Correlation of bladder base elevation with pelvic floor hypertonicity in women with lower urinary tract symptoms

Abstract

Aims: To determine whether the bladder base elevation as revealed by cystogram under fluoroscopy is associated with pelvic floor hypertonicity or bladder outlet obstruction (BOO) in women. Methods: Sixty-two women who were referred to our videourodynamic laboratory for assessment of lower urinary tract symptoms (LUTS) were included in this retrospective analysis. Thirty-one of these women with bladder base elevation - revealed by cystogram under fluoroscopy during videourodynamic study - served as the experimental group, and another group of 31 women without bladder base elevation served as control. None of the patients had neuropathy, previous pelvic surgery or chronic urinary retention. The clinical symptoms, urodynamic diagnosis, and parameters were compared between the two groups. Results: The mean voiding pressure (Pdet.Q max) and postvoid residual (PVR) were significantly greater, and maximum flow rate (Qmax) and voided volume were significantly lower in the bladder base elevation group. When a Pdet.Qmax of ≥35 cmH2O combined with a Qmax of ≤15 ml/sec in pressure flow study was used to diagnose BOO, significantly more patients in the bladder base elevation group had BOO than controls (51.6% vs. 9.7%, P = 0.0003). Pelvic floor muscle electromyogram (EMG) was dyscoordinated during the voiding phase in 18 (58.1%) and 9 (29%) of the patients with and without bladder base elevation, respectively (P = 0.0212). Conclusion: Women with LUTS and bladder base elevation revealed in the filling phase of videourodynamic study had significantly higher voiding pressure and incidence of dyscoordinated pelvic floor EMG activities during voiding, suggesting a higher incidence of BOO and pelvic floor hypertonicity. © 2007 Wiley-Liss, Inc.