[Urodynamic test with self reduction of the cystocele in the diagnosis of lower urinary tract obstruction].
OBJECTIVE
The association of cystocele and urodynamic lower urinary tract obstruction is frequent, occasionally not being possible to rule out intrinsic obstruction of bladder neck and urethra. With the aim to confirm the obstructive character of the cystocele we performed at test consisting in manual reduction of the cystocele by the patient herself, to check if by this simple manoeuvre the urodynamic parameters of obstruction disappear or diminish.


METHODS
24 patients consulting for sensation of vaginal bulge, with a mean age of 66 years, participated in the study. The initial diagnosis of lower urinary tract obstruction and cystocele was obtained after video-urodynamic tests. The urodynamic test with self reduction of the cystocele was based on cystomanometry and voiding pressure-flow tests. The parameters of the study included presence, amplitude and bladder capacity during detrusor involuntary contractions in the cystomanometry; in the voiding pressure/flow test the parameters of the study were the URA as a urethra resistance parameter, the type of obstruction with the Chess classification, and Wmax and W80-W20 as parameters of detrusor contractility.


RESULTS
A higher frequency of severe (58.3%) than moderate (41.6%) cystocele was demonstrated. No significant relation with age was demonstrated. The URA significantly diminished (p<0.01) with self reduction: from a median value of 30.5 before to 15.5 H2O cm after reduction. Although it was observed in all grades of cystocele, this reduction was greater in the severe ones. The most frequent type of obstruction was the constrictive (62.5%), over compressive (4.2%), mixed (12.5%) and unobstructed (4.2%). The constrictive obstruction significantly disappeared or diminished after reduction (p < 0.05) to a 45.8% of the cases, the compressive to 0%, the mixed to 4.2% and the nonobstructive to 50%. No significant relationship between these data and grade of cystocele was demonstrated. On the other hand, no significant differences were demonstrated with cystocele self reduction in the other urodynamic parameters (detrusor hyperactivity and contractility, Wmax and W80-W20), neither in their relationship with the grade of cystocele.


CONCLUSIONS
This test could be very useful in the diagnosis of lower urinary tract obstruction for its validity and significance, apart from being an easy to perform and reproducible test.
Salinas Casado
Jesús
J
Servicio de Urología, Hospital Clínico San Carlos, Universidad Complutense, Madrid, España. jsalinascasado@yahoo.es
Prieto Nogal
Sara
S
Virseda Chamorro
Miguel
M
Ramírez Fernández
Juan Carlos
JC
Moreno Sierra
Jesús
J
Silmi Moyano
Angel
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D052858:Cystocele / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D014524:Urethral Obstruction / Q000175:diagnosis*; D001748:Urinary Bladder Neck Obstruction / Q000175:diagnosis*; D014563:Urodynamics