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Urodynamic differences between dysfunctional voiding and primary bladder neck obstruction in women.

Benjamin M Brucker1, Eva Fong, Sagar Shah

  • 1Department of Urology, New York University Langone Medical Center, New York, New York 10016, USA. benjamin.brucker@nyumc.org

Urology
|July 4, 2012
PubMed
Summary
This summary is machine-generated.

Dysfunctional voiding (DV) and primary bladder neck obstruction (PBNO) in women present similarly but differ in emptying efficiency. Fluoroscopy is crucial for accurate diagnosis, as electromyography alone can be misleading.

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Area of Science:

  • Urology
  • Female Pelvic Medicine
  • Urodynamics

Background:

  • Dysfunctional voiding (DV) and primary bladder neck obstruction (PBNO) are common causes of non-neurogenic functional bladder outlet obstruction in women.
  • Differentiating between DV and PBNO is essential for appropriate clinical management.

Purpose of the Study:

  • To compare the clinical and urodynamic characteristics of women with DV and PBNO.
  • To evaluate the diagnostic value of simultaneous fluoroscopy in distinguishing between DV and PBNO.

Main Methods:

  • A retrospective review of urodynamic study databases from March 2003 to August 2009.
  • Diagnosis of DV based on increased external sphincter activity during voiding (EMG or fluoroscopy).
  • Diagnosis of PBNO based on failure of bladder neck opening during voiding on fluoroscopy.

Main Results:

  • DV diagnosed in 34 women, PBNO in 16. DV patients were younger (40.9 vs 59.2 years).
  • DV patients trended towards more storage symptoms and fewer voiding symptoms.
  • DV patients had higher maximal flow rates (12 vs 7 mL/s) and lower postvoid residual volumes (125 vs 400 mL) compared to PBNO patients.

Conclusions:

  • Clinical presentations of DV and PBNO are similar, but PBNO is associated with poorer bladder emptying.
  • While flow rates may differ, voiding pressures are similar between DV and PBNO.
  • Electromyography alone has questionable accuracy in differentiating DV and PBNO, highlighting the importance of fluoroscopy.