Chronic Lower Urinary Tract Symptoms in Young Men Without Symptoms of Chronic Prostatitis: Urodynamic Analyses in 308 Men Aged 50 Years or Younger

Abstract

PurposeWe investigated the etiologies of lower urinary tract symptoms (LUTS) and compared urodynamic characteristics between different diagnostic groups in young men with chronic LUTS.Materials and MethodsWe reviewed the medical records of 308 men aged 18 to 50 years who had undergone a urodynamic study for chronic LUTS (≥6 months) without symptoms suggestive of chronic prostatitis.ResultsThe men's mean age was 40.4 (±10.1) years and their mean duration of symptoms was 38.8 (±49.2) months. Urodynamic evaluation demonstrated voiding phase dysfunction in 62.1% of cases (primary bladder neck dysfunction [PBND] in 26.0%, dysfunctional voiding [DV] in 23.4%, and detrusor underactivity [DU]/acontractile detrusor [AD] in 12.7%) and a single storage phase dysfunction in 36.4% of cases (detrusor overactivity [DO] in 13.3%, small cystometric capacity in 17.9%, and reduced bladder sensation in 5.2%). Most of the demographic characteristics and clinical symptoms did not differ between these diagnostic groups. Whereas 53.9% of patients with voiding dysfunction had concomitant storage dysfunction, 69.6% of those with storage dysfunction had concomitant voiding dysfunction. Men with DV or DU/AD exhibited lower maximum cystometric capacity than did those with normal urodynamics. Low bladder compliance was most frequent among patients with PBND (10.0%, p=0.025). In storage dysfunctions, men with DO exhibited higher detrusor pressure during voiding than did those with other storage dysfunctions (p<0.01).ConclusionsBecause clinical symptoms are not useful for predicting the specific urodynamic etiology of LUTS in this population, urodynamic investigation can help to make an accurate diagnosis and, potentially, to guide appropriate treatment.

Phenotyping women with detrusor underactivity by presumed etiology: Is it plausible?

“…While this symptomatology supports the proposed definition by Chapple et al, the study does not identify any differences in etiology or clinical history among patients with DU. Several small series have attempted to identify predictive factors for impaired detrusor contractility in men, but similar to our study in women, failed to identify any significant differences . Hoag et al evaluated 79 patients with DU, 68.4% of which were female.…”

Can we improve our management of dysfunctional voiding in children and adults: International Consultation on Incontinence Research Society; ICI‐RS2018?

“…Patients with DV had again lower cystometric capacity when compared with those with normal findings. No significant differences were noted for demographic characteristics or clinical symptoms when compared with other urodynamic diagnoses of primary bladder neck dysfunction and DU . Similar rates of DV (28.7%) were diagnosed with video‐UDS in a smaller cohort of men aged 40 years or younger with at least a 6‐month history of LUTS .…”

“…Repeated uroflows with EMG and postvoid residual urines are needed to verify the diagnosis in children . In adults, symptoms and noninvasive evaluation alone may not be able to diagnose or differentiate DV from other causes of VD . Although voiding symptoms or even urinary retention may be expected in DV patients, storage symptoms, usually due to detrusor overactivity, can be quite common and a significant proportion of patients present with mixed LUTS …”

“…In a study of younger men, DV was diagnosed in 23.4% of cases. The diagnosis was based on EMG activity of the pelvic floor/EUS during PFS and free‐flow, intermittent changes in free‐flow and/or VCUG in equivocal cases . Patients with DV had again lower cystometric capacity when compared with those with normal findings.…”

“…12 Whatever the muscle involved that increases urethral resistance, it would lower the urine flow rate. Such variability of definition may explain the wide prevalence range reported among men (14%-43%) [13][14][15][16] and women with lower urinary tract symptoms (LUTS) (10.5%-34.6%). 12,17,18 Other researchers report a much lower prevalence of "learned VD" (2% of urodynamic investigations for LUTS in an adult population).…”