International Neurourology Journal

  • 제22권4호
  • /
  • Pages.268-274
  • /
  • 2018
  • /
  • 2093-4777(pISSN)
  • /
  • 2093-6931(eISSN)
대한배뇨장애요실금학회 (Korean Continence Society)
권호 표지
DOI QR코드

DOI QR Code

Urethral Pressure Measurement as a Tool for the Urodynamic Diagnosis of Detrusor Sphincter Dyssynergia

  • Corona, Lauren E. (Department of Urology, The University of Michigan) ;
  • Cameron, Anne P. (Department of Urology, The University of Michigan) ;
  • Clemens, J. Quentin (Department of Urology, The University of Michigan) ;
  • Qin, Yongmei (Department of Urology, The University of Michigan) ;
  • Stoffel, John T. (Department of Urology, The University of Michigan)
  • 투고 : 2018.07.26
  • 심사 : 2018.10.11
  • 발행 : 2018.12.31
⟨ 이전 논문 다음 논문 ⟩

초록

Purpose: To describe a technique for urodynamic diagnosis of detrusor sphincter dyssynergia (DSD) using urethral pressure measurements and examine potential associations between urethral pressure and bladder physiology among patients with DSD. Methods: Multiple sclerosis (MS) and spinal cord injured (SCI) patients with known DSD diagnosed on videourodynamics (via electromyography or voiding cystourethrography) were retrospectively identified. Data from SCI and MS patients with detrusor overactivity (DO) without DSD were abstracted as control group. Urodynamics tracings were reviewed and urethral pressure DSD was defined based on comparison of DSD and control groups. Results: Seventy-two patients with DSD were identified. Sixty-two (86%) had >20 cm $H_2O$ urethral pressure amplitude during detrusor contraction. By comparison, 5 of 23 (22%) of control group had amplitude of >20 cm $H_2O$ during episode of DO. Mean duration of urethral pressure DSD episode was 66 seconds (range, 10-500 seconds) and mean urethral pressure amplitude was 73 cm $H_2O$ (range, 1-256 cm $H_2O$). Longer (>30 seconds) DSD episodes were significantly associated with male sex (81% vs. 50%, P=0.013) and higher bladder capacity (389 mL vs. 219 mL, P=0.0004). Urethral pressure amplitude measurements during DSD were not associated with significant urodynamic variables or neurologic pathology. Conclusions: Urethral pressure amplitude of >20 cm $H_2O$ during detrusor contraction occurred in 86% of patients with known DSD. Longer DSD episodes were associated with larger bladder capacity. Further studies exploring the relationship between urethral pressure measurements and bladder physiology could phenotype DSD as a measurable variable rather than a categorical observation.

키워드

참고문헌

  1. Blaivas JG, Sinha HP, Zayed AA, Labib KB. Detrusor-external sphincter dyssynergia: a detailed electromyographic study. J Urol 1981;125:545-8. https://doi.org/10.1016/S0022-5347(17)55100-9
  2. Weld KJ, Graney MJ, Dmochowski RR. Clinical significance of detrusor sphincter dyssynergia type in patients with post-traumatic spinal cord injury. Urology 2000;56:565-8. https://doi.org/10.1016/S0090-4295(00)00761-5
  3. De EJ, Patel CY, Tharian B, Westney OL, Graves DE, Hairston JC. Diagnostic discordance of electromyography (EMG) versus voiding cystourethrogram (VCUG) for detrusor-external sphincter dyssynergy (DESD). Neurourol Urodyn 2005;24:616-21. https://doi.org/10.1002/nau.20191
  4. Bacsu CD, Chan L, Tse V. Diagnosing detrusor sphincter dyssynergia in the neurological patient. BJU Int 2012;109 Suppl 3:31-4. https://doi.org/10.1111/j.1464-410X.2012.11042.x
  5. Spettel S, Kalorin C, De E. Combined diagnostic modalities improve detection of detrusor external sphincter dyssynergia. ISRN Obstet Gynecol 2011;2011:323421.
  6. Lose G, Griffiths D, Hosker G, Kulseng-Hanssen S, Perucchini D, Schafer W, et al. Standardisation of urethral pressure measurement: report from the Standardisation Sub-Committee of the International Continence Society. Neurourol Urodyn 2002;21:258-60. https://doi.org/10.1002/nau.10051
  7. Yalla SV, Yap W, Fam BA. Detrusor urethral sphincter dyssynergia: micturitional vesicourethral pressure profile patterns. J Urol 1982;128:969-73. https://doi.org/10.1016/S0022-5347(17)53305-4
  8. Suzuki Bellucci CH, Wollner J, Gregorini F, Birnbock D, Kozomara M, Mehnert U, et al. External urethral sphincter pressure measurement: an accurate method for the diagnosis of detrusor external sphincter dyssynergia? PLoS One 2012;7:e37996. https://doi.org/10.1371/journal.pone.0037996
  9. Schafer W, Abrams P, Liao L, Mattiasson A, Pesce F, Spangberg A, et al. Good urodynamic practices: uroflowmetry, filling cystometry, and pressure-flow studies. Neurourol Urodyn 2002;21:261-74. https://doi.org/10.1002/nau.10066
  10. Weld KJ, Dmochowski RR. Effect of bladder management on urological complications in spinal cord injured patients. J Urol 2000;163:768-72. https://doi.org/10.1016/S0022-5347(05)67800-7
  11. Brown M, Wickham JE. The urethral pressure profile. Br J Urol 1969;41:211-7. https://doi.org/10.1111/j.1464-410X.1969.tb09925.x
  12. Griffiths D. The pressure within a collapsed tube, with special reference to urethral pressure. Phys Med Biol 1985;30:951-63. https://doi.org/10.1088/0031-9155/30/9/007
  13. Sakakibara R, Hattori T, Uchiyama T, Yamanishi T, Ito H, Ito K. Neurogenic failures of the external urethral sphincter closure and relaxation; a videourodynamic study. Auton Neurosci 2001;86:208-15. https://doi.org/10.1016/S1566-0702(00)00258-7

피인용 문헌

  1. Pitfalls in Urodynamics vol.6, pp.5, 2020, https://doi.org/10.1016/j.euf.2020.01.005