients diagnosed with DO. Area under the curve (AUC) was 0.702 (p<0.005, 95% confidence interval: 0.626–0.779) if FDV was determined as more than 127 ml. Patients with BO experienced significantly increased daytime urinary frequency and nocturia symptoms (<0.05). Patients with DO had a significantly higher prevalence of urgent urinary incontinence (p<0.05). In this study, a higher FDV and higher body mass index (BMI) were correlating factors for OAB patients with DO after multiple logistic regression analysis.
Conclusion: Patients with BO seemed to be on a different spectrum compared to those with DO and also had different symptom-specific and associative factors. It was also found that FDV could be good predictive indicator for detecting DO at a low filling rate.