Detrusor Underactivity and the Underactive Bladder: A New Clinical Entity? A Review of Current Terminology,Definitions, Epidemiology,Aetiology, and Diagnosis

ContextDetrusor underactivity (DU) is a common cause of lower urinary tract symptoms (LUTS) in both men and women, yet is poorly understood and underresearched.ObjectiveTo review the current terminology, definitions, and diagnostic criteria in use, along with the epidemiology and aetiology of DU, as a basis for building a consensus on the standardisation of current concepts.Evidence acquisitionThe Medline and Embase databases were searched for original articles and reviews in the English language pertaining to DU. Search terms included underactive bladder, detrusor underactivity, impaired detrusor contractility, acontractile detrusor, detrusor failure, detrusor areflexia, raised PVR [postvoid residual], and urinary retention. Selected studies were assessed for content relating to DU.Evidence synthesisA wide range of terminology is applied in contemporary usage. The only term defined by the standardisation document of the International Continence Society (ICS) in 2002 was the urodynamic term detrusor underactivity along with detrusor acontractility. The ICS definition provides a framework, considering the urodynamic abnormality of contraction and how this affects voiding; however, this is necessarily limited. DU is present in 9–48% of men and 12–45% of older women undergoing urodynamic evaluation for non-neurogenic LUTS. Multiple aetiologies are implicated, affecting myogenic function and neural control mechanisms, as well as the efferent and afferent innervations. Diagnostic criteria are based on urodynamic approximations relating to bladder contractility such as maximum flow rate and detrusor pressure at maximum flow. Other estimates rely on mathematical formulas to calculate isovolumetric contractility indexes or urodynamic “stop tests.” Most methods have major disadvantages or are as yet poorly validated. Contraction strength is only one aspect of bladder voiding function. The others are the speed and persistence of the contraction.ConclusionsThe term detrusor underactivity and its associated symptoms and signs remain surrounded by ambiguity and confusion with a lack of accepted terminology, definition, and diagnostic methods and criteria. There is a need to reach a consensus on these aspects to allow standardisation of the literature and the development of optimal management approaches.     

DETRUSOR INSTABILITY IN MEN: CORRELATION OF LOWER URINARY TRACT SYMPTOMS WITH URODYNAMIC FINDINGS

PURPOSE: We evaluated the correlation of lower urinary tract symptoms suggestive of detrusor instability with urodynamic findings in men. MATERIALS AND METHODS: Enrolled in our prospective study were 160 consecutive neurologically intact men referred for urodynamic evaluation of persistent lower urinary tract symptoms. All patients had storage symptoms suggestive of detrusor instability. Patients were further clinically categorized according to the chief complaint of urge incontinence, frequency and urgency, nocturia or difficult voiding. The clinical and urodynamic diagnosis in all patients as well as specific urodynamic characteristics of those with detrusor instability were analyzed according to the these 4 clinical categories. RESULTS: Mean patient age was 61 +/- 15 years. The chief complaint was urge incontinence in 28 cases (17%), frequency and urgency in 57 (36%), nocturia in 30 (19%) and difficult voiding in 45 (28%). Detrusor instability was diagnosed in 68 cases (43%). A higher incidence of detrusor instability was associated with urge incontinence than with the other clinical categories (75% versus 36%, p <0.01). Of the patients 109 (68%) had bladder outlet obstruction, including 50 (46%) with concomitant detrusor instability. The prevalence of bladder outlet obstruction was similar in all patients regardless of the chief complaint. All other urodynamic diagnoses were also similar in the 4 clinical categories. The mean bladder volume at which involuntary detrusor contractions occurred were lower in patients with urge incontinence and frequency and urgency than in those with nocturia and difficult voiding (277.1 +/- 149.4 and 267.7 +/- 221.7 versus 346.7 +/- 204.6 and 306.2 +/- 192.1 ml., respectively, not statistically significant, p = 0.07). CONCLUSIONS: Detrusor instability and bladder outlet obstruction are common in men with lower urinary tract symptoms. The symptom of urge incontinence strongly correlated with detrusor instability. Other lower urinary tract symptoms did not correlate well with any urodynamic findings. Therefore, we believe that an accurate urodynamic diagnosis may enable focused and more efficient management of lower urinary tract symptoms in men.     

