The definition of dysfunctional voiding was made by videourodynamic result of detrusor contraction (high or normal pressure) with a narrowing outlet at the level of external sphincter. These patients can be treated with alpha blocker and/or muscle relaxant as the medical treatment. However, some patients may not have a good response to medical treatment (i.e. suboptimal response) and require change or add-on medications, or surgical treatment. Understanding the factor predicting the suboptimal response may be helpful for early change of medications or surgical treatment. Thus the aim of this study is to elucidate the factors predicting the suboptimal response of the frontline medical treatment in women of dysfunctional voiding.

Medical records of all consecutive women with dysfunctional voiding who received alpha blocker and/or muscle relaxant as the frontline medical treatment in a tertiary referral center were reviewed. A suboptimal response to the frontline medical treatment was defined as change or add-on medication, or surgical treatment after the initiation of the frontline medical treatment. Multivariable backward stepwise Cox proportional hazard modeling were performed to predict the suboptimal response to the frontline medical treatment by using all variables with p<0.05 in the univariate analysis.

Between July 2011 and November 2019, a total of 60 women with dysfunctional voiding were included in this retrospective study. Twenty-five women were found to have the suboptimal response to the frontline medical treatment, including urethral botox injection (n=11), transurethral incision of the bladder neck (n=3), add-on medication (n=3) and change of medication (n=8). Multivariable Cox proportional hazard modeling revealed Pdet.Qmax (hazard ratio = 1.010), bladder capacity (hazard ratio = 1.004) and the use of Urief (hazard ratio = 0.320) were independent factors predicting the suboptimal response to the frontline medical treatment (Table 1 and Fig 1A & 1B). Pdet.Qmax ≥37 cmH2O was determined to be the optimum cut-off value to predict the suboptimal response using receiver operating characteristic (ROC) analysis, which provided an area under the ROC curve of 0.58 (95% confidence interval = 0.42 to 0.73; sensitivity = 68.0%, specificity =51.4%, Fig 1C). Bladder capacity ≥465 mL was determined to be the optimum cut-off value to predict the suboptimal response, which provided an area under the ROC curve of 0.69 (95% confidence interval = 0.55 to 0.83; sensitivity = 40.0%, specificity =94.3%, Fig 1D).

High Pdet.Qmax and large bladder capacity were associated with the suboptimal response to the frontline medical treatment. Nonetheless, the use of Urief seems associated with optimal response to the frontline medical treatment.

High Pdet.Qmax and large bladder capacity were factors predicting the suboptimal response to the frontline medical treatment. In addition, Urief seems to a better choice for women with dysfunctional voiding.