Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 166542

AbstractMaterial and MethodsResultsDiscussionConclusionReferencesDOI and Others
Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : June | Volume : 16 | Issue : 6 | Page : PC09 - PC12 Full Version

Association between Urodynamic and Cystoscopic findings in Women with Bothersome Lower Urinary Tract Symptoms: A Prospective Observational Study


Published: June 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/55091.16518
Sunirmal Choudhury, Kasim Atar, Dilip Kumar Pal

1. Associate Professor, Department of Urology, IPGMER and SSKM Hospital, Kolkata, West Bengal, India. 2. Post Doctorate Trainee, Department of Urology, IPGMER and SSKM Hospital, Kolkata, West Bengal, India. 3. Head, Department of Urology, IPGMER and SSKM Hospital, Kolkata, West Bengal, India.

Correspondence Address :
Dr. Dilip Kumar Pal,
Head, Department of Urology, IPGMER and SSKM Hospital, Kolkata, West Bengal, India.
E-mail: urologyipgmer@gmail.com

Abstract

Introduction: Lower Urinary Tract Symptoms (LUTS) are responsible for negative impact on quality of life of women. Urodynamic Study (UDS) is gold standard objective investigation in evaluating bothersome LUTS. Cystoscopy is important where UDS is difficult or unavailable. Despite vital role and unique properties of UDS and cystoscopy, the role of UDS and cystoscopy in the assessment of bothersome LUTS in young females continues to be heavily debatable subject as there is limited study in this age group.

Aim: To evaluate causes of LUTS in young female patients and associate them with urodynamic and cystoscopic findings.

Materials and Methods: This was a prospective observational study conducted in IPGMER and SSKM Hospital, Kolkata, West Bengal, India, from July 2019 to December 2020. A total of 100 female patients from adulthood to menopause were evaluated having decreased quality of life due to LUTS called bothersome LUTS in the form of history taking, clinical examination, basic biochemical tests, ultrasonography followed by urodynamic and cystoscopic examination. Patients were classified according to their LUTS into three groups: storage dysfunction, urinary incontinence and bladder emptying dysfunction. Association of UDS parameters like Idiopathic Detrusor Overactivity (IDO), IDO with detrusor underactivity, Compensated Bladder Outlet Obstruction (CBOO) was made with cystoscopic findings like dilated veins with cystitis, lax urethra, bladder trabeculations, diverticula, urethral stricture. Results were analysed using Microsoft Excel spreadsheet and International Business Machines (IBM) Statistical Package for the Social Sciences (SPSS) version 27.0.

Results: In storage dysfunction group, frequency with nocturia (53.3%) and in urinary incontinence group, stress urinary incontinence (58.3%) was predominant bothersome symptom. In storage dysfunction group 73.3% patients had IDO and 26.7% patients had normal UDS findings. In these patients on cystoscopic examination, 83.3% patients had dilated veins with cystitis changes. In urinary incontinence group 70.8% patients had IDO and 29.2% patients had IDO with detrusor underactivity on UDS examination. In these patients cystoscopic examination 54.2% had lax urethra with cystitis changes. In bladder emptying dysfunction group on UDS examination, all patients had CBOO and 75% had urethral stricture on cystoscopy.

Conclusion: Significant association exists between UDS and cystoscopic findings on evaluation of LUTS in young females patients. Storage dysfunction symptoms were the most common in young age group followed by urinary incontinence symptoms. Bladder emptying dysfunction symptoms were least common.

Keywords

Adulthood, Bladder emptying dysfunction, Menopause, Quality of life, Storage symptoms, Urinary incontinence

The LUTS are major cause of decreased quality of life in female population (1),(2). Women constitute a large population who undergoes UDS for LUTS (2),(3),(4). UDS is gold standard objective investigation in evaluating bothersome LUTS (5). Cystoscopy is important where UDS is difficult or unavailable due to logistic economic reasons for diagnosing LUTS. Cystoscopy however, provides visual assessment of the urethra and bladder. It gives an insight into the cause of the LUTS, the structural deterioration of the bladder wall provide us with an idea of degree of bladder outlet obstruction (6). It is imperative to diagnose the bothersome LUTS in the early stages and provide with the necessary therapy to prevent bladder decompensation and hence prevent subsequent complications (6),(7). There are no literature available which have measured bothersome LUTS prevalence in young females in the general population and association with these symptoms with UDS and cystoscopy. So, present study has estimated bothersome LUTS in specific age group of female patients and associate these symptoms with UDS and cystoscopic examination.

