Videourodynamic analysis of the urethral sphincter overactivity and the poor relaxing pelvic floor muscles in women with voiding dysfunction

Peng, Chung-Hsin; Chen, Sheng‐Fu; Kuo, Hann‐Chorng

doi:10.1002/nau.23263

Cited by 28 publications

(27 citation statements)

References 27 publications

(44 reference statements)

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“…PRES is characterized by relatively small but stable bladder [88] and low-pressure low-flow during voiding phase [89], which is different from the typical high-pressure low-flow presentation in DV or extremely large, compliant bladder in FS. The prevalence rates were 12-20% [87,89,90] and 17.6% [4] in male and female non-neurogenic VD refractory to medication patients, respectively. The incidence increased in young males [89] in patients with bladder pain syndrome [88] and in idiopathic DU patients [91].…”

Section: Urethral Sphincter Bont-a Injections In Patients With Poor Rmentioning

confidence: 94%

The Therapeutic Effects and Pathophysiology of Botulinum Toxin A on Voiding Dysfunction Due to Urethral Sphincter Dysfunction

Kao

Huang²,

Kuo

et al. 2019

Toxins

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Neurogenic and non-neurogenic urethral sphincter dysfunction are common causes of voiding dysfunction. Injections of botulinum toxin A (BoNT-A) into the urethral sphincter have been used to treat urethral sphincter dysfunction (USD) refractory to conventional treatment. Since its first use for patients with detrusor sphincter dyssynergia in 1988, BoNT-A has been applied to various causes of USD, including dysfunctional voiding, Fowler's syndrome, and poor relaxation of the external urethral sphincter. BoNT-A is believed to decrease urethral resistance via paralysis of the striated sphincter muscle through inhibition of acetylcholine release in the neuromuscular junction. Recovery of detrusor function in patients with detrusor underactivity combined with a hyperactive sphincter also suggested the potential neuromodulation effect of sphincteric BoNT-A injection. A large proportion of patients with different causes of USD report significant improvement in voiding after sphincteric BoNT-A injections. However, patient satisfaction might not increase with an improvement in the symptoms because of concomitant side effects including exacerbated incontinence, urinary urgency, and over-expectation. Nonetheless, in terms of efficacy and safety, BoNT-A is still a reasonable option for refractory voiding function. To date, studies focusing on urethral sphincter BoNT-A injections have been limited to the heterogeneous etiologies of USD. Further well-designed studies are thus needed. Key Contribution:This article summarized the effects of sphincteric BoNT-A injections among various USDs in view of pathophysiology, urodynamic outcome, and subjective patient reports.

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Section: Urethral Sphincter Bont-a Injections In Patients With Poor Rmentioning

confidence: 94%

The Therapeutic Effects and Pathophysiology of Botulinum Toxin A on Voiding Dysfunction Due to Urethral Sphincter Dysfunction

Kao

Huang²,

Kuo

et al. 2019

Toxins

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“…It is hypothesized that in women there are inappropriate activities of the pelvic floor muscles and/or the urethral sphincter during voiding, causing functional bladder outlet obstruction (BOO). 16 The relevant medical history showed no differences between the populations with or without BBD; however, when the categories were stratified by the presence or not of the corresponding disorder, the psychological history increased the chance of developing BBD, with a ratio of 4.6:1 patient. The psychological diagnosis included trauma, OCD, anxiety and ADHD.…”

Section: Discussionmentioning

confidence: 90%

Prevalence of Bladder and Bowel Dysfunction in the Outpatient Clinic of Pediatric Urology and Nephrology

