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Diagnosing Dysfunctional Voiding Non-Invasively: The SHADE Criteria Approach.

Gautam Shubhankar1, Vikas Kumar Panwar1, Md Taher Mujahid1

  • 1Department of Urology, All India Institute of Medical Sciences, Uttarakhand, India.

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Dysfunctional voiding (DV) in younger patients can be diagnosed non-invasively using the SHADE criteria. This approach aids early detection and management, especially where urodynamic studies are unavailable.

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Area of Science:

  • Urology
  • Nephrology
  • Continence Care

Background:

  • Dysfunctional voiding (DV) is an underdiagnosed cause of lower urinary tract symptoms (LUTS), particularly in younger individuals.
  • Lack of coordination between the detrusor muscle and external urethral sphincter characterizes DV, leading to frequency, urgency, and incontinence.
  • Urodynamic studies (UDS), the diagnostic gold standard, are often inaccessible in resource-limited settings.

Purpose of the Study:

  • To investigate non-invasive clinical parameters for provisional diagnosis of dysfunctional voiding (DV).
  • To identify predictors of DV in patients presenting with lower urinary tract symptoms (LUTS).

Main Methods:

  • Retrospective analysis of 516 patients with LUTS undergoing UDS between 2021-2024, excluding those with neurological disorders or urethral strictures.
  • Evaluation of symptomatology, uroflowmetry, and associated conditions across age groups (under 50 and 50+).
  • Statistical analysis using Chi-square tests and multivariate logistic regression to identify significant predictors.

Main Results:

  • 67 patients were diagnosed with DV, with 64 aged under 50.
  • Significant associations found between DV and diurnal frequency, heightened anxiety, obstructive uroflowmetry, constipation, and hypertonic anal sphincter.
  • The proposed SHADE (Staccato/obstructive voiding pattern, Heightened anxiety, Age <50, Diurnal frequency, Exclusion of stricture or neurological disease) criteria showed >95% positive predictive value for DV.

Conclusions:

  • Non-invasive clinical criteria can enhance early and accurate diagnosis of DV, especially in resource-constrained environments.
  • The SHADE criteria offer a valuable tool for provisional DV diagnosis where UDS is unavailable.
  • Implementing SHADE criteria can lead to prompt, targeted management and improved patient outcomes for DV.