Material and Methods

This was a prospective observational study conducted in a tertiary care hospital, IPGME&R and SSKM Hospital, Kolkata, India, from July 2019 to December 2020. Ethical permission for the study was obtained from Institution Ethical Committee with memo no. IPGME&R/IEC/2020/278. All the patients with bothersome LUTS who came during the study period formed the sample population.

Inclusion criteria: All female patients between adulthood to menopause who came with LUTS and decreased quality of life due to that symptoms were included during the study period in outpatient department of urology.

Exclusion criteria: Patients with less than 18 yrs of age and after menopause, patients having diabetes mellitus, neurological disorders and malignancies located in bladder or cervix, patients on drugs such as antipsychotics, antidepressants, anticonvulsants, anticholinergics, alfa-adrenergic agonists or those who were not ambulatory have been excluded from the study.

Study Procedure

In present study, authors have strictly followed recommendations given by International Continence Society (ICS) for performing UDS (3). American Urological Association (AUA) symptom index was taken as reference guide for evaluation of symptoms during initial assessment and follow-up (6). The symptoms and the clinical findings of the patients were recorded along with a focused neurological, abdominal, local, gynaecological and digital rectal examinations. Patients with bothersome LUTS were divided into three groups as storage dysfunction symptoms group (n=60), urinary incontinence symptoms group (n=24) and bladder emptying dysfunction symptoms group (n=16). Radiological investigations were done as required. This was followed by a detailed UDS and cystoscopic examination. Before UDS, the patients were confirmed to have a sterile urine culture. The non invasive uroflow measurement was done and repeated twice and the best free flow pattern was analysed. Multichannel urodynamics was performed next according to the recommendations of the ICS after obtaining proper informed consent. As per UDS findings, BOO can be classified into three groups, (a) Early (Qmax of >15 mL/s and Pdet Qmax of <30 cm H2 O); (b) Compensated (Qmax of >15 mL/s and Pdet Qmax of >30 cm H2 O); (c) Late (Qmax of <15 mL/s and Pdet Qmax of >30 cm H2 O) (7). After that cystoscopy was done under local anaesthesia in sterile urine culture with proper informed consent in dorsal lithotomy position by 21 French cystoscopic sheath. Details of cystoscopic findings noted like urethral stenosis, urethral mucosa, urethral length, bladder mucosa, bladder diverticula, trabeculations, bladder capacity, bladder neck, foreign body in bladder (7). Bothersome LUTS are to those patients who had LUTS with decreased quality of life (8).

STATISTICAL ANALYSIS

Descriptive statistics was performed as means, standard deviations and ranges using Microsoft excel. For categorical variables percentage were used. IBM SPSS-Software version 27.0 and Chi-square test was used for statistical analysis. The values of p<0.05 will be considered statistically significant.

Results

A total 148 patients who fulfilled inclusion criteria were initially selected between adulthood to menopause for this study. Out of these 148 patients, 48 patients were lost to follow-up, so finally this study result was obtained in total 100 patients. Mean age of study population (total 100 patients) was 34.7 years (SD±9.7). Majority (70%) of these patients belonged to mean age 39.47 years (SD±4.3) and rest 30% patients were belonged to mean age 31.6 years (SD±4.8). Bothersome LUTS were categorised into three main groups. On analysis of those symptoms it was found that storage dysfunction symptoms (60%) was the most common symptom group followed by urinary incontinence symptoms group (24%). Bladder emptying dysfunction symptoms group (16%) was least common.

In storge dysfunction symptoms group, out of 60 patients, 32 (53.3%) patients had frequency with nocturia, 18 (30% patients had frequency with urgency, 10 (16.7%) patients had frequency with urgency with nocturia. In incontinence group out of 24 patients, 14 (58.3%) patients had stress urinary incontinence as a predominant symptom, 7 (29.2%) patients had mixed urinary incontinence followed by 3 (12.5%) patients had urge urinary incontinence. Bladder emptying dysfunction symptom like sense of incomplete voiding with poor stream comprises 16 (16%) out of total 100 patients.

