Presentation Authors: Guy Verhovsky*, Yishai Hode Rappaport, Ilia Baberashvili, Amnon Zisman, Kobi Stav, Tzriffin, Israel
Introduction: To define factors associated with bladder outlet obstruction (BOO) in women.
Methods: All women referred for urodynamic investigation were prospectively recruited. The pre-test evaluation included: medical history, physical examination, IPSS and ultrasound (US) of the urinary tract. Women were divided into obstructed and non-obstructed groups. BOO was defined as Qmax less than 12 ml/sec and PdetQmax as more than 25 cmH2O [Defreitas GA et al. Urology 2004].
Results: 104 women were recruited. Obstructed women (n=35) were younger (54Â±18 vs. 62Â±14 years, p=0.03) and had higher IPSS (24Â±6 vs. 20Â±7, p=0.02). There were no differences between the groups in co-morbidities such as BMI, menopausal state, labors, previous pelvic floor surgeries, prevalence and stage of pelvic organ prolapse, vaginal atrophy, US findings, frequency of detrusor overactivity, bladder compliance and the rate of stress and urgency incontinence. Median sensation volumes were significantly lower in the obstructed group: 1st desire (80 vs 167 ml, p < 0.0001), normal desire (136 vs 250 ml, p=0.002), strong desire (224 vs 345 ml, p=0.02), urgency (257 vs 440 ml, P=0.03) and maximal cystometric capacity (MCC, 315 vs 480 ml, p=0.01). Since &[Prime]normal volumes&[Prime] are not clearly defined, we tried to define a more reliable parameter. First desire and MCC are considered to be the most reproducible sensation volumes in repetitive urodynamic investigations [Wyndaele et al. Eur Urol 2002]. Therefore, we instituted the proportion between 1st desire and MCC as one of the comparison parameters between the two groups in logistic regression models. The median proportion was significantly lower in the obstructed group (0.28 vs 0.38, p=0.007). In univariate and multivariate analyses, the odds ratios were 0.075 (0.01-0.61, p=0.02) and 0.67 (0.005-0.82, p=0.03), respectively (table 1). The Youden index in the ROC curve demonstrated a cutoff of 0.31 as a threshold to outflow obstruction.
Conclusions: Bladder oversensitivity in urodynamics may be a predictive factor for BOO in women. Obstruction should be suspected and evaluated whenever there are overactive bladder symptoms that are refractory to conventional treatments.