Bladder outlet obstruction is associated with bladder oversensitivity in women
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ORIGINAL ARTICLE
Bladder outlet obstruction is associated with bladder oversensitivity in women Guy Verhovsky 1
&
Yishai Hode Rappaport 1 & Ilia Baberashvili 2 & Amos Neheman 1 & Amnon Zisman 1 & Kobi Stav 1
Received: 12 July 2020 / Accepted: 2 October 2020 # The International Urogynecological Association 2020
Abstract Introduction and hypothesis Bladder outlet obstruction (BOO) in women might be associated with significant lower urinary tract storage symptoms such as increased frequency, urgency, and incontinence. This prospective study was designed to assess whether there is an objective association between BOO and abnormal parameters during filling cystometry in women. Methods A total of 169 consecutive women (mean age 56 ± 14 years) who were referred for urodynamic investigation were prospectively recruited. Comprehensive medical, obstetric, and gynecological histories were recorded. All patients underwent physical examination, renal and bladder ultrasound, and filled out the International Prostate Symptoms Score (IPSS) questionnaire. The cohort was divided into obstructed and un-obstructed groups based on pressure flow results (Obstruction: Qmax 25 cmH2O). Result There was no significant difference in the frequency of detrusor overactivity between the obstructed and nonobstructed group (37% vs 32%, p = 0.71). All bladder sensation volumes were significantly lower in obstructed women than non-obstructed women in univariate and multivariate logistic regression analyses. Of the sensation parameters, first desire to void (FDV) had the highest area under the curve (AUC = 0.75, 95% CI = 0.672–0.837, p < 0.001) for predicting BOO. FDV < 105 ml showed a strong association with BOO with OR = 9.84 (95% CI 4.122–23.508, p < 0.0001). On univariate and multivariate analyses adjusted to 50 cc reduction in sensation volume, all sensation parameters, were associated with bladder outlet obstruction. Conclusion Our results suggest that there might be a strong association between bladder oversensitivity and BOO in women. This may shed light on the pathophysiological connection between obstruction and enhanced afferent signaling from the bladder. Keywords Bladder outlet obstruction . Urodynamics . Bladder oversensitivity . Women . Overactive bladder
Introduction Up to 30% of women with lower urinary tract symptoms (LUTS) have bladder outlet obstruction in urodynamic investigation [1].
* Guy Verhovsky [email protected] 1
Department of Urology, Shamir Medical Center (Assaf Harofeh Campus), Zerifin, Affiliated to the Sackler School of Medicine, Tel Aviv University, 7030000 Tel Aviv, Israel
2
Department of Nephrology, Shamir Medical Center (Assaf Harofeh Campus), Zerifin, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
The main etiologies for BOO in women are previous antiincontinence surgery, pelvic organ prolapse, urethral stricture or narrowing and primary bladder neck obstruction [2]. Published series demonstrated that between 20% and 57% of women with BOO present with voiding
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