The UDS findings in incontinence symptoms group showed, 17 (70.8%) patients had IDO and 7 (29.2%) patients had idiopathic detrusor overactivity with detrusor under activity (Late BOO) (Table/Fig 1).

Cystoscopic examination in groups found that in storge dysfunction group, 3 (5.0%) patients had bladder granulations. In incontinence group, 7 (29.2%) patients had cystitis with urethral diverticula, 13 (54.1%) patients had lax urethra with cystitis changes. In bladder emptying dysfunction symptoms group, 12 (75.0%) patients had multiple bladder diverticula with trabeculations with urethral stricture, 3 (18.8%) patients had periurethral mass impinging in urethral lumen and 1 (6.2%) patients had ureterocele with bladder trabeculations as shown in (Table/Fig 2).

No significant association of UDS with cystoscopic findings in storage dysfunction group was found (p-value=0.2248). On association of urodynamic and cystoscopic examination in incontinence group a significant association (p-value=0.0324) was found. In bladder emptying dysfunction group in UDS all patients 16 (100%) had CBOO and on cystoscopy of these patients 12 (75.0%) patients had multiple bladder diverticula with trabeculations with urethral stricture, 3 (18.8%) patients had periurethral mass impinging in urethral lumen and 1 (6.2%) patient had ureterocele with bladder trabeculation. These findings not only showed significant association between UDS examination and cystoscopy but also detected actual cause of bladder emptying dysfunction symptoms (p-value=0.0001) (Table/Fig 3).

Discussion

The LUTS term was introduced in 1994 to describe patient’s symptoms without describing the cause of the symptoms (1),(2). LUTS have a negative impact on a patient’s quality of life from social, physical and psychological aspects, in addition to the high impact on health costs (2). In women, the prevalence of LUTS and urinary incontinence were reported to be upto 50% in some studies (3). Stress urinary incontinence represent ~50% of urinary incontinence cases, urge urinary incontinence accounts for almost 10%, while mixed urinary incontinence represents almost 40% (3),(4). The role of ageing clearly appears from the increasing of complaint of urgency and occurrence of both detrusor overactivity and detrusor hypocontractility in the older age group of patients.

In a large European population-based survey of LUTS (EPIC study), 66% of women reported atleast one LUTS, with nocturia being the most common at 54.5%, followed by urinary incontinence (13.1%) and urgency (12.8%), with an overall prevalence of 11.8% having overactive bladder syndrome (5). There are large number of females among Indians between adulthood to menopause who presents with genitourinary symptoms. The symptoms are predominantly that of storage dysfunction symptoms, urinary incontinence and bladder emptying dysfunction symptoms. Women with disorders affecting the bladder outlet, such as dysfunctional voiding, large anterior vaginal wall prolapse, and detrusor external sphincter dyssynergia have nearly identical storage symptom scores as women with LUTS that are secondary to other causes, such as detrusor overactivity (6),(7). Cystoscopy precisely diagnose the bladder wall pathology causing storage dysfunction symptoms (9).

Adulthood age by definition defined as age at beginning of 20 yrs (10). Mean age of menopause is 59.3 years (11). In present study population patients were between adulthood to menopause with mean age was 34.7 yrs and most of the patients belonging to the 4th decade of life. Population-based, randomised, cross-sectional study recruited by Timur-Tas¸han S et al., showed that 766 women aged 20 years and older from the province of Malatya, Turkey had incidence of urgency, urinary incontinence, nocturia, and frequency symptoms was 36.1%, 32.4%, 27.1%, and 22.8%, respectively (12). Another study done by van Breda HM et al., on hidden prevalence of LUTS in healthy nulligravid young women showed that LUTS were found in 67.3% of the women. In those out of 67.3% women, urgency was found in 14.5%, hesitancy was found in 14.5%, nocturia was found in 18.2% and urinary incontinence (UI) was found in 20.1% women. In a presumably healthy population of young nulligravid women the prevalence of LUTS and UI was high, but with relatively low bother (13). Limitations of these two studies are that they have not mentioned about bothersome LUTS and symptoms were not correlated with UDS and cystoscopic examination. As compared to above studies, in our study, a significant number (60%) of patients presented with bothersome symptoms predominantly of storage dysfunction symptoms. The most common symptoms were frequency with nocturia (53.3%), followed by frequency with urgency (30%) followed by frequency with urgency with nocturia (16.7%). On UDS examination of these storage dysfunction symptoms patients 73.33% patients have IDO and on cystoscopy of these patients 83.33% patients have dilated veins in bladder wall with cystitis changes. The role of urodynamic study in incontinence patients is valuable (14). Women with complaints of urinary incontinence, especially those for whom surgery is contemplated, should undergo complete urodynamic evaluation when it is available (15). Cystourethroscopy can facilitate important anatomic and functional assessments of the lower urinary tract that can lead to diagnosis of abnormality in urethra and bladder while cystoscopy and vaginoscopy can be used to determine the site, size, number, and location of genitourinary fistula relative to the ureteric orifices. In present study, 24 patients had urinary incontinence out of which 58.3% patients had stress urinary incontinence followed by 29.2% patients had mixed urinary incontinence and 12.5% patients had urge urinary incontinence. In UDS examination of all these patients, 70.8% patients had IDO detected and 29.2% patients had IDO with underactivity (Late BOO) and on cystoscopy 54.2% patients had lax urethra with cystitis changes in bladder followed by 29.2% patients with urethral diverticula, 12.5% patients with vesicovaginal fistula and 4.2% patients with cystitis with urethritis only. UDS and cystoscopic findings precisely diagnosed the cause of incontinence which helped in management plan.