Voiding dysfunction in a patient with adolescent adrenoleukodystrophy

The details are reported of bladder dysfunction in a Japanese boy with adrenoleukodystrophy. He developed gait disturbance at the age of 15 years. Spastic paraparesis progressed from the legs to the hands and brain magnetic resonance imaging showed characteristic degenerative change. Detrusor hyperreflexia was found by a urodynamic study and detrusor-sphincter dyssynergia was also suspected.     

Relationships between micturition urgency and involuntary voiding dynamics in men with urinary incontinence from idiopathic detrusor overactivity

PURPOSE: In men with urinary incontinence from idiopathic detrusor overactivity we determined whether bladder voiding dynamics differs between those with and without urgent micturition. MATERIALS AND METHODS: We retrospectively assessed urodynamic findings in 3 groups of 22 men each. Groups 1 and 2 had idiopathic detrusor overactivity with detrusor overactivity incontinence and with micturition urgency in group 1. Group 2 showed no urgency but felt a strong voiding desire just after the onset of involuntary micturition. Control group 3 included nonneurological unobstructed men undergoing urodynamic examination for mixed reasons who proved to be urodynamically normal. Patients with detrusor overactivity and controls were assessed by nonparametric statistics for significant differences in bladder voiding dynamics. RESULTS: Detrusor contraction strength proved to be increased in groups 1 and 2 with the highest levels in group 1. Detrusor contraction velocity had the highest levels in group 1 and it differed insignificantly in groups 2 and 3. Voiding contractions were equally well sustained in groups 1 and 3, and proved to be less well sustained in group 2. CONCLUSIONS: Detrusor overactivity involves enhanced detrusor contraction strength levels, particularly in patients who feel urgency. In urgency-free patients with detrusor overactivity detrusor contraction velocity differs insignificantly from that in controls and voiding detrusor contractions proved to be less well sustained than in controls and patients who experienced urgency. This suggests that detrusor contraction velocity may have a role in causing urgency and urgency may have a role in enhancing and sustaining involuntary voiding detrusor contractions in patients with detrusor overactivity.     

Correlation between motor function and lower urinary tract dysfunction in patients with infantile cerebral palsy

AIMS: The aim of this study was to evaluate urodynamic findings in patients with infantile cerebral palsy (CP) and to correlate the findings with impaired motor function. METHODS: We conducted a videourodynamic investigation on a highly select group of 29 patients (3-53 years). Motor function was assessed in each patient by the Gross Motor Function Classification System for CP (GMFCS). With this system, motor function is divided into five levels: patients in Level I have the most independent motor function and patients in Level V the least. The patients were divided into Group 1 (23 symptomatic patients with recurrent urinary tract infection or urinary incontinence) and Group 2 (6 asymptomatic patients). RESULTS: In Group 1, 21 patients (91%) had reduced compliance (0.6-16.4 ml/cmH(2)O) and 16 patients (70%) had increased DLPP (>40 cmH(2)O). Detrusor overactivity and pelvic floor overactivity were found in all 23 patients. In Group 2, two patients (33%) had reduced compliance (0.7 and 5.8 ml/cmH(2)O) and four (67%) had increased DLPP (>40 cm H(2)O). Detrusor overactivity and pelvic floor overactivity were observed in five patients (83%). Symptomatic patients showed higher GMFCS levels than asymptomatic patients. In the group of asymptomatic patients, there was no one classified as Levels IV or V, while there were no symptomatic patients classified as Level I. CONCLUSIONS: We conclude that urinary symptoms and pathological urodynamic findings increase along with the degree of motor function impairment shown by the GMFCS. Pathologic urodynamic findings can be found in both symptomatic and in asymptomatic patients.     

