title: Voiding dynamics in women with stress urinary incontinence and high-stage cystocele.
abstract: OBJECTIVE
  The aim of this study was to identify the urodynamic features of women with stress urinary incontinence (SUI) or with high-stage (stage 3 or greater) cystocele (HSC) as compared with symptom-free women.
  
  
  METHODS
  Fifty-six neurologically intact women with SUI and 47 women with HSC but without SUI were prospectively evaluated. All patients underwent full urodynamics, in addition to basic clinical evaluations. The urodynamic parameters of SUI and HSC were compared to the ones obtained from 78 urologically symptom-free normal women over the same period.
  
  
  RESULTS
  Patients with HSC, after correction of cystocele using a temporary vaginal pessary, had consistently lower maximum urinary flow rate with a lower detrusor pressure during micturition than the controls or those with SUI. On the other hand, patients with SUI had an equivalent to higher maximum urinary flow rate, normal detrusor contraction strength with a lower detrusor pressure during micturition than the controls. Both maximum Watts factor and bladder contractility index were significantly lower in the whole HSC cohort in comparison to the controls and patients with SUI. The urodynamic characteristics observed among the three groups were all maintained even after adjusting for age.
  
  
  CONCLUSIONS
  Women with SUI demonstrate voiding with low-pressure, normal contraction strength with an equivalent to high urinary flow rate. Women with HSC demonstrate voiding with low pressures with weak contraction strengths and low urinary flow rates, suggesting a higher prevalence of detrusor underactivity. Chronically decreased or increased urethral resistance might alter voiding dynamics and performance.
authors.affiliation: Department of Urology, Graduate School of Medical Sciences, Kyushu University Hospital, Fukuoka, Japan. narihito@uro.med.kyushu-u.ac.jp
authors.forename: Narihito
authors.initials: N
authors.lastname: Seki
authors.forename: Nouval
authors.initials: N
authors.lastname: Shahab
authors.forename: Ritsuko
authors.initials: R
authors.lastname: Hara
authors.forename: Mineo
authors.initials: M
authors.lastname: Takei
authors.forename: Akito
authors.initials: A
authors.lastname: Yamaguchi
authors.forename: Seiji
authors.initials: S
authors.lastname: Naito
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D052858:Cystocele / Q000150:complications* / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009119:Muscle Contraction / Q000502:physiology; D011312:Pressure; D014521:Urethra / Q000502:physiology; D014550:Urinary Incontinence, Stress / Q000209:etiology* / Q000503:physiopathology*; D014554:Urination / Q000502:physiology*; D055815:Young Adult