Diagnosing Dysfunctional Voiding Non-Invasively: The SHADE Criteria Approach

Objective: Dysfunctional voiding (DV) is an often-underdiagnosed condition primarily affecting younger patients with lower urinary tract symptoms (LUTS). Characterized by a lack of coordination between the detrusor muscle and the external urethral sphincter, DV commonly manifests as urinary frequency, urgency, and incontinence. Despite its significant impact, urodynamic studies (UDS), the gold standard for diagnosis, are frequently inaccessible in remote or under-resourced areas. This study investigates non-invasive clinical parameters to facilitate provisional DV diagnosis. Methods: A retrospective analysis of 813 patients who underwent UDS for LUTS over 3 years (2021-2024) was conducted. Excluding those with neurological disorders or urethral strictures, 516 patients were evaluated, identifying 67 with DV. Parameters were examined across 2 age groups: under 50 years and 50 years or older, focusing on symptomatology, uroflowmetry, and associated conditions. Statistical analyses, including Chi-square tests and multivariate logistic regression, were employed to identify significant predictors. Results: Of the 67 patients diagnosed with DV, 64 were under 50 years of age. Statistically significant associations were found between DV and increased diurnal frequency, pre-existing heightened anxiety, obstructive uroflowmetry patterns, constipation, and hypertonic anal sphincter. The proposed non-invasive criteria-SHADE (Staccato/obstructive voiding pattern, Heightened anxiety, Age <50, Diurnal frequency, Exclusion of stricture or neurological disease)-demonstrated over 95% positive predictive value for DV. Conclusion: Early and accurate diagnosis of DV can be enhanced through non invasive clinical criteria, particularly in settings where urodynamic testing is limited. Implementing the SHADE criteria can facilitate prompt, targeted management of DV, improving patient outcomes in resource-constrained environments.