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Voiding dysfunction in women: How to manage it correctly.

A Abdel Raheem1, Helmut Madersbacher2

  • 1Department of Urology, Tanta University Hospital, Egypt.

Arab Journal of Urology
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PubMed
Summary

Female voiding dysfunction (VD) in women over 40 may stem from detrusor underactivity (DU) or bladder outlet obstruction (BOO). Accurate diagnosis and tailored treatments are crucial for symptom relief and complication management.

Keywords:
ApBO, acute prolonged bladder overdistensionBTA, botulinum toxin ABladder diaryCIC, clean intermittent self-catheterisationDM, diabetes mellitusDO, detrusor overactivityDSD, detrusor sphincter dyssynergiaDU, detrusor underactivityDV, dysfunctional voidingEMG, electromyographyIVES, intravesical electrical stimulationMUS, mid-urethral slingPFM, pelvic floor musclesPFS, pressure-flow studyPOP, pelvic organ prolapsePVR measurementPVR, postvoid residual urine volumePdet, detrusor pressurePdetQmax, Pdet at QmaxPdetmax, maximum PdetQmax, maximum urinary flow rateSNM, sacral neuromodulationTVT, tension-free vaginal tapeUS, ultrasonographyUroflowmetryVCUG, voiding cysto-urethrogramVD, voiding dysfunctionWomen

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Area of Science:

  • Urology
  • Female Pelvic Medicine

Background:

  • Voiding dysfunction (VD) affects 6% of women over 40.
  • The precise definitions linking VD to detrusor underactivity (DU) and bladder outlet obstruction (BOO) in women remain unclear.
  • This review synthesizes current literature to clarify the diagnosis and treatment of female VD.

Purpose of the Study:

  • To review and define the diagnosis and treatment of female voiding dysfunction (VD).
  • To clarify the relationship between VD, detrusor underactivity (DU), and bladder outlet obstruction (BOO) in women.
  • To provide a comprehensive overview of current therapeutic strategies for female VD.

Main Methods:

  • A systematic literature search was conducted using PubMed from 1975 to 2012.
  • Keywords included 'female voiding dysfunction', 'detrusor underactivity', 'acontractile detrusor', and 'bladder outlet obstruction and urinary retention in women'.
  • Original English-language studies focusing on prevalence, etiology, diagnosis, and treatment of female VD were selected.

Main Results:

  • Twenty original studies were identified, with an additional 45 references sourced from their bibliographies.
  • All selected studies were relevant to the topic of female voiding dysfunction.
  • Pertinent findings from these studies were incorporated into the review.

Conclusions:

  • Female VD can be associated with DU and/or BOO, often presenting with coexisting voiding and storage symptoms.
  • Accurate diagnosis requires targeted clinical investigation, imaging, and urodynamics, though universally accepted criteria for DU and BOO in women are lacking.
  • Treatment goals focus on symptom relief and minimizing complications, with options ranging from behavioral therapy and catheterization to neuromodulation and urinary diversion, tailored to individual patient needs and pathophysiology.