2279 URODYNAMIC FINDINGS IN WOMEN WTH OBSTRUCTIVE VOIDING SYMPTOMS

Abstract

INTRODUCTION AND OBJECTIVES: Bladder outlet obstruction (BOO), once thought to be unique to the male population, has recently been recognized as a common cause of voiding dysfunction in women presenting for evaluation of obstructive voiding symptoms. However, the symptoms of BOO in women are often mixed and non-specific, making diagnosis difficult. Furthermore, the potential etiologies of BOO are diverse. We reviewed the urodynamic findings and diagnoses in women with obstructive voiding symptoms in order to characterize the range of diagnoses and assess the correlation between presenting symptoms and eventual diagnosis. METHODS: We queried the Columbia University Department of Urology IRB approved voiding dysfunction database for patients with obstructive voiding symptoms or an elevated post void residual (PVR), at least one documented UDS evaluation, and a cystoscopic exam. Obstructive symptoms were defined as hesitancy, straining to void, decreased flow, intermittency, or feelings of incomplete emptying. All patients were evaluated by a urologist fellowship trained in female urology and urodynamics. Retrospective chart review was performed by an independent reviewer. RESULTS: From 2005 to 2012, 282 women presented with obstructive voiding symptoms or an elevated PVR and underwent UDS evaluation and cystoscopy (average age 55.8, range 20-85). Ninety-six women (34.2%) were found to be obstructed using established UDS criteria for BOO in women (free Qmax 12 mL/s, pdet.Qmax 20 cm H2O). The causes of BOO were dysfunctional voiding (41%), pelvic organ prolapse (24%), primary bladder neck obstruction (12.5%), urethral stricture (7.3%), urethral diverticulum (4.2%), prior pelvic surgery (4.2%), and prior anti-incontinence surgery (2.1%). The majority of patients (51.9%) were not obstructed by UDS criteria and a small subset (13.8%) was unable to void during UDS evaluation and thus could not be definitively diagnosed with BOO. Subjective symptoms at presentation did not correlate with ultimate UDS diagnosis. CONCLUSIONS: Based on UDS criteria, BOO is present in roughly one third of women who present with obstructive voiding symptoms. Since subjective symptoms are not an accurate predictor of diagnosis, UDS is a useful and necessary component of the initial evaluation of these patients. UDS allows for the accurate determination of the etiology of obstructive symptoms and facilitates the selection of an appropriate therapy to target the underlying pathophysiology.