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Effect of videourodynamic subtypes on treatment outcomes of female dysfunctional voiding

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Abstract

Introduction and hypothesis

Dysfunctional voiding (DV) is not uncommon in women and is typically challenging to treat. This study retrospectively investigated the long-term treatment outcomes of DV women with different videourodynamics (VUDS) characteristics.

Methods

Data of women with VUDS-proven DV (n = 302) were retrospectively analyzed. All patients at first received biofeedback pelvic floor muscle training and medications; urethral sphincter botulinum toxin A injection was administered after treatment failure. Long-term follow-up outcomes were graded by global response assessment (GRA) and objective responses of decrease of detrusor pressure (Pdet), increase in maximum flow rate (Qmax) and voiding efficiency (VE). The treatment outcomes were investigated among different VUDS subgroups.

Results

Of 302 women, 165 (54.6%) had mid-urethral DV, 117 (38.7%) had distal urethral DV, and 20 (6.6%) had both bladder neck dysfunction (BND) and mid-urethral DV. A total of 170 (56.3%) patients were available for follow-up VUDS after treatment. Pdet was decreased in all three subgroups, but increase in Qmax and VE was only noted in the BND plus DV subgroup. Overall, 120 (70.6%) patients showed improvement (GRA ≥ 1), including 14 with BND plus DV (93.3%), 50 with mid-urethral DV (60.8%) and 56 with distal urethral DV (77.8%) (p = 0.044). All three subgroups showed significant reduction in bladder outlet obstruction index after treatment, with BND plus DV subgroup showing the greatest reduction.

Conclusions

Women with DV have different VUDS characteristics resulting from different pathophysiological mechanisms and treatment results. The VUDS characteristics may help predict treatment outcomes of female DV.

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Data availability statement

Data are available on request from the corresponding author.

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Funding

This study was supported by the Buddhist Tzu Chi Medical Foundation, grant no. TCMF-MP 110-03-01.

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Authors and Affiliations

  1. Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Tzu Chi University, 707, Section 3, Chung-Yang Road, Hualien, Taiwan

    Cheng-Ling Lee, Sheng-Fu Chen, Yuan-Hong Jiang & Hann-Chorng Kuo

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  1. Cheng-Ling Lee
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  2. Sheng-Fu Chen
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  3. Yuan-Hong Jiang
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  4. Hann-Chorng Kuo
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Contributions

CL Lee: methodology, investigation, data collection, manuscript writing

SF Chen: investigation, data collection

YH Jiang: investigation, data collection

HC Kuo: Conceptualization, investigation, data collection, review and editing

Corresponding author

Correspondence to Hann-Chorng Kuo.

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Lee, CL., Chen, SF., Jiang, YH. et al. Effect of videourodynamic subtypes on treatment outcomes of female dysfunctional voiding. Int Urogynecol J 33, 1283–1291 (2022). https://doi.org/10.1007/s00192-022-05154-0

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  • DOI: https://doi.org/10.1007/s00192-022-05154-0

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