Voiding dysfunction

Voiding dysfunction in women is common, but is frequently undiagnosed until the patient presents with symptoms. The aetiology of voiding dysfunction includes the following, any of which may lead to acute or chronic disorders: obstructive causes; postsurgical conditions; neurological disorders; overdistension; inflammatory, pharmacological, psychogenic causes and learned voiding dysfunction; detrusor myopathy and urethral sphincter hypertrophy. Clinical assessment should include history, and general, neurological and pelvic examinations. Investigations may include uroflowmetry, ultrasound for residual urine and upper urinary tract dilatation, urodynamic assessment and electromyography. New surgical techniques to identify vesical branches of the pelvic nerves intraoperatively during radical hysterectomy have been shown to help prevent voiding dysfunction postoperatively. If acute retention occurs, then bladder drainage is the most important measure. Suprapubic catheters are superior to transurethral catheters if long-term voiding difficulties are expected. Whenever possible, patients with chronic retention should be taught clean intermittent self-catheterization. Depending on the cause, other possible treatment options include urethral dilatation, insertion of an intraurethral device, and neuromodulation. Voiding dysfunction in women is still poorly understood. Prompt management of acute retention is essential, and clean intermittent self-catheterization remains the most effective therapy for chronic retention.