Upper and lower urinary tract evaluation of 104 patients with myelomeningocele without adequate urological management

To evaluate the upper and lower urinary tract and revise the urodynamic parameters on myelomeningocele patients without adequate urological management. 104 myelomeningocele patients without previous adequate urological management were assessed by clinical, urodynamic and imaging evaluation. The urodynamic.data were correlated with the status of the upper urinary tract (UUT). Thirty patients presented with vesico-ureteral reflux. Six patients presented signs of UUT damage without reflux. The cystometry showed detrusor overactivity (DO), poor compliance, increased bladder capacity and normal cystometry in 48, 49, 2 and 1% of the patients, respectively.Detrusor leak point pressure (DLPP) over 40 cm H₂O was associated with UUT damage. Patients with decrease on functional bladder capacity (FBC) ≤ 33% had more renal scars than their counterparts (P = 0.01). Overall, urological untreated myelomeningocele patients have 26% of kidney damage. DLPP ≥ 40cmH₂O and decrease in FBC ≤ 33% are associated with greater UUT damage. DO and poor compliance are predominant and pose similar risk of UUT damage.     

Correlation of the AUA symptom index with urodynamics in patients with suspected benign prostatic hyperplasia

The AUA symptom index is widely used to access patients with suspected benign prostatic hyperplasia (BPH). In order to determine how well symptoms as assessed by this index correlate with urodynamic findings, we evaluated 83 patients referred to our urology clinics with symptoms of BPH. All patients completed the AUA symptom index and then underwent a multichannel urodynamic evaluation. Patients were classified as obstructed, unobstructed, or equivocal according to the Abrams Griffiths nomogram. The AUA symptom index was recorded as the total score and, for purposes of symptom classification, further subdivided into an obstructive score (questions 3, 5, and 6) and an irritative score (questions 1, 2, 4, and 7). The mean age of the 83 patients was 67 (45–84). The mean total AUA symptom score was 16.6 (6–34), mean obstructive score was 6.1 (0–15), and the mean irritative score 10.4 (3–20). Pressure flow analysis using the Abrams-Griffiths nomogram classified 28 patients (34%) as obstructed, 17 (20%) as unobstructed, and 38 (46%) as equivocal. Using the analysis of variance procedure (ANOVA) there was no statistically significant difference in the mean total (P = 0.446), obstructive (P = 0.979), or irritative (P = 0.136) scores. Detrusor instability was present in 45 patients (54%). While total and obstructive scores were not significantly different in patients with detrusor instability vs. those with stable bladders, irritative scores were higher in patients with instability (P = 0.028) using the T-test procedure. Using ANOVA, the difference in post void residual (PVR) between the groups was not quite statistically significant (P = 0.057). The AUA symptom score does not appear to correlate with urodynamic obstruction. However, higher irritative symptom scores are associated with detrusor instability. It is likely that in many men with “BPH,” symptoms are not caused by outlet obstruction and may be related to changes in the aging bladder. © 1994 Wiley-Liss, Inc.     

Preliminary report: Detrusor hyperreflexia in schizophrenia

The object of this study was to demonstrate detrusor hyperreflexia (DH) in schizophrenic patients. Twelve consecutive schizophrenic patients were evaluated by DSM-IIIR diagnostic criteria and other standard psychiatric measures, urological history and examination, and urodynamic study All were referred for clinical indication, voiding dysfunction, or incontinence. Two patients were excluded for confounding variables, mental retardation and benign prostatic hypertrophy. Of the ten evaluable patients, four hud DH. Detrusor hyperreflexia does occur in a subset of schizophrenic patients, even in the absence of other recogni/ed disease to explain the occurrence. This relationship, previously unreported. warrants further investigation. © 1995 Wiley-Liss, Inc.     

