Voiding difficulties in the female: prevalence, clinical and urodynamic review

The urodynamic questionnaires of 600 consecutive female patients attending a urodynamic clinic with a variety of urologic symptoms were reviewed. Investigations consisted of independent uroflowmetry and either twin-channel subtracted cystometry or videocystourethrography with synchronous bladder pressure and urine flow recordings. Urodynamic evidence of voiding difficulty was defined as a repeated peak flow rate of less than 15 ml/sec or more than 200 ml of residual urine. One hundred ninety-five patients complained of voiding difficulties; this was substantiated in only 87. An additional 12 patients had no symptoms suggestive of impaired voiding, but had urodynamic evidence of voiding difficulty. Symptoms of voiding difficulty were found to be unreliable. Neurologic disease was a significant etiologic finding. Uroflowmetry was advised for patients who were to undergo suprapubic surgery for incontinence or radical pelvic surgery.