NEUROUROLOGY & FEMALE UROLOGY

Correlation of Bladder Base Elevation with Pelvic Floor Hypertonicity in Women with Lower Urinary Tract Symptoms
Chuang FC, Kuo HC.
Department of Obstetrics and Gynecology, Yu-Li Veteran Hospital, and Tzu Chi University, Hualien, Taiwan.
Neurourol Urodyn. 2007;26:502-6

• 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. Qmax) 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 >or=35 cm H₂O combined with a Qmax of <or=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. Copyright (c) 2007 Wiley-Liss, Inc.
  
  
• Editorial Comment
  The authors in this study highlight another potential advantage of radiographic imaging of the bladder during the evaluation of urinary incontinence. They noted that female patients with lower urinary tract symptoms and fluoroscopic bladder base elevation would exhibit higher voiding pressures and abnormal pelvic floor EMG activity. Though this study population did not have any additional radiographic imaging of the pelvis to preclude a mass effect causing the elevation of the bladder base, it was noted that the bladder base did descend during the voiding phase in all patients except for those who had evidence of bladder outlet obstruction. It would be of interest to see if patients who have iatrogenic induced bladder base elevation on radiographic imaging from surgical repair of the anterior compartment will have the same degree of voiding dysfunction as noted by these patients. The value of fluoroscopy in the evaluation of female lower urinary tract symptoms has already been highlighted in the literature (1).

Reference
1. Akikwala TV, Fleischman N, Nitti VW. Comparison of diagnostic criteria for female bladder outlet obstruction. Journal of Urology. 2006; 176: 2093-7.

Dr. Steven P. Petrou
Associate Professor of Urology
Chief of Surgery, St. Luke’s Hospital
Associate Dean, Mayo School of Graduate Medical Education
Jacksonville, Florida, USA
E-mail: petrou.steven@mayo.edu