Detrusor instability in men: Correlation of lower urinary tract symptoms with urodynamic findings

Purpose: We evaluated the correlation of lower urinary tract symptoms sugge stive of detrusor instability with urodynamic findings in men. Materials an d Methods: Enrolled in our prospective study were 160 consecutive neurologi cally intact men referred for urodynamic evaluation of persistent lower uri nary tract symptoms. All patients had storage symptoms suggestive of detrus or instability. Patients were further clinically categorized according to t he chief complaint of urge incontinence, frequency and urgency, nocturia or difficult voiding. The clinical and urodynamic diagnosis in all patients a s well as specific urodynamic characteristics of those with detrusor instab ility were analyzed according to the these 4 clinical categories. Results: Mean patient age was 61 +/- 15 years. The chief complaint was urge incontinence in 28 cases (17%), frequency and urgency in 57 (36%), nocturi a in 30 (19%) and difficult voiding in 45 (28%). Detrusor instability was d iagnosed in 68 cases (43%). A higher incidence of detrusor instability was associated with urge incontinence than with the other clinical categories ( 75% versus 36%, p <0.01). Of the patients 109 (68%) had bladder outlet obst ruction, including 50 (46%) with concomitant detrusor instability. The prev alence of bladder outlet obstruction was similar in all patients regardless of the chief complaint. All other urodynamic diagnoses were also similar i n the 4 clinical categories. The mean bladder volume at which involuntary d etrusor contractions occurred were lower in patients with urge incontinence and frequency and urgency than in those with nocturia and difficult voidin g(277.1 <plus/minus> 149.4 and 267.1 +/- 221.7 versus 346.7 +/- 204.6 and 3 06.2 +/- 192.1 mi., respectively, not statistically significant, p = 0.07). Conclusions: Detrusor instability and bladder outlet obstruction are common in men with lower urinary tract symptoms. The symptom of urge incontinence strongly correlated with detrusor instability. Other fewer urinary tract s ymptoms did not correlate well with any urodynamic findings. Therefore, we believe that an accurate urodynamic diagnosis may enable focused and more e fficient management of lower urinary tract symptoms in men.