Voiding dysfunction is a common condition in elderly people. As an important clinical manifestation of benign prostatic hyperplasia, it has been extensively studied in male population. However, voiding dysfunction in women has not been fully understood.
A recent publication in the online journal PLoS ONE retrospectively analyzed the urodynamic characteristics of 1,914 women with voiding dysfunction who failed behavioral modification or medication including anticholinergics and alpha-blocker. In the article, Dr. Yang et al reported that as high as 42.3% women were diagnosed as bladder outlet obstruction according to video urodynamic findings. Moreover, detrusor underactivity (DU), hypersensitive bladder (HSB), detrusor hyperactivity with impaired contractility (DHIC), and detrusor overactivity (DO) were found in 23.1%, 17%, 12% and 2.6% of patients respectively. In addition, 2.9% of women presented normal urodynamic features. Focusing on the women with DU, authors found a significant reduction in bladder sensation, which demonstrates an increased threshold of first sensation of bladder filling (FSF), full sensation (FS), and cystometric bladder capacity (CBC), compared to the counterparts in DHIC, HSB, and DO groups. Linear regression analysis further showed that bladder sensation of the DU patients was negatively associated with bladder contractility.
Traditionally, the etiology of DU is mainly attributed to obstructive or neurogenic factors. Recently, increasing evidence reveals that abnormal sensory signaling and afferent nerve activity may play an important role in etiology of DU. A retrospective study showed that DU patients had a decreased central sensitivity to bladder afferent activity. Another study further demonstrated that DU patients had a down-regulated sensory protein expression. The current study showed that DU patients had an increased threshold of FSF, FS and CBC, which also suggests that a reduced bladder sensation may be specific to the etiology of DU. More importantly, this study clarified the urodynamic characteristics in women with voiding disorders, which significantly contributes to the understanding about female voiding dysfunction.
Article by Ran Pang on behalf of the Publications and Communications Committee
Yang T-H, Chuang F-C, Kuo H-C. Urodynamic characteristics of detrusor underactivity in women with voiding dysfunction. PLoS ONE.2018, 13(6): e0198764