Urodynamic study clinically useful in young men with LUTS

By Joanna Lyford, Senior medwireNews Reporter

Urodynamic studies are useful for aiding diagnosis and treatment decisions in young men with chronic lower urinary tract symptoms (LUTS) but without symptoms suggestive of chronic prostatitis, Korean researchers say.

Their review found that urodynamic parameters discriminated between the various manifestations of voiding phase dysfunction – primary bladder neck dysfunction (PBND), dysfunctional voiding (DV) and detrusor underactivity/acontractile detrusor (DU/AD) – and those of storage phase dysfunction – detrusor overactivity (DO), small bladder capacity (SC) and reduced bladder sensation (RBS).

“Because clinical symptoms are not useful for predicting the specific urodynamic etiology of LUTS in this population, urodynamic investigation can help to make an accurate diagnosis and, potentially, to guide appropriate treatment”, write Sang Eun Lee (Seoul National University, Seongnam, South Korea) and co-authors in the Korean Journal of Urology.

The study was a medical chart review of 308 men aged 18 to 50 years (mean age 40.4 years) who had experienced LUTS for a mean duration of 38.8 months. None had symptoms suggestive of prostatitis; 80.2% had storage symptoms, 53.9% had voiding symptoms and 41.9% had postmicturitional symptoms.

Results of urodynamic investigation revealed voiding phase dysfunction in 62.1% of the cohort, storage phase dysfunction in 36.4% and were normal in 25.6%.

Of the voiding phase disorders, PBND was present in 26.0%, DV in 23.4% and DU/AD in 12.7%. Of the storage disorders, DO was present in 22.7%, SC in 26.9% and RBS in 5.8%.

Clinical urinary symptoms did not differ significantly among the diagnostic groups, the researchers note. Many men were found to have multiple abnormalities on urodynamic investigation: 53.9% of those with voiding phase dysfunction had concomitant storage dysfunction, while 69.6% of those with storage dysfunction also had a voiding dysfunction.

The researchers remark that chronic LUTS in young men are not uncommon yet have received little scientific attention, and proper diagnosis and management can be challenging.

“Chronic LUTS among young men have a variety of underlying etiologies”, they write.

The team concludes: “Urodynamic investigation in this population is helpful in making an accurate diagnosis and may guide adequate treatment, because clinical symptoms are not useful in predicting a specific urodynamic etiology.”

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