Urodynamic and clinical features in women with overactive bladder: When to suspect concomitant voiding dysfunction?

Abstract

The aim of this study is to describe the prevalence and type of female voiding dysfunction (FVD) in patients with overactive bladder (OAB) who were studied by urodynamics and its relationship with voiding symptoms.Methods: This is a cross-sectional study of female adult patients with OAB syndrome who underwent UDS in a University Hospital in Chile between January 2015 and April 2020. FVD was defined either as bladder outlet obstruction (BOO) or detrusor underactivity (DU). BOO was established if the Solomon-Greenwell BOO index was higher than 18. DU was diagnosed when the invasive maximum flow rate (Qmax) was ≤15 ml/sec, detrusor pressure at Qmax (Pdet@Qmax) was ≤20 cmH 2 O and postvoid residual (PVR) was greater than 10%. Urodynamic data and clinical features were compared between groups.Results: Two hundred and ninety-nine UDS were selected and analyzed.Bladder outlet obstruction was diagnosed in 59 patients (19.7%), whereas DU was found in 10 patients (3.3%). In the multivariate analysis, the logistic regression to predict BOO demonstrated that night-time frequency, the presence of detrusor overactivity and a higher PVR were independent predictors of BOO. Instead, for DU, the only independent predictor was a smaller voided volume in the pressure-flow study. Conclusion: Female voiding dysfunction was found in 23% of patients with overactive bladder. BOO is more frequent than DU, and should be suspected in patients with higher night-time frequency, presence of detrusor overactivity and a high PVR. Instead, DU should be suspected in patients with a smaller voided volume.

Prevalence and Predictors of Bladder Outlet Obstruction in Women With Chronic Urinary Symptoms and a History of Urethral Sling Surgery

“…The diagnosis of female bladder outlet obstruction is a matter of debate. 4,14,15 Multiple algorithms for diagnosis of female bladder outlet obstruction have been suggested, however none have been widely validated or accepted. The Blaivas criteria were used for diagnosis in this study as it has been shown to be accurate and reliable with over 90% of obstructed patients meeting criteria.…”

Systematic review of urinary biomarkers of female bladder outlet obstruction (fBOO)

“…BOO is more frequent than DU and should be suspected in patients with higher night-time frequency, presence of detrusor overactivity and a high post-void residual. Instead, DU should be suspected in patients with a smaller voided volume (8). Several combinations of nomograms were tested to increase the accuracy of diagnosing BOO and detrusor underactivity (DU) among women with LUTS (9).…”

Defining bladder outlet obstruction and detrusor underactivity in females with overactive bladder: Are we forgetting about the free uroflowmetry?

“…Even up to one‐third of patients with overactive bladder (OAB) have been described to have concomitant voiding dysfunction in the form of either bladder outlet obstruction (BOO) or detrusor underactivity (DU) 1,2 . A recent report from our institution showed a prevalence of 23% of BOO and 3.3% of DU in OAB patients submitted to a urodynamic study (UDS) 3 …”

“…1,2 A recent report from our institution showed a prevalence of 23% of BOO and 3.3% of DU in OAB patients submitted to a urodynamic study (UDS). 3 It is well recognized that the goal of UDS (recreating a usual filling micturition cycle) has many obstacles. Besides the stress of being examined, the presence of urethral catheters has been broadly reported to influence the values of maximum flow rate during pressure-flow study (PFS).…”