Diagnosing Dysfunctional Voiding Non-Invasively: The SHADE Criteria Approach

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.