Wang Connie N, Ha Albert, Chung Doreen E
Department of Urology, Columbia University Irving Medical Center, New York, NY, United States.
Front Urol. 2023 May 25;3:1173506. doi: 10.3389/fruro.2023.1173506. eCollection 2023.
There is a lack of understanding of the clinical significance of detrusor contraction duration (DCD) measured on urodynamic studies (UDS). We aimed to identify patient characteristics, presenting symptoms and urodynamic parameters associated with DCD in women.
Using a single-institution database of UDS (2015-2019), 405 female patients with measurable detrusor contractions were identified. Baseline characteristics, presenting symptoms and UDS parameters were analyzed. Bladder outlet obstruction (BOO) was characterized using the Blaivas-Groutz nomogram. Wilcox Rank Sum Tests were used for descriptive statistics, and a univariable generalized linear model conforming to a gamma distribution was used.
Median age was 65 years (IQR 52-75), BMI was 27.5 kg/m2 (IQR 23.9-31.1) and DCD was 90 seconds (IQR 57-124). On univariable analysis, degenerative disc disease (β = -17.9, p = 0.02), pelvic radiation (β = -31.91, p = 0.04), and stress incontinence (β = -14.11, p = 0.03) were associated with reduced DCD. Black race was associated with longer DCD (β = 22.92, p = 0.01). Analysis of UDS parameters revealed a significant increase in DCD per unit increase of bladder capacity (β = 0.08, p<0.001), detrusor pressure (Pdet) at maximum flow (Qmax) (β = 0.96, p<0.001), and maximum Pdet (β = 1.2, p<0.001). In contrast, a significant decrease in DCD was noted per unit increase in Qmax (β = -1.43, p<0.001). Finally, mild (β = 34.4, p<0.001), moderate (β = 72.52, p<0.001), and severe (β = 64.6, p<0.001) BOO were all associated with increased DCD.
Median DCD in women is 90 seconds. Longer DCD is associated with greater degree of BOO, higher maximum Pdet, Pdet at Qmax, and bladder capacity. Disc disease, irradiation and stress incontinence are associated with reduced DCD. Further studies are needed to evaluate the predictive value of DCD in women.
人们对尿动力学检查（UDS）中测得的逼尿肌收缩持续时间（DCD）的临床意义缺乏了解。我们旨在确定与女性DCD相关的患者特征、症状表现及尿动力学参数。
利用一个单机构的UDS数据库（2015 - 2019年），确定了405例有可测量逼尿肌收缩的女性患者。对基线特征、症状表现和UDS参数进行了分析。使用布莱瓦斯 - 格劳茨列线图对膀胱出口梗阻（BOO）进行特征描述。采用威尔科克森秩和检验进行描述性统计，并使用符合伽马分布的单变量广义线性模型。
中位年龄为65岁（四分位间距52 - 75岁），体重指数（BMI）为27.5kg/m²（四分位间距23.9 - 31.1），DCD为90秒（四分位间距57 - 124）。单变量分析显示，椎间盘退变（β = -17.9，p = 0.02）、盆腔放疗（β = -31.91，p = 0.04）和压力性尿失禁（β = -14.11，p = 0.03）与DCD缩短有关。黑人种族与较长的DCD相关（β = 22.92，p = 0.01）。对UDS参数的分析显示，膀胱容量每增加一个单位，DCD显著增加（β = 0.08，p<0.001），最大尿流率（Qmax）时的逼尿肌压力（Pdet）每增加一个单位，DCD显著增加（β = 0.96，p<0.001），最大Pdet每增加一个单位，DCD显著增加（β = 1.2，p<0.001）。相反，Qmax每增加一个单位，DCD显著降低（β = -1.43，p<0.001）。最后，轻度（β = 34.4，p<0.001）、中度（β = 72.52，p<0.001）和重度（β = 64.6，p<0.001）BOO均与DCD增加有关。
女性的中位DCD为90秒。较长的DCD与更高程度的BOO、更高的最大Pdet、Qmax时的Pdet以及膀胱容量相关。椎间盘疾病、放疗和压力性尿失禁与DCD缩短有关。需要进一步研究来评估DCD对女性的预测价值。
