Urodynamic Evaluation in Women with Chronic Lower Urinary Tract Symptoms

Abstract

Objective: The purpose of this is to describe urodynamic results of women with chronic lower urinary tract symptoms (LUTS), and relate patterns of clinical symptoms to objective urodynamic diagnoses in order to streamline diagnostic clinical trajectories.

Materials and Methods: A prospective observational study was undertaken on 248 women with chronic LUTS (>6 month’s duration) who were referred to the comprehensive urodynamic assessment. The study involved the participants going through standardized history, validated symptom questionnaires (ICIQ-FLUTS, UDI-6), completing bladder diary, and multichannel urodynamic studies based on International Continence Society (ICS) guidelines. Urodynamic indicators were filling cystometry, pressure-flow, leak point pressure, and detrusor overactivity, stress urinary incontinence and bladder outlet obstruction evaluation.

Results: The median age was 52.3 -12.7 years with a median of 4.2 -3.1 years of symptoms. Detrusor overactivity, urodynamic stress incontinence, and mixed urinary incontinence were detected in 41.9% (n=104), 38.3% (n=95) and 29.8% (n=74). Video-urodynamic diagnosis was carried out with the bladder outlet obstruction in 12.5% (n=31) cases. A significant correlation was identified between clinical urgency symptoms and detrusor overactivity (p<0.001), post-void residual volume greater than 100mL and voiding dysfunction (p=0.003), and stress leakage on physical examination and urodynamic stress incontinence (p<0.001). It is worth noting that on urodynamics, 34.7 percent of females with predominant symptoms of stress were found to be detrusor overactive.

Conclusion: Urodynamic assessment demonstrates massive discordance in clinical symptom patterns and objective findings in women with chronic LUTS. Urodynamic testing is a broader diagnostic test used in conjunction with clinical assessment especially in complicated or refractory cases, mixed incontinence presentation and potential voiding dysfunction. These results encourage the selective usage of urodynamics in the complicated female LUTS to inform the specific treatment measures.