NEUROUROLOGY & FEMALE UROLOGY

Parameters of Bladder Function in Pre-, Peri-, and Postmenopausal Continent Women without Detrusor Overactivity
Pfisterer MH, Griffiths DJ, Rosenberg L, Schaefer W, Resnick NM
Bethanien-Krankenhaus-Geriatrisches Zentrum-Kontinenzberatungsstelle, Heidelberg, Germany
Neurourol Urodyn. 2007; 26: 356-61

• Aims: To determine normative data for lower urinary tract function in asymptomatic continent women without detrusor overactivity (DO) across the age span.
• Methods: Healthy female volunteers aged > or =20 years were recruited from the community. Comprehensive assessment included bladder diary, physical examination, uroflowmetry, and video-urodynamics. Continent women without history of frequent urgency and without DO were selected. Data on bladder storage, voiding and urethral sphincter function, urine output and frequency are presented for pre-, peri-, and postmenopausal women.
• Results: Twenty-four asymptomatic women (mean age 50.2 years, range 22-80 years) met the inclusion criteria, including 7 pre- (29.2 years), 7 peri- (48.8 years), and 10 postmenopausal (66.0 years) women. For all subjects, maximum single voided volume in bladder diary was 500 ml and maximum cystometric capacity was 580 ml (median values). Strong desire to void (SDV) was reported at 287, 366, and 425 ml for pre-, peri-, and postmenopausal groups, respectively. The maximum flow rate was 25, 32, and 23 ml/sec in uroflowmetry and 23, 24, and 18 ml/sec in pressure-flow study, respectively. Median post-void residual volume (PVR) was below 20 ml in all groups. At maximum flow rate subjects voided with detrusor pressures of 29, 26, and 24 cm H(2)O, respectively. Maximum urethral closure pressure was 94, 74, and 42 cm H(2)O, respectively.
• Conclusions: We provide normative data on bladder function in asymptomatic, continent, pre-, peri-, and postmenopausal women without DO.
  
  
• Editorial Comment
  As stated by the authors “this is the first comprehensive evaluation of voiding storage and urethral sphincter function in carefully selected asymptomatic continent, pre-, peri-, and post-menopausal women without DO”. A well-written manuscript that deserves to be included in one’s file of reference articles. Of note is that the rigid criteria used combined with the prevalence of detrusor overactivity and urodynamic/voiding abnormalities yielded a very small study population distilled from a much larger population of volunteers: of the 396 women that initially responded and were interviewed over the telephone only 24 patients met the selection criteria and in addition only 3 of these were over the age of 73 years of age. This finding solidly raises the question of what really is normal with regards to bladder function and voiding habits as opposed to what is physiologic perfection.

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