Urodynamic Study Of Female Voiding Dysfunction

Objective: The aim of this study was to explore the advantages and disadvantages of non-invasive uroflowmetry in the diagnosis of female urinary dysfunction(FVD),and test the applicability of the Blaivas-Groutz nomogram for diagnosing female bladder outlet obstruction(FBOO)from patients with dysuria in the outpatient department of urology.Methods: 55 women with complaints of dysuria were diagnosed as FVD or No-FVD according to the Qmax/Qave-Liverpool nomogram(Qmax: maximum flow rate in free uroflow studies,Qave: average flow rate in free uroflow studies),respectively.Then,the diagnosis results were compared by the age and urodynamic parameters.Besides,these patients were classified through the Blaivas-Groutz nomogram,then we analyzed the patients' age and urodynamic parameters among the FBOO and also unobstructed(No-FBOO).Finally,we studied the distribution of the patients with detrusor underactivity(DU,diagnostic criteria: detrusor pressure at maximum flow rate(Pdet.Qmax)<20cm H2 O,the maximum value of watts factor(WFmax)<5W/m2)on the Blaivas-Groutz diagram and its characteristics.Results: 36 cases(65.45%)of the 55 patients were diagnosed as FVD through the Qmax-liverpool nomogram,19 cases(34.55%)as No-FVD.The age,maximum cystometric capacity(MCC),Pdet.Qmax,maximum urethral closure pressure(Pura.clos.max)and obstruction coefficient(OCO)of the FVD patients showed no difference from the No-FVD patients.The proportion of patients with postvoid residual urine volume(PVR)?50ml,urethral resistance factor(URA)and Abrams-Griffiths number/bladder outlet obstruction index(AG number/BOOI)of FVD patients were significantly higher than those of No-FVD patients(P<0.05;P<0.05;P<0.001).While the maximum flow rate in free uroflow studies(Free Qmax),detrusor contraction coefficient(DECO),WFmax and the ratio of time to maximum flow to flow time(TQmax/FT ratio)were significantly lower than those of No-FVD patients(P<0.0001;P<0.0001;P<0.001;P<0.01).33 cases(60%)of the 55 patients were diagnosed as FVD through the Qave-liverpool nomogram,22 cases(40%)as No-FVD.The age,PVR,MCC,Pdet.Qmax,Pura.clos.max,URA,AG number/BOOI,WFmax and OCO of the FVD patients showed no difference from those of the No-FVD patients,while the Free Qmax?DECO and TQmax/FT ratio were significantly lower than No-FVD patients(P<0.01;P<0.05;P<0.01).2 cases were excluded for didn't get complete urodynamic study data,after that 53 patients were classified according to the Blaivas-Groutz nomogram.16 patients(30.19%)were classified as No-FBOO,37 patients(69.81%)as FBOO,including 31 patients(58.49%)as mildly,5 patients(9.43%)as moderately and 1 patient(1.89%)as severely obstructed.The age,PVR,MCC,Pura.clos.max,DECO and WFmax of the FBOO patients showed no difference from those of the No-FBOO patients.The Free Qmax and TQmax/FT ratio of the FBOO patients were significantly lower than those of the No-FBOO patients(P < 0.0001;P < 0.01),and the Pdet.Qmax,URA,AG/BOOI number and OCO were significantly higher than those of the No-FBOO patients(P<0.01;P<0.01;P<0.001;P<0.01).Besides,with the increase of the obstruction degree,the PVR mean,Pdet.Qmax,URA,AG /BOOI number and OCO increased synchronously.13 patients(24.53%)were diagnosed as DU,and they all distributed in the lower left corner of the Blaivas-Groutz nomogram,among which 6 cases were classified as unobstruction,7 cases as mildly obstruction.Conclusion: The Qmax/Qave-Liverpool nomogram has certain advantages in the diagnosis of FVD,for these nomograms were established on the basis of non-invasive uroflowmetry and its easy to perform,but it cannot further identify DU and BOO.Compared with the Qave-Liverpool nomogram,the Qmax-Liverpool nomogram has more advantages in the diagnosis of FVD.The Blaivas-Groutz nomogram plays a certain role in the diagnosis of FBOO,but it cannot identify DU.Moreover,it's still necessary for female patients who were diagnosed as No-BOO or mild BOO by the Blaivas-Groutz nomogram to undergo a pressure-flow studies to find whether they are suffering from the DU.TQmax/FT ratio has potential value in diagnosing FVD,but it needs further verification.