The relationship of detrusor instability and symptoms with objective parameters used for diagnosing bladder outlet obstruction: a prospective study

PURPOSE: Detrusor instability is a common urodynamic finding in patients with prostatic obstruction. In prospective fashion we evaluated detrusor instability in patients with lower urinary tract symptoms attributable to benign prostatic hyperplasia and determined its possible association with the degree of obstruction. MATERIALS AND METHODS: A total of 459 men with a mean age plus or minus standard deviation of 60.4 +/- 9.4 years who were investigated for lower urinary tract symptoms at our facility answered an Arabic standardized version of International Prostate Symptom Score and underwent simple uroflowmetry, outpatient cystoscopy and transrectal ultrasound. Invasive urodynamics, including filling and voiding cystometry, was done with pressure flow analysis according to the Sch?fer nomogram. Statistical significance was tested by the Mann-Whitney U and Wilcoxon rank sum tests. RESULTS: Of the 459 patients 108 (23.5%) had detrusor instability. Instability significantly affected patient symptom score and conception of quality of life. Moreover, instability significantly affected the degree of obstruction, as measured by the maximum flow rate, post-void residual urine, prostate volume and Sch?fer grade of obstruction. CONCLUSIONS: Detrusor instability affects patient symptoms and quality of life. It also signifies a more severe degree of obstruction in male patients with lower urinary tract symptoms and bladder outlet obstruction due to benign prostatic hyperplasia.     

Urethral resistance factor (URA) versus Schäfer's obstruction grade and Abrams-Griffiths (AG) number in the diagnosis of obstructive benign prostatic hyperplasia

Different methods of analyzing pressure/flow plots to quantify bladder outlet resistance in men with lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) were developed in the past. The aims of this study were to quantify the degree of agreement between the diagnosis of obstruction by the different methods, and to compare the applicability of the different methods in the evaluation of bladder outflow conditions, in a large group of these men. In consecutive men with LUTS basic initial evaluations, recommended diagnostic tests, and urodynamic investigations were performed. From pressure/flow studies, the group-specific resistance factor (URA), Sch?fer's obstruction grade, and Abrams-Griffiths (AG) number were estimated. Men with 21 cm H(2)O < or = URA < or = 29 cm H(2)O and men with Sch?fer's grade equal 2 were classified as equivocal. In conformity with the provisional ICS definition, men with 20 < or = AG number < or = 40 were classified as equivocal. In 78% of the 565 included men Sch?fer's classification agreed with URA classification. In 82% ICS classification agreed with URA classification. Most agreement (94%) existed between Sch?fer's classification and ICS classification. All differences were near the points of intersection of the different boundaries, and a decision whether to perform surgery on a patient is not likely to be influenced by this disagreement. Males with relatively low detrusor pressure at maximum flow and relatively low maximum flow had a high prevalence among those in whom URA and Sch?fer's classifications and among those in whom URA and ICS classifications differed.     

Urethral instability and sacral nerve stimulation-a better parameter to predict efficacy?

PURPOSE: Urodynamic parameters that predict the outcome of sacral nerve stimulation are difficult to define. We studied the predictive value of urethral instability and other urodynamic parameters on the efficacy of sacral nerve stimulation. MATERIALS AND METHODS: Patients with refractory voiding disorders were implanted with a neurostimulator after responding with more than 50% improvement in main symptoms after percutaneous nerve evaluation. Filling cystometry was performed with 3 urethral sensors and 1 bladder sensor at baseline and 6 months after implantation. Urethral pressure variations more than 15 cm H(2)O were considered pathological and defined as urethral instability. Clinical efficacy was evaluated by voiding diary data and defined as successful when greater than 50% improvement was observed. RESULTS: A total of 19 female patients enrolled in the study. At baseline detrusor overactivity was observed in 9 patients, while 18 showed urethral instability. Sacral nerve stimulation therapy was successful in 13 patients (68%). The number of pads used per day and the severity of leakage decreased significantly. Of the 13 successfully treated patients 12 showed urethral instability at baseline. Detrusor overactivity was present in 4 successfully treated patients. Urethral instability disappeared in 7 of the 13 successfully treated patients and detrusor overactivity disappeared in only 1 of these patients. CONCLUSIONS: In this study urethral instability appeared to be a valuable urodynamic parameter for predicting the outcome of sacral nerve stimulation.     

