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Journal of Peking University(Health Sciences) ›› 2019, Vol. 51 ›› Issue (5): 856-862. doi: 10.19723/j.issn.1671-167X.2019.05.011

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Analysis of urodynamic study of female outpatients with lower urinary tract symptoms and follow-up of the patients with detrusor underactive

Wei-yu ZHANG1,Qiu-xiang XIA2,Hao HU1,Jing-wen CHEN1,Yi-ran SUN1,Ke-xin XU1,Xiao-peng ZHANG1,△()   

  1. 1. Department of Urology, Peking University People’s Hospital, Beijing 100044, China
    2. Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 43000, China
  • Received:2018-03-19 Online:2019-10-18 Published:2019-10-23
  • Contact: Xiao-peng ZHANG E-mail:myqad@sina.com

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Abstract:

Objective: To find out the prevalence of lower urinary tract symptoms (LUTS) and analyze the characteristics of the urodynamics diagnosis in female outpatients. To study the natural history of detrusor underactive (DU) by the followed up. Methods: A retrospective study of the female LUTS outpatients in Peking University People’s Hospital from Jan. 2005 to Dec. 2015 was performed. The basic information and the urodynamic results of a total of 656 female outpatients were collected. The distribution of storage symptoms, voiding symptoms, complications and urodynamic diagnosis were analyzed. The symptoms and urodynamic results were compared among the groups, which were divided according to age, urodynamic diagnosis and diabetes mellitus. A follow-up of 163 female DU outpatients was performed, including the treatments and the American Urological Association symptoms scores (AUAss). Results: Frequency (25.03%) is the most common symptom in female outpatients, followed by stress urinary incontinence (20.04%), urgency (19.97%), and difficulty of voiding (17.32%). Stress urinary incontinence (SUI) accounted for the first (36.04%) of the whole outpatients, followed by the DU (24.08%), and bladder outlet obstruction (17.58%). The patients aged 51-60 years occupied the peak of almost all the diagnosis. There was a higher proportion of the young female patients than that of the middle and old patients diagnosed with no abnormal after the urodynamic study. The first, strong, urge and maximum bladder capacity were significantly larger in DU patients with diabetes than without diabetes. Follow-up results of the DU patients showed there was no significantly difference of the AUAss scores in both the two groups before and after the follow-up, but the quality of life decreased significantly. Conclusion: Female LUTS outpatients showed a main complaint of storage symptoms. SUI ranked the first in female patients with LUTS. With the increase of age, bladder sensation and detrusor function decrease. In elderly patients, DU became the first ranked disease instead of SUI. Diabetes can affect the sensory function of bladder in patients with DU, and then increase the difficulty of voiding. The patients with DU, absent from treatment, experienced a lower quality of life.

Key words: Lower urinary tract symptoms, Urodynamics, Urinary bladder disease, Female, Outpatients

CLC Number: 

  • R694.5

Figure 1

The incidence of lower urinary tract symptoms among female outpatient"

Figure 2

The age distribution of 656 patients underwent urodynamic examination"

Table 1

Distribution of LUTS and urodynamic diagnosis among different age groups n(%)"

Index Young-age group
(<30 years, n=34)		 Middle-age group
(30-60 years, n=379)		 Older-age group
(>60 years, n=243)		 P value
Feature of LUTS 0.703
Symptoms at storage phase 25 (52.1) 244 (38.6) 177 (40.1)
Symptoms at urinating phase 13 (27.1) 164 (25.9) 109 (24.8)
Urodynamic diagnosis <0.001
DU 7 (18.9) 82 (19.8) 80 (28.1)
DO 6 (16.2) 24 (5.8) 35 (12.3)
BOO 10 (27.1) 81 (19.5) 60 (21.1)
SUI 2 (5.4) 166 (40.0) 75 (26.3)
Decreased compliance of bladder wall 4 (10.8) 19 (4.6) 14 (4.8)
No abnormalities 8 (21.6) 43 (10.3) 21 (7.4)

