Differences in Urodynamic Parameters According to the Presence of a Hunner Lesion in Women With Interstitial Cystitis/Bladder Pain Syndrome / 대한배뇨장애요실금학회지

PURPOSE: Differences in the severity of subjective symptoms have been noted depending on whether a Hunner lesion is present in women with interstitial cystitis/bladder pain syndrome (IC/BPS). In this study, we aimed to identify differences in objective urodynamic parameters in women with IC/BPS according to the presence of a Hunner lesion. METHODS: This cross-sectional study included a total of 55 patients with IC/BPS. IC/BPS and the presence of a Hunner lesion on cystoscopy were diagnosed according to American Urological Association guidelines. The patients were categorized into a Hunner IC/BPS group and a non-Hunner IC/BPS group according to the presence of a Hunner lesion on cystoscopy. At the initial visit, a medical history was taken from all patients with IC/BPS, and they underwent symptom assessment using a 3-day voiding diary and laboratory tests. A urodynamic study was then performed before any treatment was performed. Baseline characteristics and urodynamic parameters were compared between the 2 groups. RESULTS: Of the 55 patients, 23 (41.8%) had a Hunner lesion on cystoscopy. As documented in the voiding diaries, the Hunner IC/BPS group had more frequent voids and a smaller maximal voided volume (P=0.045, P < 0.001, respectively). Regarding urodynamic parameters, the mean volume at the first desire to void, normal desire to void, strong desire to void (SDV), and maximum cystometric bladder capacity (MBC) was significantly lower in the Hunner IC/BPS group (P=0.001, P=0.004, P < 0.001, and P < 0.001, respectively). On receiver operating characteristic curve analysis, patients with an SDV≤210 mL (area under the curve [AUC]=0.838, P < 0.001) and an MBC≤234 mL (AUC=0.857, P < 0.001) were likely to be in the Hunner IC/BPS group. CONCLUSIONS: The differences in patients’ subjective symptoms between the Hunner IC/BPS and non-Hunner IC/BPS groups were confirmed to correspond to differences in objective urodynamic parameters.

Characteristics of Mixed Urinary Incontinence and Stress Urinary Incontinence: Relationship between Lower Urinary Tract Symptoms and Urodynamic Parameters

PURPOSE: The purpose of this study was to analyze the relationship between lower urinary tract symptoms and urodynamic parameters to investigate the characteristics of mixed urinary incontinence (MUI) and stress urinary incontinence (SUI). METHODS: The subjects were 318 women with MUI and 128 women with SUI. Data were collected retrospectively from electronic medical records including Bristol Female Lower Urinary Tract Symptoms-Scored Form (BFLUTS-SF), Incontinence Quality of Life Instrument (I-QOL), voiding diaries, and urodynamic parameters. RESULTS: Compared with the SUI group, the MUI group was older and showed lower I-QOL and more severe urinary tract symptoms. The MUI group had more urinary frequency, more nocturia, and a higher urgency score than the SUI group. In the correlation analysis, the greatest difference between the two groups was that urgency was associated with Qmax, maximal cystometric capacity, and detrusor condition over activity only in the MUI group (r=−.175, p=.004; r=−.281, p<.001; r=.232, p<.001, respectively). CONCLUSION: As a result of this study, we propose that a customized management program that emphasizes the control of pelvic floor for the MUI group, and one that effectively strengthens the weak pelvic floor for the SUI group.

Urodynamics parameters in female urinary incontinence patients with pelvic organ prolapse / 中华泌尿外科杂志

Objective To compare the urodynamic parameters in female patients with incontinence with or without pelvic organ prolapse. Methods The urodynamic data from 140 patients diagnosed urinary incontinence and another 42 patients coexisted with pelvic organ prolapse were reviewed and analyzed. The urodynamics parameters were compared in perfusion, urination, bladder compliance, maximum urinary flow rate (Qmax), detrusor muscle pressure of maximum urinary flow rate (Pdet,Qmax), minimum urinary flow rate(Pdet, Qmax), urethral resistance factor (RUA), obstruction of bladder index (OBI) and normalized detrusor contractility. The influence of pelvic organ prolapses with incontinence on bladder filling and voiding function was evaluated also.Results There were no significant differences between 140 patients of urinary incontinence and 42 patients coexisted with pelvic organ prolapse in perfusion (P=0.142), bladder compliance (P=0.273), Qmax(P=0.192),Pdet (P=-0. 629), Qmin (P=0.365) and normalized detrusor contractility (P=0.380). There were significant differences in age(P=2.2×10-5), urination(P=0.034), Pdet.Qmax(P=0.045), RUA(P=0.018), OBI (P=0.017). Conclusions There is not clinically significant change in urine storage function of bladder in patients with pelvic organ prolapse, but the parameters of voiding function of bladder may existe difference. The increased bladder outlet resistance and postvoid residual urine are noticed in patients with pelvic organ prolapse.