老年女性糖尿病排尿异常患者尿动力学检查的意义

目的：探讨60岁以上女性排尿异常糖尿病患者的尿动力学变化特点及其临床意义.方法：回顾性分析57例老年女性排尿异常糖尿病患者（69.3±7.0）岁的尿动力学资料,同时选取40例排尿异常的非糖尿病患者（68.8±6.1）岁和20例正常老年女性作为对照组（68.3±4.2）岁.全部患者均行自由尿流率、压力-流率、静态尿道压力测定并比较各组间相关参数异同.结果：排尿异常的糖尿病患者38.6%（22/57）表现为逼尿肌活动低下,19.3%（11/57）逼尿肌过度活动、24.6%（14/57）膀胱出口梗阻和17.5%（10/57）尿动力学表现正常;糖尿病组与正常对照组相比,最大尿流率时逼尿肌压力、膀胱顺应性、最大膀胱容量、剩余尿量,最大尿流率等参数之间差异均有统计学意义（P〈0.05）;与非糖尿病排尿异常患者相比.糖尿病组最大膀胱容量显著增多（592.1±165.2）ml vs.（468.8±101.3）ml（P＜0.05）,其他各项尿动力学参数未见明显差异.结论：60岁以上女性糖尿病和非糖尿病排尿异常患者尿动力学表现异常同样多见,但是前者最大膀胱容量显著增多,提示膀胱敏感性降低.     

Efficacy of extended‐release tolterodine for the treatment of neurogenic detrusor overactivity and/or low‐compliance bladder

Objective: To evaluate the efficacy of extended‐release (ER) tolterodine 4 mg/day for the treatment of neurogenic detrusor overactivity (NDO) and/or low‐compliance bladder by assessing urodynamic parameters. Methods: Forty‐six patients (25 male, 21 female; mean age 57.6 ± 20.7 years) with NDO (n = 39) and/or low‐compliance bladder (n = 7) were included in this 12‐week single‐arm study. Twenty‐one patients (46%) were on clean intermittent catheterization and other patients could void on their own. A video urodynamic study was performed before and at 3 months after treatment. Changes in Overactive Bladder Symptom Score (OABSS), International Consultation on Incontinence Questionnaire–Short Form (ICIQ‐SF), and King's Health Questionnaire (KHQ) as well as changes in number of voids, amount of each void, and number of leaks in 24 h according to the 3‐day voiding diary were also evaluated before treatment and at weeks 4 and 12 after treatment. Results: Bladder capacity at first sensation and maximum cystometric capacity increased significantly, by an average of 36.8 mL (P = 0.0402) and 82.3 mL (P < 0.0001), respectively. Maximum cystometric capacity increased by more than 50 mL in 19 patients (49%) following treatment. Detrusor overactivity disappeared in three of 32 patients (9%), bladder capacity at first involuntary contraction increased significantly (P = 0.0009), and amplitude of detrusor overactivity decreased significantly (P = 0.0025). In patients with low‐compliance bladder, bladder compliance increased significantly (P = 0.0156). Overactive bladder symptom score, International Consultation on Incontinence Questionnaire–Short Form score, number of voids (per 24 h and night‐time), number of urgency episodes in 24 h, number and amount of leaks in 24 h, and amount of mean and maximum voided volumes all decreased significantly after treatment. Conclusion: Tolterodine is effective and well tolerated for the treatment of NDO and/or low‐compliance bladder in patients with neurogenic bladder.     

Is the bladder a reliable witness for predicting detrusor overactivity?

