Diagnosis and management of outlet obstruction in the female

Bladder outlet obstruction in women results from a remarkable diversity of underlying pathologies. The potential array of presenting symptoms often makes the diagnosis complex, although the condition is predominantly assessed by the urologist as a consequence of incontinence surgery. Recent advances in the diagnosis and management of outlet obstruction in women and the impact on clinical practice are outlined. Recent trials have defined the importance of early intervention for successful resolution of acute, surgically induced obstruction in women. Methods of management for persistent symptoms due to induced obstruction have been reported that render improved symptomatic response.

We present strategies for diagnostic evaluation of bladder outlet obstruction, including history taking and physical exam, as well as a review of appropriate imaging modalities and utilization of videourodynamics. Common conditions resulting in bladder outlet obstruction are discussed along with disease-specific treatment strategies. Diagnostic definitions of obstruction have evolved and improved nomograms have been developed to define study populations.

Recent data have underscored the need for a structured management algorithm. Areas of future research should focus on understanding the natural history of outlet obstruction in women, especially when it occurs in women who have undergone surgery for incontinence and have developed obstruction. Lower urinary tract response to acute obstruction and method of optimal management remain to be defined.