Urological Science

EDITORIAL COMMENT
Year
: 2021  |  Volume : 32  |  Issue : 3  |  Page : 102--103

“True gold fears no fire” – High-quality videourodynamic studies make possible precision diagnosis of lower urinary tract symptoms in women


Eric Chieh-Lung Chou 
 Department of Urology, China Medical University Hospital; School of Medicine, China Medical University, Taichung, Taiwan

Correspondence Address:
Eric Chieh-Lung Chou
Department of Urology, China Medical University Hospital, No. 2, Yude Rd, North Dist, Taichung 404
Taiwan




How to cite this article:
Chou EC. “True gold fears no fire” – High-quality videourodynamic studies make possible precision diagnosis of lower urinary tract symptoms in women.Urol Sci 2021;32:102-103


How to cite this URL:
Chou EC. “True gold fears no fire” – High-quality videourodynamic studies make possible precision diagnosis of lower urinary tract symptoms in women. Urol Sci [serial online] 2021 [cited 2023 Feb 5 ];32:102-103
Available from: https://www.e-urol-sci.com/text.asp?2021/32/3/102/326929


Full Text



Lower urinary tract symptoms (LUTSs) are highly prevalent in women,[1],[2] and they can manifest as storage- or voiding-predominant symptoms. The study by Heidler et al. showed that LUTSs were reported by 80 out of 223 women (35.9%) (mean age 50.3 years; range 21–79 years) at baseline, and the proportion of women reporting LUTS had increased to 47.1% at the end of the 6.5-year longitudinal study.[3] Clinical presentation of female LUTS often can be diverse and concurrent, making correct diagnosis a great challenge for urologists. An urodynamic test is regarded as “the gold standard” in assessing urinary symptoms; likewise, a detailed videourodynamic study (VUDS) is the most important diagnostic tool for LUTS in women.

In recent years, precision medicine has become a trending topic and has applications ranging from diagnosis to treatment. Because urinary bladder is possibly the only visceral smooth-muscle organ under voluntary control of the cerebral cortex, the outcome of urodynamic studies could be affected by patients' consciousness as well as external factors surrounding the testing environment. Therefore, only, a carefully conducted and properly controlled urodynamic session can provide correct information. This article provides a wealth of information about the application of VUDS in the diagnosis and treatment of LUTS in women.

Interstitial cystitis/painful bladder syndrome (IC/PBS) is a clinical diagnosis based on a cluster of symptoms, including urinary frequency, urgency, and bladder pain. There is currently no consensus on the diagnosis of IC with urodynamic study. The authors mentioned that “it is essential to instill 30 mL of potassium chloride (KCl) of 0.4 M concentration to check for the absence of bladder outlet obstruction (BOO) and the presence of IC/BPS.” The American Urological Association IC treatment guidelines state that urodynamics should be considered as an aid to diagnosis only for complex cases of IC. These tests are not necessary for making diagnosis in uncomplicated cases. Even though “the KCl test has a sensitivity of 85.5% and a specificity of 81.6% in diagnosing IC/BPS,” KCl test should only be performed when necessary for diagnosis. Patients should be informed beforehand that these tests can be painful and uncomfortable.

Intrinsic sphincter deficiency (ISD) and overactive bladder often occur simultaneously in patients. This is due to urine leakage into the proximal urethra, stimulating the urethral mucosa, eliciting the urethrovesical stimulating reflex, and ultimately leading to detrusor contraction.[4] ISD is a pathological condition that is diagnosed by using urodynamics to measure the Valsalva leak point pressure and the maximal urethral closure pressure. However, “ISD” and “urethral hypermobility” are often mixed in women with stress urinary incontinence (SUI) in the current concept. Regardless of the type of SUI, as long as urine leakage into the proximal urethra may induce detrusor overactivity.

Dysfunctional voiding is another common cause of LUTS in women. These patients tend to have the symptoms of frequent urination, difficulty urinating, and larger PVR volume. The clinical manifestations are similar to those of neurogenic bladder, but physical and neurological examinations are normal. VUDS can provide evidence for the diagnosis of dysfunctional voiding. However, before arriving at the diagnosis of dysfunctional voiding, it is important that cystourethroscopy and MRI be performed to rule out urethral stricture or urethral diverticulum, respectively.

Female LUTSs are common and have complex etiology. Urodynamic studies are valuable for precision diagnosis. Sound urodynamics, accompanied by skilled interpretation from experienced urologists, can make the potential of this diagnostic examination fully realized.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Nørby B, Nordling J, Mortensen S. Lower urinary tract symptoms in the Danish population: A population-based study of symptom prevalence, health-care seeking behavior and prevalence of treatment in elderly males and females. Eur Urol 2005;47:817-23.
2Boyle P, Robertson C, Mazzetta C, Keech M, Hobbs FD, Fourcade R, et al. The prevalence of lower urinary tract symptoms in men and women in four centres. The UrEpik study. BJU Int 2003;92:409-14.
3Heidler S, Deveza C, Temml C, Ponholzer A, Marszalek M, Berger I, et al. The natural history of lower urinary tract symptoms in females: Analysis of a health screening project. Eur Urol 2007;52:1744-50.
4Shafik A, Shafik IA, El Sibai O, Shafik AA. Effect of urethral stimulation on vesical contractile activity. Am J Med Sci 2007;334:240-3.