Study On The Correlation Between Lower Urinary Tract Symptoms Suggestive Of Female Bladder Outlet Obstruction And Anxiety And Depression And The Distribution Characteristics Of TCM Syndromes

Background:Lower urinary tract symptom(LUTS)is a group of urinary symptoms,including symptoms of urinary storage(daytime frequent urination,nocturnal urine,urgent urination,and urinary incontinence),Micturition symptoms(slow flow rate,bifurcation or spraying of micturition,phasing of micturition,waiting of micturition,laborious micturition,dripping at the end of urine)and post-micturition symptoms(dripping after micturition,feeling of dysuria)are composed.LUTS is common in both male and female patients,and its prevalence is increasing year by year,with women in the majority.Age is an obvious risk factor,and its prevalence increases with age.Lower urinary tract symptom suggestive of bladder outlet obstruction(LUTS/BOO)refers to the existence of any urinary symptoms or other Lower urinary tract symptoms.Female Bladder Outlet Obstruction(FBOO)includes neurogenic Obstruction and non-neurogenic Obstruction.Non-neurogenic Obstruction can be divided into anatomical Obstruction and functional Obstruction.The causes of anatomic obstruction include anti-incontinence surgery,pelvic organ prolapse,urethral stricture,tumor,infection,etc.The causes of functional obstruction include functional urination disorder,primary bladder neck obstruction,and Fowler’s syndrome.The LUTS shown by FBOO is non-specific and there is no unified diagnostic standard at present.The diagnosis and treatment process is difficult,which is one of the important reasons for the potential and easy to be ignored of female LUTS.In long-term clinical observation and research,it has been proposed that female LUTS can cause different degrees of disturbance to patients’ daily work,life and study,and significantly reduce their quality of life.In severe cases,LUTS will further lead to related emotional disorders,such as anxiety,depression,and even suicide tendency and other extreme behaviors.Previous studies have focused on mood disorders secondary to related diseases such as Overactive bladder(OAB)or Stress urinary incontinence(SUI),indicating a bidirectional relationship between them.OAB or SUI are significantly correlated with mood disorders in the development and outcome of the disease.However,there are few reports on the correlation between FBOO and anxiety and depression.Therefore,this study starts from female LUTS/BOO,conducts correlation analysis with anxiety and depression,and further discusses the correlation between FBOO and anxiety and depression.Urination is one of the important contents of TCM consultation,and TCM has a comprehensive understanding of it.According to the analysis of its symptoms and characteristics,BOO belongs to the category of "difficult in Urination" of TRADITIONAL Chinese medicine.TCM has a long history of treating difficult in urination and has various methods,which are safe,convenient and flexible,and has unique advantages.At present,TCM has been proved effective in treating bladder outlet obstruction caused by Benign Prostatic Hyperplasia(BPH)from the long bi Angle.However,it is seldom mentioned in the literature to treat FBOO from the long bi Angle.Since there is no unified diagnostic standard for FBOO,this study analyzed the TCM syndrome type classification of FEMALE LUTS/BOO to explore the TCM syndrome distribution characteristics of FBOO.Objective:By evaluating the severity of lower urinary tract symptoms and anxiety and depression in female LUTS/BOO patients,the correlation between the two was analyzed to try to explore the correlation between FBOO and anxiety and depression.The TCM four-diagnosis information of female LUTS/BOO patients was collected to analyze the TCM syndrome type classification of female LUTS/BOO,and further explore the TCM syndrome distribution characteristics of FBOO patients.Method:1.Study designProspective cross-sectional methods were used.Female patients with LUTS/BOO who visited the outpatient and ward of urology Department of Guang’anmen Hospital,China Academy of Chinese Medical Sciences from July 21,2020 to December 21,2020 were selected as the research objects.A clinical observation table was made.General data(basic data and clinical data),physical and chemical indicators(urine routine,biochemical),auxiliary examination(bladder B ultrasound,urine flow rate measurement,cystoscopy),etc.IPSS and QOL scale were used to evaluate the severity of lower urinary tract symptoms.Zung’s and Hamilton Anxiety and Depression Scale were used to evaluate the severity of mood disorders.The correlation between each factor and the scores of anxiety and depression was analyzed,and the correlation between FBOO and anxiety and depression was explored.The