Factors predicting the suboptimal response of the frontline medical treatment in women with dysfunctional voiding

Hsiao S1, Lee C2, Chen S2, Jhang J2, Jiang Y2, Kuo H2

Research Type

Clinical

Abstract Category

Female Lower Urinary Tract Symptoms (LUTS) / Voiding Dysfunction

Abstract 590
Infection and Pot Pourri
Scientific Podium Short Oral Session 38
Saturday 21st November 2020
15:07 - 15:15
Brasilia 2
Female Voiding Dysfunction Pathophysiology
1. Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital, New Taipei, Taiwan, 2. Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
Presenter
S

Sheng-Mou Hsiao

Links

Abstract

Hypothesis / aims of study
The definition of dysfunctional voiding was made by videourodynamic result of detrusor contraction (high or normal pressure) with a narrowing outlet at the level of external sphincter. These patients can be treated with alpha blocker and/or muscle relaxant as the medical treatment. However, some patients may not have a good response to medical treatment (i.e. suboptimal response) and require change or add-on medications, or surgical treatment. Understanding the factor predicting the suboptimal response may be helpful for early change of medications or surgical treatment. Thus the aim of this study is to elucidate the factors predicting the suboptimal response of the frontline medical treatment in women of dysfunctional voiding.
Study design, materials and methods
Medical records of all consecutive women with dysfunctional voiding who received alpha blocker and/or muscle relaxant as the frontline medical treatment in a tertiary referral center were reviewed. A suboptimal response to the frontline medical treatment was defined as change or add-on medication, or surgical treatment after the initiation of the frontline medical treatment. Multivariable backward stepwise Cox proportional hazard modeling were performed to predict the suboptimal response to the frontline medical treatment by using all variables with p<0.05 in the univariate analysis.
Results
Between July 2011 and November 2019, a total of 60 women with dysfunctional voiding were included in this retrospective study. Twenty-five women were found to have the suboptimal response to the frontline medical treatment, including urethral botox injection (n=11), transurethral incision of the bladder neck (n=3), add-on medication (n=3) and change of medication (n=8). Multivariable Cox proportional hazard modeling revealed Pdet.Qmax (hazard ratio = 1.010), bladder capacity (hazard ratio = 1.004) and the use of Urief (hazard ratio = 0.320) were independent factors predicting the suboptimal response to the frontline medical treatment (Table 1 and Fig 1A & 1B). Pdet.Qmax ≥37 cmH2O was determined to be the optimum cut-off value to predict the suboptimal response using receiver operating characteristic (ROC) analysis, which provided an area under the ROC curve of 0.58 (95% confidence interval = 0.42 to 0.73; sensitivity = 68.0%, specificity =51.4%, Fig 1C). Bladder capacity ≥465 mL was determined to be the optimum cut-off value to predict the suboptimal response, which provided an area under the ROC curve of 0.69 (95% confidence interval = 0.55 to 0.83; sensitivity = 40.0%, specificity =94.3%, Fig 1D).
Interpretation of results
High Pdet.Qmax and large bladder capacity were associated with the suboptimal response to the frontline medical treatment. Nonetheless, the use of Urief seems associated with optimal response to the frontline medical treatment.
Concluding message
High Pdet.Qmax and large bladder capacity were factors predicting the suboptimal response to the frontline medical treatment. In addition, Urief seems to a better choice for women with dysfunctional voiding.
Figure 1 Fig. 1
Figure 2 Table 1.
Disclosures
Funding None Clinical Trial Yes Public Registry No RCT No Subjects Human Ethics Committee Research Ethics Committee, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation Helsinki Yes Informed Consent Yes