In men, the quantitative evaluation of the voiding function is done by a pressure flow analysis of the micturition cycle. The maximum flow rate (Qmax) and detrusor pressure at maximum flow rate (PdetQmax) are the two urodynamic parameters that are used in various nomograms for the diagnosis of BOO (16). In females, however, due to normal voiding pressure being significantly lower, these nomograms may not be applicable. In females, the voiding LUTS were classified into three stages of urodynamic BOO (17). In large retrospective reviews of women referred for evaluation of LUTS, 2.7-8% had urodynamic evidence of BOO (18). However, in present study, patients between adulthood to menopause 16% were categorised as clinically obstructed in which UDS examination of these patients showed all had CBOO and on cystoscopy of these patients all had multiple bladder trabeculations and nearly 75% patients had urethral stricture. In these patients urodynamic and cystoscopic findings consistently associate with their findings. Urethral stricture is generally not seen on vaginal palpation, but conditions like urethral caruncle, uterine prolapse and carcinoma should be obvious (19).

Cystoscopy should be used as a first-line investigation to diagnose LUTS among young female patients with bothersome LUTS, especially where UDS is a difficult option because of logistic reasons. As discussed in the results, the cystoscopic findings in these patients associate well with the UDS findings. There was a definite positive association between the UDS and cystoscopic in storage symptom group and bladder emptying dysfunction group. Patients with bothersome LUTS between adulthood to menopause needs good history, physical examination along with UDS followed by cystoscopic examination for proper evaluation of patients which helps in appropriate diagnosis and management.

Limitation(s)

Limitations of this study was patients before menarche and after menopause were not considered. Patients were considered only having bothersome symptoms. Study population could be increased beyond 100 patients. This study was done only in single centre tertiary care hospital. In future, we need to be much more specific about each symptom and associate the UDS and cystoscopic finding for that symptom.

Conclusion

Major bothersome LUTS in patients between adulthood to menopause were storage symptoms followed by incontinence followed by bladder emptying dysfunction symptoms. Storage and bladder emptying dysfunction symptoms associate well with urodynamic and cystoscopic findings. UDS followed by cystoscopic examination of these patients not only helped in identifying the actual cause of bothersome LUTS but also revealed the proper diagnosis which further helped in formatting definitive treatment plan of these patients.

