Urodynamic Analysis of the Functional Voiding Disorders in Young Adult

Sung, Deuk Jae; Kim, Je Jong; Lee, Jeong Gu

Abstract

Functional voiding disorder is characterized by symptoms referable to the genitourinary organs without organic obstruction or neurovesical dysfunction. In an attempt to understand possible mechanisms of symptoms of functional voiding disorder in young male adult, we retrospectively reviewed the urodynamic findings of 51 men with functional voiding disorder between the ages of 19 and 51 (mean 40.7 years). Presenting symptoms are divided into three groups: 1) Sx. of irritation(irritation group) in 17 patients; 2) Sx. of bladder outlet obstruction(BOO group) in 25 patients; 3) Sx. of bladder outlet obstruction with episodes of overdistention (overdistention group) in 9 patients. On filling cystometry, time of first filling sense and urge sense was delayed significantly in overdistention group and involuntary contraction was found in 5 patients with BOO(20%), in 3 patients with irritation(18%), and in 1 patients with episodes of overdistention. In overdistention group, maximal voiding detrusor pressure was significantly lower and amount of postvoiding residual urine was significantly larger than other two group on pressure/flow study. Total voiding time and time to maximal uroflow rate were delayed significantly in BOO and overdistention group. Pseudo detrusor-sphincter-dyssynergia was found in 3 patients among 25 patients with BOO. Therefore, we were able to find correlations between specific symptomatic group and urodynamic parameters by this result. Results of urodynamic assessment were divided into 5 categories: Impaired detrusor contractility(IDC), detrusor instability(DI), obstruction, sensory urge syndrome, and equivocal studies. DI was found in 20% of patients with irritation or BOO. IDC was found in 80% of patients with episodes of overdistention and in 24% of patients with BOO. Thorough care is necessary in determining the treatment modality, and in follow up evaluation for patients showing IDC, DI or obstruction on urodynamic study. Conclusively, urodynamic study is thought to afford the opportunity in identifying these specific voiding disorder.