Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, and Tzu Chi University, 707, Section 3, Chung-Yang Road, Hualien, Taiwan.
Int Urol Nephrol. 2022 Jun;54(6):1215-1223. doi: 10.1007/s11255-022-03175-8. Epub 2022 Mar 16.
Treatment of voiding dysfunction due to detrusor underactivity (DU) remains challenging. This study sought to determine the characteristics of video urodynamic study (VUDS) in female DU and outcomes after active treatment.
A total of 409 female patients with VUDS-proven DU were recruited. All patients received conservative bladder management, with others receiving active treatment, such as oral medication, transurethral incision of bladder neck (TUI-BN), surgery for prolapse, and urethral botulinum toxin A (BoNT-A) injection, according to their VUDS characteristics. Treatment outcomes were then analyzed by different VUDS characteristics.
Satisfactory treatment outcomes were noted in 123 patients (30.0%), among whom 35 and 88 had a VE of > 90% and > 66.7%, respectively. A total of 165 patients (40.3%) had voiding efficiency (VE) of 33.3-66.7%, whereas 121 (29.6%) remained unable to void (12.5%) or had a VE of < 33.3% (17.1%). Conservative treatment had the worst outcome. Patients with normal or slightly reduced bladder sensation (49.3%) and those with a post-void residual (PVR) of < 250 mL (59.4%) displayed better satisfactory outcome after treatment; while TUI-BN and urethral BoNT-A injection promoted better treatment results. Patients with detrusor acontractility and a PVR of ≥ 500 mL still achieved high VE rates (> 66.7%) after TUI-BN. A 56.3% satisfactory outcome was achieved after TUI-BN, whereas 58.1% satisfactory outcome was noted in those with a tight external sphincter after medical treatment.
Female patients with DU exhibited VE improvement after active treatment. Patients with very low detrusor contractility and absent bladder sensation generally exhibited poor treatment outcomes.
逼尿肌活动低下（DU）导致的排尿功能障碍的治疗仍然具有挑战性。本研究旨在确定女性 DU 患者的视频尿动力学研究（VUDS）特征以及积极治疗后的结果。
共招募了 409 名 VUDS 证实的 DU 女性患者。所有患者均接受保守性膀胱管理，根据 VUDS 特征，其他患者接受积极治疗，如口服药物、经尿道膀胱颈切开术（TUI-BN）、脱垂手术和尿道肉毒毒素 A（BoNT-A）注射。然后根据不同的 VUDS 特征分析治疗结果。
123 例（30.0%）患者治疗效果满意，其中 35 例和 88 例 VE 分别>90%和>66.7%。共有 165 例（40.3%）患者的排尿效率（VE）为 33.3-66.7%，而 121 例（29.6%）仍无法排尿（12.5%）或 VE<33.3%（17.1%）。保守治疗的效果最差。膀胱感觉正常或稍有降低（49.3%）和残余尿量（PVR）<250 毫升（59.4%）的患者治疗后获得更好的满意结果；而 TUI-BN 和尿道 BoNT-A 注射促进了更好的治疗效果。逼尿肌无收缩性和 PVR≥500 毫升的患者在接受 TUI-BN 治疗后仍能获得较高的 VE 率（>66.7%）。TUI-BN 治疗后，56.3%的患者治疗效果满意，而接受药物治疗后，外括约肌紧张的患者中有 58.1%治疗效果满意。
女性 DU 患者积极治疗后 VE 得到改善。逼尿肌收缩力极低和膀胱感觉缺失的患者一般治疗效果较差。
