Therapeutic effects of transurethral incision of the bladder neck on primary bladder neck dysfunction refractory to alpha-adrenergic blockade in men

SummaryBackgroundDysfunctional voiding is an abnormality of bladder emptying in neurologically normal individuals where the external sphincter activity increases during voiding, and it is difficult to diagnose by symptoms alone. Videourodynamic study could provide great help in differentiating dysfunctional voiding and other voiding disorder. In this retrospective study, we analyze the videourodynamic parameters of the patients with dysfunctional voiding.PurposeTo investigate the clinical presentations and videourodynamic characteristics of adult women with dysfunctional voiding (DV).MethodsA total of 1605 women with lower urinary tract symptoms (LUTS) were investigated with videourodynamic (VUD) studies from 1997 to 2010. The clinical urinary symptoms and VUD characteristics of DV were compared with a group of urodynamically normal controls. Antimuscarinic or alpha-blocker treatment, with or without a skeletal muscle relaxant according to the chief complaint was given.ResultsThere were 168 women diagnosed with DV. Detrusor overactivity (DO) occurred in 69% of women with DV. Patients with DV had significantly lower cystometric bladder capacity, higher detrusor pressure, lower maximum flow rate, and larger post-void residual volume than the controls. A total of 114 (67.9%) patients had storage symptoms and 54 (32.1%) had voiding symptoms as their chief complaints among those with DV. Among them, urinary frequency (n = 69, 41.1%) was the most common chief complaint, followed by dysuria (n = 54, 32.1%), and urgency incontinence (n = 26, 15.5%). The incidence of urgency incontinence and dysuria were significantly greater than that in the control group, however, the incidence of frequency, urgency, or nocturia showed no significant difference between DV and control groups. Recurrent UTI was a common adverse event, and happened in 20 patients (12%) with DV. The medication, alpha-blocker or antimuscarinic agent, was prescribed to the patients with DV according to their symptoms. The success rates were 41.2% (n = 47) for antimuscarinic therapy and 51.9% (n = 28) for alpha-blocker therapy in patients with storage and voiding LUTS, respectively (p = 0.366).ConclusionDO and storage LUTS commonly occurred in women with DV, suggesting DO could be one of the etiology in the pathophysiology of DV. VUD studies yielded a high diagnostic rate for DV in women with LUTS.