Voiding dysfunction in young,nulliparous women: symptoms and urodynamic findings

The objective was to determine urodynamic findings in young, premenopausal, nulliparous women with bothersome lower urinary tract symptoms and assess whether or not symptoms are predictive of specific urodynamic abnormalities. The records of 57 women were reviewed. Those with neurological disease or a primary complaint of stress incontinence were excluded. All completed the American Urological Association Symptom Index (AUASI) and underwent videourodynamics. Symptoms were compared in patients with and without bladder dysfunction and/or voiding phase dysfunction. Bladder dysfunction was diagnosed in 86% of patients with urge incontinence vs. 17% of those without (p<0.0001). Patients with voiding phase dysfunction had higher total and voiding AUASI scores. Occult neurological disease was later diagnosed in 4 women (24%) with urge incontinence and bladder dysfunction. Urge incontinence and voiding symptoms are frequently associated with urodynamically demonstrable abnormalities. Urge incontinence and bladder dysfunction may be a sign of occult neurological disease in this population. The presenting symptoms are useful in determining the utility of urodynamics in this population.Editorial Comment: Voiding dysfunction in young women tends to be an incompletely described phenomenon. This patient cadre is often treated presumptively, and as we see from this study, incorrectly. The clinical tendency for minimalist evaluation represents a disservice to these individuals as accruing data supports the use of urodynamics as an intrinsic component in the evaluation of these women. Obviously, data on pressure / flow dynamics would provide further insight into subtle pelvic floor and sphincteric dysfunctions manifested in this group. The authors are to be commended for this opus