Female Bladder Outlet Obstruction Research Articles

MP76-02 THE DEVELOPMENT AND VALIDATION A NEW NOMOGRAM FOR DIAGNOSING BLADDER OUTLET OBSTRUCTION IN WOMEN

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Non-neurogenic Voiding Dysfunction1 Apr 2014MP76-02 THE DEVELOPMENT AND VALIDATION A NEW NOMOGRAM FOR DIAGNOSING BLADDER OUTLET OBSTRUCTION IN WOMEN Eskinder Solomon, Habiba Yasmin, Julie Jenks, Mahreen Pakzad, Rizwan Hamid, Jeremy Ockrim, Julian Shah, and Tamsin Greenwell Eskinder SolomonEskinder Solomon More articles by this author , Habiba YasminHabiba Yasmin More articles by this author , Julie JenksJulie Jenks More articles by this author , Mahreen PakzadMahreen Pakzad More articles by this author , Rizwan HamidRizwan Hamid More articles by this author , Jeremy OckrimJeremy Ockrim More articles by this author , Julian ShahJulian Shah More articles by this author , and Tamsin GreenwellTamsin Greenwell More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2395AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Bladder outlet obstruction (BOO) in men has been extensively researched and the ICS BOO nomogram is widely used. In women however, the criteria for obstruction is less defined and there are two main reasons why a well-accepted nomogram remains elusive. Blaivis and Groutz (Neuro&Urodyn 2000;19:553–64) have previously proposed a female BOO nomogram that plots maximum detrusor pressure (not necessarily at Qmax) against freeflow Qmax. The validity of using non-concurrent pressure-flow values to define resistance is debatable and a subsequent publication has reported an unlikely high prevalence of BOO when using the Blaivis-Groutz nomogram (Massolt et al, Neuro&Urody 24(3) 237-242). The aim of this study is to develop and validate a criteria for classifying BOO in women derived from concurrent Pdet.Qmax and Qmax based on radiographic evidence of increased urethral resistance. METHODS Retrospective video-urodynamics and clinical data of 186 women were analysed. The women were divided into six groups. The first four groups are categorised according to the primary cause of BOO; functional obstruction; anatomical obstruction; anti-incontinence surgery obstruction and cystocele. The fifth group consists of patients without voiding symptoms or stress urinary incontinence (SUI) and the sixth where SUI is demonstrated. The detrusor pressure at peak flow (Pdet.Qmax) were plotted against peak flow (Qmax) for voids with a volume > 100 ml. Cluster analysis was performed to derive an axis (BOO criterion) that best divides the definitively obstructed and unobstructed. The sensitivity and specificity of the BOO criterion was then validated by applying it to a further 350 women who have undergone video-urodynamics in our unit. RESULTS The axis of Pdet.Qmax = 2Qmax best divides the women with and without evidence of radiographic BOO in the original cohort. In the validation cohort, the criterion Pdet.Qmax > 2Qmax identifies BOO in women with sensitivity of 0.94, specificity of 0.93 and accuracy of 0.94. The figure below shows: Pdet.Qmax and Qmax for the validation cohort CONCLUSIONS The criterion Pdet.Qmax > 2Qmax defines BOO in women with excellent accuracy and should be utilised for urodynamic diagnosis of BOO in women. © 2014FiguresReferencesRelatedDetailsCited byWein A (2016) Re: Evaluation of Obstructed Voiding in the Female: How Close Are We to a Definition?Journal of Urology, VOL. 195, NO. 4 Part 1, (1041-1041), Online publication date: 1-Apr-2016. Volume 191Issue 4SApril 2014Page: e882 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Eskinder Solomon More articles by this author Habiba Yasmin More articles by this author Julie Jenks More articles by this author Mahreen Pakzad More articles by this author Rizwan Hamid More articles by this author Jeremy Ockrim More articles by this author Julian Shah More articles by this author Tamsin Greenwell More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Voiding Chain Cystourethography: Assessing A Historical Test's Role in Selection for Urethrolysis

To analyze the benefit of voiding chain cystourethrography (VCC) [placing a radiographic opaque chain into the urethra and bladder and asking the patient to void under fluoroscopy] in the urodynamic evaluation of female bladder outlet obstruction (BOO). Females with post anti-incontinence operation voiding dysfunction who underwent urodynamic evaluation augmented with VCC and later had urethrolysis were identified. Six diagnostic criteria for obstruction were applied to each patient: (1) VCC ( obstructed: chain was angulated and could not be voiding out) (2) Video urodynamic study (VUDS) (detrusor contraction combined with radiographic obstruction) (3) maximum flow (Qmax) ≤ 15 cc/sec, detrusor pressure (pDet)@ Qmax ≥ 20 cm H20 (4) Qmax ≤ 11 cc/sec, pDet@ Qmax ≥ 25 cm H20 (5) Qmax ≤ 12 cc/sec, pDet@ Qmax ≥ 25 cm H20 (6) Blaivas-Groutz (B-G) nomogram. Urethrolysis results were reviewed. Agreement in assessment of BOO criteria was assessed by estimating the proportion of pair-wise agreements along with an exact binomial 95% confidence interval (CI) and by estimating kappa along with a 95 % CI. Twenty-one patients were identified. Twenty of the 22 urethrolyses (91%) were clinically successful. Diagnosis of BOO was most common for VCC (86 %) and then B-G Nomogram (67 %). Agreement with the VCC was relatively poor for each of the five other methods (14% -62%) with the video urodynamic study (VUDS) being the best. Three patients with successful urethrolysis were diagnosed only by the VCC. All of kappa values regarding agreement with the VCC were low; the highest value of 0.15 was observed for VUDS. VCC may augment selection criteria for urethrolysis.