TCM four-diagnosis information of female LUTS/BOO patients was collected.Based on the TCM syndrome differentiation standard,syndrome differentiation and classification were conducted to explore the TCM syndrome distribution characteristics of FBOO.2.ParticipantsFrom July 2021 to December 2021,80 female patients with lower urinary tract symptoms in the urology outpatient department and ward of Guang ’anmen Hospital,China Academy of Chinese Medical Sciences were further screened out according to inclusion and exclusion criteria,indicating bladder outlet obstruction.3.Observation indicatorsGeneral information,IPSS and QOL scores,SAS/HAMA scores,SDS/HAMD scores,TCM four diagnosis information.Result:1.General data showed that among the 80 female LUTS/BOO patients,young women accounted for 40%,accounting for the largest proportion,middle-aged 22.5%,elderly 37.5%;In the distribution of disease course,32.5%of patients had been sick for 1 year or less,and the proportion of patients with chronic disease course over 1 year was larger,which was 67.5%.The distribution of education level,higher education accounted for 35%;The mean urine volume,maximum urine flow rate and average urine flow rate were 279.51,14.05 and 6.45 respectively.Among the distribution of IPSS score and QOL score,73.8%of patients with severe IPSS score and 80.0%with unsatisfactory quality of life;In the mood assessment,55 percent were diagnosed with anxiety disorder and 38.8 percent with depression disorder.In addition,SAS self-rating scale showed that 33.7%of the patients were in different degrees of anxiety,HAMA other rating scale showed that 97.5%of the patients may have different degrees of anxiety;SDS self-rating scale showed that 36.3%of the patients were in varying degrees of depression,and HAMD scale showed that 70%of the patients may have varying degrees of depression.2.Correlation analysis between general condition and anxiety and depression:age,course of disease,education level and anxiety,compared with the scores of depression self-rating scale and other rating scale,all three groups showed NO statistical difference(P>0.05),which did not constitute confounding factors.3.Chi-square test and correlation test of female LUTS/BOO patients with diagnosis of anxiety and depression showed that there was no statistical correlation between FEMALE LUTS/BOO patients with diagnosis of anxiety and depression and IPSS score;There was statistical correlation between the diagnosis of anxiety and QOL,while there was no statistical correlation between the diagnosis of depression and QOL.4.Correlation analysis of IPSS,QOL score and anxiety and depression in female LUTS/BOO patients showed that urination effort,QOL score and anxiety and depression were significantly correlated(P<0.01).5.The correlation analysis of IPSS and QOL scores with anxiety and depression scores of different degrees showed that there were statistical differences between anxiety and depression scores and different severity of urinary insufficiency and urination difficulty(P<0.05).There were significant differences between the severity of QOL score,anxiety score and depression score(P<0.01).6.Distribution characteristics of TCM syndromes in female LUTS/BOO patients:R-type clustering analysis was conducted on the main symptoms of LUTS/BOO patients,and the results showed that it was appropriate to divide them into three categories.The syndrome differentiation of TCM four diagnosis elements of the three categories was:spleen deficiency syndrome,liver stagnation and blood stasis syndrome,and phlegm and blood stasis syndrome.Conclusion:1.In this study,there are more young women at the age of the disease,which on the one hand indicates that the disease tends to be younger,and on the other hand may be related to the low attendance rate of elderly women.2.General information,such as age,course of disease and education level,has no correlation with anxiety and depression in FBOO patients.3.This study showed that more than half of female LUTS/BOO patients had anxiety and depression disorders of varying degrees,suggesting that clinical specialists should be more alert to the important impact of mood disorders on the occurrence,development and outcome of FBOO disease during diagnosis and treatment,and should make a more detailed assessment of emotion-related adverse life events during consultation.4.The typical symptoms of FBOO are more likely to cause anxiety and depression disorders in patients,affecting the quality of life.The more serious the symptoms are,the more serious the anxiety and depression disorders are.Urination effort,sense of urination is associated with mood disorders.5.The TCM syndromes of FBOO patients are mainly spleen deficiency syndrome,liver stagnation and blood stasis syndrome,and phlegm and blood stasis syndrome.