Barco‐Castillo

Mejía

Echeverry

et al. 2020

Revista Urología Colombiana / Colombian Urology Journal

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Purpose Bladder and bowel dysfunction (BBD) is defined as the presence of functional alterations in both organs. The correct diagnosis and treatment prevent the exposure of patients to multiple antibiotic treatments, invasive procedures and radiological studies. The aim of the present study was to estimate the prevalence of BBD in the outpatient clinic of pediatric urology and nephrology. Methods A prospective cohort composed of 334 patients aged between 5 and 18 years was evaluated. The Pediatric Lower Urinary Tract Symptom Score (PLUTSS) was applied. A score higher than 8 was considered as significant urinary symptomatology. Moreover, the Bristol Stool Scale and the Rome IV Criteria for functional constipation and fecal incontinence were used. Patients with organic pathologies were excluded. The risk factors were evaluated using logistic regression models. Results The median age was 9 years old (interquartile range [IQR]: 6–13). The PLUTSS questionnaire was significant in 16.5% of the kids, constipation was found in 31.9%, and fecal incontinence, in 4%. The prevalence of BBD was of 27.8%. The female gender (odds ratio [OR]: 2.47; p = 0.002) and psychological disorders (OR: 4.637; p = 0.024) were considered risk factors. The evaluation of the PLUTSS questionnaire showed relevance regarding incontinence (OR: 3.059; p = 0.038), enuresis (OR: 8.532; p < 0.001); intermittent flow (OR: 9.211; p = 0.004), frequency (OR: 6.73; p = 0.005), and constipation (OR: 34.46; p < 0.001). Conclusions The prevalence of BBD is of 27.8% in the outpatient clinic. It is important to prevent associated complications and the exposure to multiple antibiotic treatments, as well as invasive and imaging procedures, which also generate high costs to the health system.

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“…Our results corroborate those of Zhu et al 4 , who found that poor relaxation of the pelvic oor may be involved in the etiology of OAB in NP women. Peng et al also reported a high prevalence of the co-existence of poor relaxation in pelvic oor muscles and VD 20 . In addition, abnormal voiding patterns were higher in the NP group (65.16%) than in the CS group (42.11%) and NSD group (38.00%).…”

Section: Discussionmentioning

confidence: 95%

Overactive Bladder Syndrome is Associated With Detrusor Overactivity and Abnormal Voiding Pattern in Nulliparous Women

Fang

Yen

et al. 2020

Preprint

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Pregnancy and childbirth are frequently associated with overactive bladder syndrome (OAB). However, the role of parous effects in OAB among nulliparous (NP) women remains controversial. This study investigated abnormal voiding patterns and DO among NP woman with OAB in comparison with parous women. From August 2011 to December 2018, 906 patients met the inclusion criteria for participation and were divided into three groups: 221 patients in the NP group, 571 patients in the normal spontaneous delivery (NSD) group, and 114 patients in the cesarean section (CS) group. Urodynamic study (UDS) examinations were performed, and the presence of DO, abnormal voiding patterns, and maximum urethral closure pressure (MUCP) were recorded. Data were analyzed using analysis of variance, χ2 tests, and independent t tests. Compared with parous women in the NSD and CS groups, patients in the NP group had a significantly higher prevalence of abnormal voiding patterns, DO and MUCP. Furthermore, abnormal voiding patterns were significantly associated with DO and MUCP respectively, especially in the NP group. We hypothesized that hypertonicity or poor relaxation of the pelvic muscle in NP women may cause functional BOO, which is related to their OAB.

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Videourodynamic analysis of the urethral sphincter overactivity and the poor relaxing pelvic floor muscles in women with voiding dysfunction

Abstract: DV and PRES were highly prevalent among the adult women with voiding dysfunction. Patients with DV had VUDS characteristics of BOO and urodynamic DO. The clinical symptoms of PRES were similar to those of DV, but the patients had low detrusor contractility and low DO rates.

Cited by 28 publications

References 27 publications

The Therapeutic Effects and Pathophysiology of Botulinum Toxin A on Voiding Dysfunction Due to Urethral Sphincter Dysfunction

The Therapeutic Effects and Pathophysiology of Botulinum Toxin A on Voiding Dysfunction Due to Urethral Sphincter Dysfunction

Prevalence of Bladder and Bowel Dysfunction in the Outpatient Clinic of Pediatric Urology and Nephrology

Overactive Bladder Syndrome is Associated With Detrusor Overactivity and Abnormal Voiding Pattern in Nulliparous Women

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