Urodynamic diagnosis of female bladder outlet obstruction

Abstract

Female bladder outlet obstruction (BOO) remains a controversial topic in terms of definition and diagnosis. It is a condition that is far less common in women than in men and has an estimated incidence of 2.7e8%.1,2 The etiology for organic BOO or anatomic BOO (but not including functional BOO) is more diverse in women because of various anatomical or iatrogenic changes affecting vaginal support, the urethra, and/or the bladder. Some changes such as prolapse are related to aging, whereas other changes are related to urethral pathology or previous surgeries (e.g., sling procedure, urethropexy). Furthermore, the urethral anatomical sites for BOO can be further subcategorized by extrinsic compression, urethral wall conditions (e.g., fibrosis, urethral diverticulum), or luminal factors (e.g., stricture disease).3 Owing to the complexity of etiology and nonspecific voiding symptoms, the diagnosis of female BOO requires a high index of suspicion and recourse to a variety of modalities, and includes a thorough history, questionnaires, noninvasive flow and residual assessment, physical examination, cystoscopy, imaging, and urodynamic or videourodynamic studies.