Menorrhagia and Uterine Volume Associated with Lower Urinary Tract Symptoms in Patients with Adenomyosis

BACKGROUND Adenomyosis is a gynecological disorder with symptoms most presenting as dysmenorrhea and heavy menstrual bleeding. However, the presence of lower urinary tract symptoms (LUTS) among women with adenomyosis remains unclear. This study was designed to determine the prevalence of LUTS and factors related to the severity of these symptoms in this population. METHODS From July 2016 to November 2016, a total of 298 untreated symptomatic adenomyosis patients and 280 age-matched controls were enrolled. Demographics, LUTS, pain symptoms, ultrasonographic uterine size, and serum CA125 level were recorded. LUTS were evaluated using the International Prostate Symptom Score (IPSS) questionnaire. Factors related to the severity of LUTS were detected using the logistic regression analysis presented as odds ratio (OR) and 95% confidence interval (CI). RESULTS Compared with the control group, patients with adenomyosis had a greater IPSS total (4 [2-8] vs. 2 [0-3], Z = -8.159, P 0.001), IPSS storage (2 [1-4] vs. 1[0-2], Z = -7.361 P 0.001), and IPSS voiding (2 [0-4] vs. 0 [0-1], Z = -7.194, P 0.001). Of the patients with adenomyosis, 30.2% had moderate-to-severe lower urinary tract symptoms (IPSS ≥8). The most prevalent LUTS were daytime frequency (40.9%), followed by nocturia (24.8%), weak stream (24.2%), and incomplete emptying (23.5%). In study group, patients with an IPSS total score ≥8 had higher proportion of menorrhagia (51.1% vs. 30.8%, χ2= 11.162 P= 0.025) and larger uterine volumes (183.3 [109.8-273.8] cm3 vs. 148.5 [96.4-262.7] cm3, Z = -1.441, P= 0.150) compared to patients with an IPSS total score <8. On multivariate logistic regression analysis, patients with menorrhagia were associated with an increased risk of an IPSS total score ≥8 (OR: 2.309, 95% CI: 1.310-4.070, P= 0.004), an IPSS storage subscore ≥4 (OR: 2.422, 95% CI: 1.395-4.206, P= 0.002), and an IPSS voiding subscore ≥5 (OR: 1.971, 95% CI: 1.176-3.302, P= 0.010). However, patients with uterine volume more than 180 cm3 had more than 2-fold risk of bearing IPSS total score ≥8 (OR: 2.437, 95% CI: 1.381-4.300, P= 0.002), IPSS storage subscore ≥4 (OR: 2.486, 95% CI: 1.433-4.314, P= 0.001), and IPSS voiding subscore ≥5 (OR: 2.700, 95% CI: 1.485-4.908, P= 0.001). CONCLUSIONS Lower urinary tract symptoms are prevalent in patients with symptomatic adenomyosis and greatly affect patients' quality of life. Menorrhagia and large uterine volume could be potential risk factors that increase the occurrence of moderate-to-severe LUTS.