PURPOSE: We determined how well the symptoms of OAB syndrome correlate with urodynamic DO using International Continence Society definitions. MATERIALS AND METHODS: The study included adult males and females 18 years or older who attended a tertiary referral center for urodynamics from February 2002 to February 2004. Patients were selected based on OAB syndrome symptoms (urgency, urgency urinary incontinence and frequency). The percent of patients who had symptoms alone or in combination and DO was calculated. RESULTS: There was a better correlation in results between OAB symptoms and the urodynamic diagnosis of DO in men than in women. Of men 69% and 44% of women with urgency (OAB dry) had DO, while 90% of men and 58% of women with urgency and urgency urinary incontinence (OAB wet) had DO. Stress urinary incontinence seems to have accounted for the decreased rates in women since 87% of women with urgency urinary incontinence also had the symptom of stress urinary incontinence. The ICS definition does not specify what constitutes abnormal voiding frequency. Analysis of results showed that increasing voiding frequency did not have any effect on increasing the accuracy of diagnosis of DO except in women with 10 or more daytime micturition episodes. CONCLUSIONS: The bladder is a better and more reliable witness in men than in women with a greater correlation between OAB symptoms and urodynamic DO, more so in the OAB wet than in OAB dry patients.     

Changes in bladder function following a surgical alteration in outflow resistance

The changes in bladder function occurring after a surgical alteration in bladder outflow resistance were studied in 20 males undergoing transurethral prostatectomy (TURP) and in 20 females undergoing an endoscopic bladder neck suspension (EBNS). Serial cystometrograms (CMG) were performed before operation, and on alternate days after spontaneous micturition was re-established, for 5 days in the males and for 21 days in the females. CMGs were repeated at 3 months and 1 year after operation. After TURP voiding pressures (P_det) fell rapidly from a mean of 118 cm H₂O before operation to 57 cm H₂O at 5 days, with an increase in flow rate during this time from 10.5 ml/s to 24 ml/s. Detrusor instability that had been present in 14 patients resolved within 2 days in 12. There was no further significant urodynamic change over the 1-year study period. After EBNS, there was an early rise in voiding pressure (P_det rose from 26 cm H₂O before operation to 42 cm H₂O at 3 days). This continued to increase up to 21 days particularly in those patients with initial large residuals. Three patients developed detrusor instability. Flow rates were greatly reduced at first (27 ml/s before operation and 13 ml/s at 3 days), and gradually increased in line with voiding pressures, yet were still diminished 1 year after operation. The urodynamic changes following a reduction in bladder outflow resistance by TURP are immediate and sustained and unlikely to be the result of structural changes within the bladder wall. EBNS produces an increase in outflow resistance and it can be several weeks before balanced voiding is achieved, with significantly increased detrusor pressures needed to achieve complete bladder emptying at a reduced flow rate.     

Voiding dysfunction after radical retropubic prostatectomy: more than external urethral sphincter deficiency

OBJECTIVES: To analyse the relationship between RRP and urodynamic bladder dysfunction, and compare preoperative and postoperative functional status over long-term follow-up. Hypothesis on the pathophysiologic mechanism underlying urodynamic dysfunction has been reported. METHODS: PubMed databank search for original articles followed by review of urodynamic parameters: bladder filling sensation, detrusor overactivity, bladder compliance, cystometric bladder capacity, impaired detrusor contractility, bladder outlet obstruction, urinary incontinence. RESULTS: Detrusor dysfunction was rarely present as the sole diagnosis and was usually coupled with intrinsic sphincter deficiency. Data on bladder filling sensation, cystometric capacity, detrusor overactivity, impaired detrusor contractility, and bladder outlet obstruction were limited and contradictory. Detrusor overactivity was a de novo dysfunction in 2%-77% of patients. Impaired bladder compliance was present in 8%-39% of patients and was de novo in about 50%. Impaired detrusor contractility was found in 29%-61% of patients, was de novo in 47%, and recovered in about 50% of patients. The role of these dysfunctions as etiologic agents of urinary incontinence or voiding symptoms was unevenly assessed. CONCLUSIONS: Postoperative decentralization of the bladder, inflammation and/or infection, and geometric bladder wall alteration associated with preexisting hypoxemia with/without neuroplasticity have been posited as causes of detrusor dysfunction. Nevertheless, the lack of consistent preoperative urodynamic investigation makes it difficult to assess the operation's exact role in causing these dysfunctions. Thus, urodynamics performed, at least in selected cases, preoperatively and during follow-up could help arrive at a precise diagnosis of the underlying dysfunction, indicate the appropriate treatment, and prevent the incidence and onset of postoperative urinary incontinence.     

