The Clinical Significance Of Urodynamics Clissification In The Management Of Female Idiopathic Overactive Bladder

Objective（s）:This paper introduces a new urodynamic classification method of female idiopathic overactive bladder（OAB）,and discusses its clinical significance and value in diagnosis and treatment.Methods:In this prospective cohort study,female patients who attended the urology clinic of the Second Affiliated Hospital of Kunming Medical University from2020 to 2022 and were clearly diagnosed with idiopathic OAB were collected and divided into urodynamic Clissification treatment group（experimental group）and empirical treatment group（control group）according to whether the treatment was guided by urodynamic Clissification or not,and the patients’subjective symptoms,quality of life and satisfaction after treatment were compared between the two groups,in which diagnostic and urodynamic-related operations were performed by the same group of urologists.Baseline data and Urodynamic studies（UDS）results were collected,and patients in the experimental group were classified into four types according to their UDS results:Type I:UDS with Bladder hypersensitive（BHS）,without low bladder compliance,detrusor overactivity（DO）and bladder outlet obstruction（BOO）;Type Ⅱ:UDS presents with low bladder compliance without DO and BOO;Type Ⅲ:UDS presents with detrusor overactivity（DO）without BOO.;Type Ⅳ:UDS manifested as bladder outlet obstruction（BOO）.In the experimental group,the physicians treated type I patients with antimuscarinics,β₃-adrenoceptor agonist,or bladder perfusion according to their UDS findings;type Ⅱ patients with antimuscarinics,β₃-adrenoceptor agonist;type Ⅲ patients with antimuscarinics,β₃-adrenoceptor agonist;and type Ⅳ patients withα-adrenoceptor antagonists or transurethral bladder neck incision.The control group was treated with antimuscarinics,β₃-adrenoceptor agonist orα-adrenoceptor antagonists according to the physician’s experience and the patient’s symptoms.Patients were followed up after3 months of treatment with the Overactive Bladder Symptom Score（OABSS）,the American Urological Association symptom score（AUASS）,the Quality of life score（QOL）and the Patient global impression of improvement scale（PGI-I）.The study data were statistically analyzed and processed using SPSS26.0 statistical software.The statistical data were expressed as percentages（%）and the chi-square test was used for comparison between groups;the measures that conformed to normal distribution were expressed as Mean±SD and the t-test for two independent samples was used for comparison between groups;the measures that did not conform to normal distribution were expressed as M（P25,P75）and the nonparametric rank sum test was used for comparison between groups.Results:A total of 70 patients who met the inclusion and exclusion criteria were collected in this study,of which 7 were excluded due to incomplete clinical data and missed visits,and a total of 63 patients were finally included in the study.A total of 33patients（52.4%）were included in the experimental group,including 12 patients（36.4%）with type I,10 patients（30.30%）with type Ⅱ,3 patients（9.10%）with type Ⅲ,and 8 patients（24.20%）with type Ⅳ;a total of 30 patients（47.6%）were included in the control group.The follow-up period was 3 months.The difference in OABSS before and after treatment in the experimental group[5.00（4.00,7.00）points]was significantly higher than the difference in OABSS before and after treatment in the control group[2.00（1.00,3.00）points],and the difference in AUASS before and after treatment in the experimental group[9.00（7.50,15.50）points]was significantly higher than the difference in AUASS before and after treatment in the control group[（4.87±3.27）points],and the difference in QOL before and after treatment in the control group[2.00（1.00,2.25）points]was significantly lower than the difference in QOL before and after treatment in the experimental group[（3.73±1.28）points],and the differences were statistically significant（P<0.001）.The number of patients who were satisfied with the efficacy after treatment was 30（91.00%）and 11（37.00%）in the two groups,respectively,and the difference was statistically significant（P<0.001）.The effect of whether the patients were guided by urodynamic Clissification on their post-treatment symptom relief was statistically significant（P<0.001）.Conclusion（s）:Our study confirmed that compared with empirical treatment,targeted treatment based on the urodynamic classification proposed in this study can make OAB patients obtain better treatment effect,indicating that the urodynamic classification proposed in this study has certain clinical practical value and is worth further study.