References

1.
Agarwal A, Eryuzlu LN, Cartwright R, Thorlund K, Tammela TL, Guyatt GH, et al. What is the most bothersome lower urinary tract symptom? Individual- and population-level perspectives for both men and women. Eur Urol. 2014;65(6):1211-17. [crossref] [PubMed]
2.
Homma Y, Yoshida M, Yamanishi T, Gotoh M. Core Lower Urinary Tract Symptom score (CLSS) questionnaire: A reliable tool in the overall assessment of lower urinary tract symptoms. Int J Urol. 2008;15(9):816-20. [crossref] [PubMed]
3.
Gordon D, Groutz A. Evaluation of female lower urinary tract symptoms: Overview and update. Curr Opin Obstet. Gynecol. 2001;13:521-27. [crossref] [PubMed]
4.
Abrams P, Blaivas JG, Stanton SL, Anderson JT. The standardizationof terminology of lower urinary tract function recommended by the international continence society. Neurourol Urodyn. 1988;7:403 26. [crossref]
5.
Blaivas JG, Groutz A. Bladder outlet obstruction nomogram for women with lower urinary tract symptomatology. Neurourol Urodyn. 2000;19(5):553-64. 3.0.CO;2-B>[crossref]
6.
Choudhury S, DAS SK, Jana D, Pal DK. Is cystourethroscopy alone enough to diagnose bladder outlet obstruction in postmenopausal female patients? A comparative analysis with urodynamic and radiological evaluation. Sch J App Med Sci. 2017;5:3680-86.
7.
Groutz A, Blaivas JG, Fait G, Sassone AM, Chaikin DC, Gordon D. The significance of the American Urological Association symptom index score in the evaluation of women with bladder outlet obstruction. J Urol. 2000;163(1):207-11. [crossref]
8.
Bertaccini A, Vassallo F, Martino F, Luzzi L, Rossetti SR, Di Silverio F, et al. Symptoms, bothersomeness and quality of life in patients with LUTS suggestive of BPH. European Urology. 2001;40(Suppl. 1):13-18. [crossref] [PubMed]
9.
Acar Ö, Tarcan T. Cystoscopic evaluation and clinical phenotyping in interstitial cystitis/bladder pain syndrome. J Turk Ger Gynecol Assoc. 2019;20(2):117. [crossref] [PubMed]
10.
Arnett JJ. Emerging adulthood: A theory of development from the late teens through the twenties. American Psychologist. 2000;55(5):469. [crossref] [PubMed]
11.
Ostergard DR, McCarthy TA. Anatomy of female urinary tract. Am J Obstet Gynaecol. 1980;137:401 03. [crossref]
12.
Timur-Tas¸ han S, Beji NK, Aslan E, Yalçin Ö. Determining lower urinary tract symptoms and associated risk factors in young women. Int J Gynaecol Obstet. 2012;118(1):27-30. [crossref] [PubMed]
13.
van Breda HM, Bosch JL, de Kort LM. Hidden prevalence of lower urinary tract symptoms in healthy nulligravid young women. Int Urogynecol J. 2015;26(11):1637-43. [crossref] [PubMed]
14.
Summitt Jr RL, Stovall TG, Bent AE, Ostergard DR. Urinary incontinence: Correlation of history and brief office evaluation with multichannel urodynamic testing. Am J Obstet Gynecol. 1992;166(6):1835-44. [crossref]
15.
Andreoni C, Bruschini H, Truzzi JC, Simonetti R, Srougi M. Combined vaginoscopy- cystoscopy: A novel simultaneous approach improving vesicovaginal fistula evaluation. J Urol. 2003;170(6):2330-32. [crossref] [PubMed]
16.
Griffiths D, Hofner K, van Mastrigt R, Rollema HJ, Spangberg A, Glaeson D. Standardization of terminology of lower urinary tract function: Pressure-flow studies of voiding, urethral resistance, and urethral obstruction. Neurourol Urodyn. 1997;16(1):01-18. 3.0.CO;2-I>[crossref]
17.
Elmissiry MM, Ali AG, Ali GA. Different urodynamic patterns in female bladder outlet obstruction: Can urodynamics alone reach the diagnosis? Arab J Urol. 2013;11(2):127-30. [crossref] [PubMed]
18.
Chassagne S, Bernier PA, Haab F, Roehrborn CG, Reisch JS, Zimmern PE. Proposed cutoff values to define bladder outlet obstruction in women. Urology. 1998;51(3):408-11. [crossref]
19.
Massey JA. Obstructed voiding in the female. Br J Urol. 1988;61:36-39. [crossref] [PubMed]

DOI and Others

DOI: 10.7860/JCDR/2022/55091.16518

Date of Submission: Jan 20, 2022
Date of Peer Review: Feb 24, 2022
Date of Acceptance: Apr 25, 2022
Date of Publishing: Jun 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Jan 21, 2022
• Manual Googling: Apr 23, 2022
• iThenticate Software: May 03, 2022 (21%)

ETYMOLOGY: Author Origin

JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • Embase
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)
  • www.omnimedicalsearch.com