Can Female Voiding Dysfunction be Predicted Using a Questionnaire?.

Abstract

Introduction: Individual symptoms of female voiding dysfunction (VD) has low predictability and often necessitates invasive urodynamic studies. This has led to the development of non-invasive tools such as the validated International Prostate Symptoms Score (IPSS) to assess the severity of benign prostatic hyperplasia in men. Whether this or a modified version of it can be used to assess VD in women has yet to be assessed. Objective(s): To elucidate symptoms and/or clinical factors that could predict objective VD in women. Method(s): This is a retrospective analysis of 1083 women who underwent urodynamic assessment and completed a modified IPSS questionnaire (wIPSS) (Figure 1) between 2012 and 2022. A detailed general, obstetric and urogynaecological history, and Pelvic Organ Prolapse Quantification (POP-Q) examination was included in the assessment. A history of diabetes or neurological disease were considered as significant medical history. Objective VD was defined as a maximum flow rate <10th centile on the Liverpool nomogram. Associations of parameters with objective VD were assessed by standard bivariate tests. Additionally, a CART analysis was conducted to compare the predictive value of the IPPS score and the additional items in the modified version for objective VD. Result(s): Median age of the total sample of 1083 women was 63 years (IQR 51-72) with 70.5% of women being post-menopausal. The median body mass index (BMI) was 27.3kg/m2 (IQR 23.7-31.2) and median parity 2 (IQR 2-3). Previous history of hysterectomy, POP surgery or anti-incontinence surgery was reported in 31.8%, 20% and 10.7% respectively. At time of review, the median POP-Q for Ba was -2 (IQR -3 to 0), C -6 (IQR -6 to -4) and Bp -2 (-3 to -1). Objective voiding dysfunction, as defined by Qmax <10th centile, was present in 30.9% (n=325/1051) and the median wIPSS was 13 (IQR 9-18). Objective voiding dysfunction was found to be significantly associated with age, menopausal status, previous hysterectomy, previous POP surgery, current degree of anterior/apical prolapse, having a significant medical history, as well as with the wIPSS score; hesitancy, quality of life (QoL) and force of stream (FOS) (Table 1). CART analysis revealed that force of stream and hesitancy were the strongest predictors for objective VD. The two extreme groups identified with these two variables were women with a FOS > 80 (n=224) with an observed VD prevalence of 15.6%. Women with a FOS up to 50 (n=138) and with hesitancy more than rarely had a 55.8% VD prevalence. Conclusion(s): Objective VD was significantly associated with wIPSS score (p<0.001) as well as 2 out of the 3 modified IPSS items (hesitancy(p<0.001) and force of stream(p<0.001). The latter two proved to be the most powerful predictors. The modified IPSS may be a useful tool in predicting objective voiding dysfunction.