Pathophysiologie von Drang-, Belastungs- und Mischinkontinenz

According to the new ICS classification, urinary incontinence is subdivided by symptomatic, clinical, and urodynamic criteria. Understanding the pathophysiological interactions is important to find the correct diagnosis. Disturbances in bladder storage include urge incontinence due to neurogenic or non-neurogenic (idiopathic) detrusor hyperactivity as well as stress urinary incontinence caused by an insufficient urethral closure mechanism due to reduced pressure transmission (active-passive), hypotonic urethra, hyporeactivity of sphincter musculature, or involuntary relaxation of the urethra. Stress and urge incontinence can occur in combination and then be defined as mixed incontinence.     

Do female patients with predominant voiding symptoms really have objective voiding-phase dysfunction?

ObjectivesTo investigate whether female patients with predominant voiding symptom really have objective voiding phase dysfunction.MethodsFemale patients with lower urinary tract symptoms who underwent video-urodynamic study between January 2009 and December 2012 were recruited. All patients completed a 3-day frequency-volume chart. Symptom severity was evaluated using International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score (OABSS) and Urogenital Distress Inventory (UDI-6) questionnaires. The patients with IPSS-voiding subscores greater than IPSS-storage subscores and their most bother symptom are one of voiding symptom of IPSS were defined as subjective voiding dysfunction group (SVD group). The demographics, IPSS scores, OABSS scores, frequency-volume charts and urodynamic variables were compared between SVD and non-SVD groups.ResultsOf the 842 enrolled patients, 142 (16.9%) were classified into SVD group. Total IPSS and IPSS-voiding subscores of SVD group were significantly higher than those of non-SVD group. Conversely, IPSS-storage subscores, OABSS and UDI-6 scores of SVD group were significantly lower than those of non-SVD group. The prevalence of urodynamic voiding phase dysfunction was 64.7% in SVD group, which was significantly higher than those of non-SVD group (37.8%, p < 0.01). SVD group showed more prevalent bladder outlet obstruction (50.0% vs. 27.0%, p < 0.01). There were no significant differences in the prevalence of impaired detrusor contractility between SVD and non-SVD group. Detrusor overactivity was more prevalent in non-SVD group (5.6% vs. 18.6%, p < 0.01).ConclusionsEven though the female patients complain of predominant voiding symptoms, only two thirds of them were identified having urodynamic voiding phase dysfunction. On the other hand, in female patients whose predominant complaint are not voiding symptom, around one third of them were found to have urodynamic voiding phase dysfunction. This study clearly indicates that in females subjective low urinary tract symptoms are not necessarily reliable.     

自体骨髓干细胞移植治疗脊髓损伤神经源性膀胱疗效观察:1例脊髓损伤患者移植前后尿动力学指标变化

目的 探讨自体骨髓干细胞移植治疗脊髓损伤患者神经源性膀胱的效果.方法 脊髓损伤患者1例,于伤后13 d开始给予规律自体骨髓干细胞移植治疗,共9次,检测治疗前后尿动力学指标.结果 患者伤后26 d最大尿道压及尿道闭合压力明显升高,膀胱容量增大;伤后140 d时患者膀胱感觉恢复,可诱发出逼尿肌自主收缩,最大压力为30 cm...