The Clinical Significance of Detrusor Contraction Duration as a Predicting Parameter for Evaluaing Bladder Outlet Obstruction with Lower Urinary Symptoms in Men / 대한비뇨기과학회지

PURPOSE: Recently, detrusor contraction duration (DCD) has been suggested to be a useful urodynamic parameter for differentiating bladder outlet obstruction. Therefore, we studied the relationship between DCD and bladder outlet obstruction to determine whether DCD is a useful parameter for characterizing bladder outlet obstruction with lower urinary tract symptoms in men. MATERIALS AND METHODS: The urodynamic records of 212 consecutive male patients with lower urinary tract symptoms subdivided into 4 groups as bladder outlet obstruction (BOO), detrusor underactivity (DU), detrusor instability (DI), and normal (NL). DCD was defined as the contraction time elapsed between the first rise in detrusor pressure from baseline to the time at which detrusor pressure returned to baseline at the end of voiding. The correlations of DCD with other urodynamic parameters were assessed. RESULTS: DCD was significantly increased in patients with BOO and DU groups compared to other groups (DI, NL) (p<0.05). However, DCD were only weakly correlated with other urodynamic obstructive parameters in the BOO groups. CONCLUSIONS: Since DCD may also depend on detrusor contractility and bladder volume, DCD alone cannot be used as obstructive parameters to diagnose bladder outlet obstruction. However, considering the fact that the bladder outlet obstruction can be easily differentiated from the decreased detrusor contractility with other urodynamic parameters, DCD seems to be useful proxy for evaluating bladder outlet obstruction.

The Correlation between Symptom Score and Urodynamic Parameters in Diagnosing Benign Prostatic Hyperplasia / 대한비뇨기과학회지

PURPOSE: Although symptom score, peak flow rate(Qmax), postvoid residuals(PVR) and prostate volume are measured in the diagnosis of bladder outlet obstruction(BOO) caused by benign prostatic hyperplasia, pressure flow study is the most objective parameter in diagnosing BOO. To predict the degree of bladder outlet obstruction or detrusor contractility, correlations between clinical and urodynamic parameters such as linear passive urethral resistance relation(L-PURR) nomogram were estimated and also determined whether it is possible to predict the presence of BOO by non-invasive clinical variables in patients with lower urinary tract symptoms(LUTS). MATERIALS AND METHODS: The study was composed of 56 male patients referred for urodynamic study due to LUTS. Patients with disease that might directly or indirectly affect detrusor function and those undergone operation may affect bladder mechanics were excluded from the study. BPH was diagnosed by symptom score(IPSS), uroflowmetry, transrectal ultrasound and urodynamic study. Correlations between L-PURR nomogram grade and other clinical variables(symptom score, Qmax, PVR and prostate volume) were obtained. Predictive value of peak flow rate and prostate volume in diagnosing bladder outlet obstruction were also determined. Comparison of clinical and urodynamic parameters between obstructive(LPURR>3) and nonobstructive as well as those between normal and low contractility groups were performed. RESULTS: Grade of obstruction in urodynamic study correlated with symptom score(r=0.34, p<0.05) and peak flow rate(r=-0.36, p<0.01) but not with PVR and prostate volume. Contractility grade didn`t correlate well with other clinical parameters. Obstruction grade correlated with voiding symptom(question 1, 6) and bother score(r=0.34, p<0.05, r=0.42, p<0.01, r=0.49, p<0.01, respectively). Voiding symptoms(question 1, 5), bother and total symptom score were significantly greater in obstructive group than in nonobstructive one. Qmax was significantly lower in obstructive than in nonobstructive group(8.9+/-0.9 vs 14.0+/-1.0ml/sec, p<0.01). Detrusor pressure at peak flow was significantly greater in obstructive than in nonobstructive group (76.6+/-16.7 vs 42.2+/-3.1cmH2O, p<0.01). Positive predictive values of BOO were 86.2% if Qmax is less than 10ml/sec but 15.4% if Qmax is more than 15ml/sec(x2=16.6, p<0.01). CONCLUSIONS: Obstruction grade of L-PURR correlated well with obstructive symptom and negatively with peak flow rate. Obstructive symptoms in the obstructive group were significantly higher compared to those in the nonobstructive group. Peak flow rate combined with L-PURR seems to be effective parameters in predicting obstruction. Conclusively, L-PURR nomogram was thought to be a good parameter in predicting the presence and degree of bladder outlet obstruction caused by BPH.