[Non-coordinated voiding syndrome: classification and urodynamic characterization]

Abstract

Objectives: To determine the urodynamic characteristics of uncoordinated voiding.

Methods: Fifty consecutive patients with a diagnosis of uncoordinated voiding were studied; 82% were females and 18% were males; mean age 11.9 years (range 5 to 34 yrs). All patients had a complete urodynamic study including patient history, neurological evaluation, uroflowmetry, cystometry and detrusor pressure/voiding flow. The perineal electromyographic (EMG) activity was recorded throughout the study using surface electrodes. To rule out neurogenic detrusor-sphincter dyssynergy, periurethral sphincter EMG using concentric nail-electrodes was performed in selected cases (20% of the patients). Based on our urodynamic findings, three subtypes of uncoordinated voiding can be distinguished: Type A: micturition is achieved through detrusor involuntary contraction. Type B: micturition is achieved through detrusor voluntary contraction. Type C: micturition is achieved through abdominal straining.

Results/conclusions: The most important urodynamic findings in uncoordinated voiding, independently of Q max, were the absence of relaxation and increased perineal EMG activity during uroflowmetry. The detrusor pressure/voiding flow test was essential in the classification of uncoordinated voiding. In our series, 58% of the patients were type A, 28% type B and 14% type C.