Background: We hypothesized that voiding symptoms in women with normal free uroflow were not related to irritative symptoms and bladder storage dysfunction. Purpose: This study was designed to explore the clinical associations between voiding symptoms in women without obvious anatomic urethral obstruction and dysfunctional voiding. Methods: We retrospectively reviewed an urodynamic database and identified 335 women who had a positive response to the category of voiding symptoms in a questionnaire. All 335 women had undergone urodynamic studies and urethrocystoscopic examinations for voiding symptoms. None of the women had inappropriate sphincteric activity during voiding or anatomic evidence of urethral obstruction. In addition to categorization by menopausal status, the study subjects were further stratified based on the maximum flow rate on free uroflowmetry into two groups: the low flow group and the normal flow group. A further 125 women with lower urinary tract symptoms but without voiding symptoms and who had negative urodynamic findings were identified and served as controls. Results: Of the 335 women, 137 (41%) belonged to the low flow group, including 73 pre-menopausal women and 64 postmenopausal women; 198 (59%) belonged to the normal flow group, including 127 premenopausal women and 71 postmenopausal women. Among premenopausal women, the frequency of irritative symptoms was significantly higher for those with voiding symptoms than for those without voiding symptoms. Urodynamic studies showed that lower flow rates, prolonged time to maximum flow, higher micturition resistance, and high postvoid residual urine volume were common characteristics of women with low uroflow. Irritative symptoms and bladder storage dysfunction (lower first desire to void volume and maximum cystometric capacity) were the common characteristics of premenopausal women with voiding symptoms. Conclusion: Our study revealed the interesting finding that voiding symptoms in premen-opausal women with normal uroflow are associated with irritative symptoms and that bladder storage dysfunction may cause voiding symptoms.
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