Videourodynamic differential diagnosis of voiding dysfunction in Taiwanese women

Fei-Chi Chuang^a, Hann-Chorng Kuo^b

^a Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Kaohsiung Medical Center and Chang University College of Medicine, Kaohsiung, Taiwan
^b Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan

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Abstract
Objective

Voiding dysfunction in women is common, but the differential diagnosis of the underlying pathophysiology is not easy. This study analyzed lower urinary tract dysfunction in women with voiding dysfunction based on videourodynamic study (VUDS).

Patients and Methods

A total of 781 consecutive women with complaints of difficult urination were included. All patients underwent VUDS and a final diagnosis was made. The clinical symptoms and video urodynamic characteristics were analyzed.

Results

Difficult urination was the main symptom in 446 patients and an associated symptom in 335. A normal VUDS tracing was found in 96, detrusor overactivity in 112, bladder oversensitivity in 128, and interstitial cystitis in 40. The other 405 women were classified as having voiding dysfunction, including 178 with detrusor underactivity, 55 with detrusor overactivity and inadequate contractility, 88 with dysfunctional voiding, 20 with bladder neck dysfunction, 10 with urethral stricture, and 54 with poor pelvic floor muscle relaxation. Difficult urination was the main symptom in 62%, urinary retention in 11.2%, and frequency, urgency, or urgency incontinence in 24.6% of all patients with voiding dysfunction. A total of 93.8% of patients had both storage and empty symptoms, whereas only 6.2% had empty symptoms alone. Urodynamic parameters could only differentiate bladder outlet obstruction and detrusor underactivity based on voiding detrusor pressure in all patients with voiding dysfunction.

Conclusion

Storage and voiding symptoms are common in women with voiding dysfunction. VUDS is the best diagnostic tool in the differential diagnosis of female voiding dysfunction.

Keywords
Dysuria; Lower urinary tract symptoms; Videourodynamics; Women