Voiding dysfunction is a common condition among women. Since voiding and storage symptoms can coexist, evaluation necessitates further investigations with urodynamic studies (UDS). Some predominant dysfunction can hide a less critical one. We retrospectively reviewed UDS of non-neurological women referred for evaluation of lower urinary tract dysfunction and studied the rate of concomitant urodynamic diagnoses that might have gone unnoticed without a thorough examination.

Urodynamic tracings of 563 consecutive non-neurological women referred for primary evaluation of lower urinary tract symptoms were reviewed. Criteria for exclusion were neurological disease, diabetes mellitus, stage ≥ 2 prolapse and failure to understand simple orders or a Mini-Mental State score < 20. UDS comprised free uroflow, cystomanometry, pressure-flow study and urethral profilometry. Initial urodynamic diagnosis was given according with ICS/IUGA recommendations1 using specific urodynamic criteria. For bladder outlet obstruction (BOO), cut-off values Qmax< 12 mL/s and pdet.Qmax> 25 cm H2O and comparison with Solomon-Greenwell index BOOIf = (pdet.Qmax– 2.2*Qmax) (likely obstructed when BOOIf was higher than 5 and obstruction almost certain when BOOIf was higher than 18); for detrusor hyperactivity with impaired contractility (DHIC) detrusor overactivity during storage and impaired emptying ; for detrusor hyperactivity (DO) inhibited detrusor contractions during filling ; for detrusor underactivity (DU) low pressure-low flow : pdetQmax<20 cmH2O, Qmax<15 mL/s and BVE%<90 ; for normal (N) no abnormality detected during PFs ; for intrinsic sphincter deficiency  (ISD) : low maximal urethral closure pressur (MUCP) vs age ((120 – age) - 20%) or MUCP less than 20/35 cm H2O and/or positive Valsalva leak point pressure (VLPP) less than 60 cm H2O ; for urethral voiding (URA) voiding triggered by urethral relaxation.   Concomitant UDS diagnoses were sought out by analyzing the values of other parameters which were hidden by the main diagnosis.

Concomitant diagnoses were found in 167(29.7%) women. Mean age was 58.4±16.5 years [20-96y]. Main complaint was urinary incontinence: 121 stress (SUI),  170 mixed (MUI), and 154 urge (UUI). One hundred and eighteen with complaints other than incontinence were called OTHER; among them, 46 complained of urinary frequency (PK) and  72 from dysuria (Dys).  Concomitant UDS diagnoses included  bladder outlet obstruction (67), detrusor underactivity (22) and  intrinsic sphincter deficiency (78).

Concomitant diagnoses were mainly observed for women with predominant diagnosis of detrusor overactivity (62.2%) and detrusor overactivity with impaired contractility (60.%) (Table). 
A significant rate (22.9%) of possible concomitant urodynamic diagnoses was found in non-neurological women referred for evaluation of lower urinary tract dysfunction.

Due the possible overlap of UDS diagnoses, the practitioner reviewing UDS reports must pay attention to all parameters reported to reach and to recommend the correct management approach.

Haylen BT et al. NAU. 2010; 29: 4-20.