郭育成、郭漢崇¹

台北市立聯合醫院泌尿科；¹佛教慈濟綜合醫院暨慈濟大學醫學系泌尿科

Yuh-Chen Kuo, Hann-Chorng Kuo¹

Department of Urology, Taipei City Hospital, Taipei, Taiwan; Department of Urology¹, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan

 

Purpose: Urodynamic study (UDS) has been controversial with regard to its value in interstitial cystitis/bladder pain syndrome (IC/BPS). There is a paucity of current literature evaluating the role of UDS in IC/BPS. We reported the videourodynamic study (VUDS) findings in IC/BPS patients and the association with clinical characteristics.

Materials and Methods: IC/BPS patients with complete data of a symptom assessment, VUDS, potassium sensitivity  test (PST) and cystoscopic hydrodistention were reviewed retrospectively. The VUDS was set up in accordance with the recommendations of the International Continence Society using C-arm fluoroscopy during the filling and voiding phases. Diagnoses of bladder dysfunction and bladder outlet obstruction (BOO) including dysfunctional voiding (DV), poor relaxation of external urethral sphincter (PRES) and bladder neck dysfunction (BND) were made according to the criteria suggested in our previous publications. The distribution of the different VUDS diagnoses in IC/BPS patients were determined. The clinical and UDS parameters between normal and abnormal VUDS diagnoses were analyzed.

Results: A total of 414 IC/BPS patients (66 men and 348 women; mean age, 48.8±13.5) were enrolled in this study. Among them, 26 had ulcer type IC/BPS and 381 had non-ulcer type I/BPS. Bladder dysfunction (hypersensitive bladder, HSB) were found in 364 (87.9%) patients and BOO in  244 (58.9%). The causes of BOO included DV in 42 (10.1%), PRES in 193 (46.5%), BND in 9 (2.1%). HSB was more prevalent in IC/BPS patients with a positive PST, with smaller volume of cystoscopic maximal bladder capacity (MBC), and with higher grade of glomerulations. IC/BPS patients with DV had smaller volumes at first sensation of filling, first desire to void (FD), strong desire to void, cystometric bladder capacity, voided volume, lower maximum flow rate (Qmax), higher detrusor pressure at Qmax (Pdet) and larger volume at postvoid residual (PVR) than those with normal tracing. Patients with PRES also had lower volumes at SD and voided volume, higher Pdet, lower Qmax, larger PVR than those with normal tracing. BND was more prevalent in male than in female patients. Detrusor overactivity was more prevalent in patients with DV or BND than those with normal tracing. Pooling all the patients with BOO together, univariate logistic regression analysis revealed a significant positive correlation of disease duration and negative correlations of urodynamic volume parameters with BOO presented in IC/BPS patients. Multivariate logistic regression analysis found a cut-off value of Qmax≦11 ml/s predicts BOO in IC/BPS patients with a ROC area of 0.78 (sensitivity = 79.4%, specificity = 65.8%).

Conclusions: Hypersensitive bladder and bladder outlet obstruction are common findings of VUDS

performed in IC/BPS patients. BOO is associated with disease duration and hypersensitive bladder. A Qmax ≦11 ml/s predicts BOO in IC/BPS.