Department of Urology, Hualien General Hospital, Hualien, Taiwan.
Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan.
J Formos Med Assoc. 2014 Mar;113(3):161-5. doi: 10.1016/j.jfma.2012.04.008. Epub 2012 Aug 9.
BACKGROUND/PURPOSE: Dysfunctional voiding (DV) is an abnormality of bladder emptying in neurologically normal individuals where the external sphincter activity increases during voiding. This study investigated the clinical presentations and videourodynamic characteristics of adult women with DV.
A total of 1605 women with lower urinary tract symptoms (LUTS) were investigated with videourodynamic (VUD) studies from 1997 to 2010. The clinical urinary symptoms and VUD characteristics of DV were compared with a group of urodynamically normal controls. Antimuscarinic or alpha-blocker treatment according to the chief complaint of storage or voiding LUTS was respectively given.
There were 168 women diagnosed with DV. Detrusor overactivity (DO) occurred in 69% of women with DV. Patients with DV had significantly lower cystometric bladder capacity, higher detrusor pressure, lower maximum flow rate, and larger post-void residual volume than the controls. A total of 114 (67.9%) patients had storage symptoms and 54 (32.1%) had voiding symptoms as their chief complaints among those with DV. Among them, urinary frequency (n = 69, 41.1%) was the most common chief complaint, followed by dysuria (n = 53, 32.1%), and urgency incontinence (n = 26, 15.5%). The incidence of urgency incontinence and dysuria were significantly greater than that in the control group, however, the incidence of frequency, urgency, or nocturia showed no significant difference between DV and control groups. The success rates were 41.2% (n = 47) for antimuscarinic therapy and 51.9% (n = 28) for alpha-blocker therapy in patients with storage and voiding LUTS, respectively (p = 0.366).
DO and storage LUTS commonly occurred in women with DV, suggesting DO could be one of the etiology in the pathophysiology of DV. VUD studies yielded a high diagnostic rate for DV in women with LUTS.
背景/目的：排尿功能障碍（DV）是一种在神经系统正常的个体中出现的膀胱排空异常，其特征是外括约肌在排尿过程中活动增加。本研究旨在探讨成年女性 DV 的临床表现和尿动力学特征。
对 1997 年至 2010 年间进行尿动力学（VUD）研究的 1605 例下尿路症状（LUTS）女性进行了调查。将 DV 的临床尿症状和 VUD 特征与一组尿动力学正常的对照组进行了比较。根据储存或排空 LUTS 的主要症状，分别给予抗毒蕈碱或α-受体阻滞剂治疗。
共有 168 例女性被诊断为 DV。69%的 DV 患者存在逼尿肌过度活动（DO）。与对照组相比，DV 患者的膀胱容量明显更小，逼尿肌压力更高，最大尿流率更低，残余尿量更大。在有 DV 的患者中，114 例（67.9%）有储存症状，54 例（32.1%）有排空症状作为主要症状。其中，最常见的主要症状是尿频（n=69，41.1%），其次是尿痛（n=53，32.1%）和急迫性尿失禁（n=26，15.5%）。急迫性尿失禁和尿痛的发生率明显高于对照组，而尿频、尿急或夜尿症的发生率在 DV 组和对照组之间无显著差异。在有储存和排空 LUTS 的患者中，抗毒蕈碱治疗的成功率分别为 41.2%（n=47）和 51.9%（n=28），抗α-受体阻滞剂治疗的成功率分别为 41.2%（n=47）和 51.9%（n=28）（p=0.366）。
DO 和储存 LUTS 常见于 DV 女性，提示 DO 可能是 DV 病理生理学的病因之一。VUD 研究对 LUTS 女性的 DV 诊断率较高。