Table 2

Comparison of urodynamic parameters among different age groups"

Index Young-age group
(<30 years, n=34)		 Middle-age group
(30-60 years, n=379)		 Older-age group
(>60 years, n=243)
Uroflowmetry
Qmax/(mL/s) 17.49 (8.4) 15.40 (10.0) 12.90 (10.0)##
Qave/(mL/s) 9.30 (6.3) 8.10 (6.4) 6.50 (4.60)##
Voided volume/mL 202.00 (128.00) 216.50 (159.00) 199.00 (189.00)##
Bladder sensation
Capacity of first desire/mL 123.00 (77.00) 134.00 (70.00)* 155.00 (78.00)**
Capacity of strong desire/mL 167.83±69.25 216.37±85.61** 220.80±84.42**
Capacity of urge desire/mL 230.00 (155.00) 295.00 (93.00)* 276 (110.00)*
Maximum cystometric capacity/mL 280.00 (117.00) 336.00 (90.00)** 329.00 (110.00)*#
Pressure-flow study
Qmax/(mL/s) 14.10 (13.50) 13.70 (9.60) 11.10 (8.80)##
Qave/(mL/s) 7.50 (8.1) 7.60 (5.90) 5.90 (5.60)##
PdetQmax/cmH2O 45.00 (35.00) 35.15 (22.00) 31.00 (17.00)*
Pdetmax/cmH2O 36.30 (24.70) 27.10 (15.80)* 24.90 (15.7)**
Residual urine volume/mL 0 (10.00) 0 (25.00) 30 (86.00)##

Figure 3

The age distribution of patients with different urodynamic diagnosis Abbreviations as in Tabble 1. 1, 11-20 years; 2, 21-30 years; 3, 31-40 years; 4, 41-50 years; 5, 51-60 years; 6, 61-70 years; 7, 71-80 years; 8, 81-90 years."

Figure 4

The age discrepancy of different urodynamic diagnosis Abbreviations as in Table 1. *P<0.05, #P<0.01."

Table 3

Comparison of LUTS and urodynamic parameters between DU patients with or without diabetes"

Index With diabetes (n=25) Without diabetes (n=138) P value
Age/years, x?±s 66.96±10.43 57.55±14.59 0.002
LUTS, n(%) 0.661
Symptoms at storage phase 17 (68) 104 (75.4)
Symptoms at urinating phase 21 (84) 110 (79.7)
Uroflowmetry
Qmax/(mL/s) 12.40 (3.00) 17.00 (7.80) 0.646
Qave/(mL/s) 7.10 (2.30) 8.90 (5.30) 0.750
Voided volume/mL 230.00(188.00) 205.00 (154.00) 0.088
Bladder sensation
Capacity of first desire/mL 144.00 (56.00) 137.00 (59.00) 0.043
Capacity of strong desire/mL 279.55±88.78 223.19±90.41 0.011
Capacity of urge desire/mL 360.31±87.93 285.68±94.74 0.004
Maximum cystometric capacity/mL 332.00 (82.00) 334.00 (122.00) 0.031
Pressure-flow study
Qmax/(mL/s) 14.80 (9.50) 11.60 (7.20) 0.506
Qave/(mL/s) 6.70 (6.60) 7.90 (5.60) 0.989
Pdetmax/(cmH2O) 31.63±19.64 30.06±18.13 0.407
PdetQmax/(cmH2O) 30.00 (16.80) 26.70 (16.30) 0.584
Residual urine volume/mL 170.60±160.92 120.45±124.29 0.331

Table 4

The change of AUAss before and after follow-up (x?±s)"

Score At examination At follow-up P value
AUAss 13.46±6.41 13.37±7.50 0.940
Urinating phase 9.89±5.66 9.61±6.10 0.792
Storage phase 3.57±3.02 3.73±3.04 0.735
QoL 4.73±0.84 4.18±1.32 0.001
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