Different urodynamic patterns in female bladder outlet obstruction: Can urodynamics alone reach the diagnosis?

ObjectiveTo define the different urodynamic patterns in female bladder outlet obstruction (BOO) and to assess whether urodynamics alone can be relied on for the diagnosis. Patients and methodsThis prospective study included 60 clinically obstructed women and 27 with stress urinary incontinence as a control group. All patients had pressure-flow studies and were divided into four groups. Group A (control group, 27 patients) and group B (22) had a maximum urinary flow rate (Qmax) of >15mL/s and a detrusor pressure at Qmax (PdetQmax) of <30 or >30cm H2O, respectively. Group C (20 patients) and group D (18) had a Qmax of <15mL/s and a PdetQmax of >30 or <30cm H2O, respectively. ResultsThe mean Qmax for groups A, B, C, and D were 21.8, 21.9, 10.8 and 9.9mL/s, respectively, while the mean PdetQmax was 20.8, 40.4, 48.7, and 18.7cm H2O, respectively. The residual urine volume was <100mL in groups A and B but >100mL in groups C and D. When compared with group A, groups B–D had a significant difference in vesical pressure, groups B and C had a significant difference in PdetQmax, while Qmax, the maximum voided volume and residual urine volume were significantly different in groups C and D. Group A was obviously unobstructed, group B might have early obstruction, group C had compensated obstruction, while group D can be considered to have late de-compensated obstruction. ConclusionsBOO in females has three different urodynamic patterns, i.e. early, compensated and late obstruction. However, urodynamics should be combined with the clinical presentation and residual urine volume for an accurate diagnosis.

Dorsal onlay vaginal graft urethroplasty for female urethral stricture

Introduction:Female urethral stricture is an underdiagnosed and overlooked cause of female bladder outlet obstruction. The possible etiologies may be infection, prior dilation, difficult catheterization with subsequent fibrosis, urethral surgery, trauma, or idiopathic. We present our technique and results of dorsal onlay full thickness vaginal graft urethroplasty for female urethral stricture.Materials and Methods:A retrospective review was performed on 16 female patients with mid-urethral stricture who underwent dorsal onlay vaginal graft urethroplasty from January 2007 to June 2011. Of these, 13 patients had previously undergone multiple Hegar dilatations, three had previous internal urethrotomies. The preoperative work up included detailed voiding history, local examination, uroflowmetry, calibration, and micturating cystourethrogram.Results:All patients had mid-urethral stricture. Mean age was 47.5 years. Mean Qmax improved from 6.2 to 27.6 ml/s. Mean residual volume decreased from 160 to 20 ml. Mean duration of follow-up was 24.5 months (6 months to 3 years). Only one patient required self-calibration for 6 months after which her stricture stabilized. None of the patient was incontinent.Conclusion:Dorsal vaginal onlay graft urethroplasty could be considered as an effective way to treat female urethral stricture.

Management of Urethral Stricture in Women

We describe the diagnosis and treatment of urethral strictures in women. We retrospectively identified female urethral strictures from 1998 to 2010. Study inclusion criteria were 1) clinical diagnosis of stricture, 2) stricture seen on cystoscopy, 3) urethral obstruction on videourodynamics according to the Blaivas-Groutz nomogram and/or 4) urethral caliber less than 17Fr. Postoperative recurrence was defined by the preoperative criteria. We identified 17 women with a mean age of 62 years (range 32 to 91) with stricture. Stricture was idiopathic in 8 patients, iatrogenic in 6, traumatic in 2 and associated with a urethral diverticulum in 1. Videourodynamics could not be done in 3 women due to complete obliteration of the urethra. Ten of 14 patients satisfied videourodynamic criteria for obstruction and 4 had impaired detrusor contractility. Nine women underwent vaginal flap urethroplasty, including 5 who also had a pubovaginal sling and 1 who had a Martius flap. One patient received a buccal mucosal graft as primary treatment after initial dilation. There was no recurrence at a minimum 1-year followup but 2 strictures recurred 5½ and 6 years postoperatively, respectively. These 2 women received a buccal mucosal graft and were stricture free 12 to 15 months postoperatively. Of 17 patients initially treated with urethral dilation recurrence developed in 16, requiring repeat dilations until urethroplasty was performed. In select women vaginal flap urethroplasty and buccal mucosal graft have high success rates, including 100% at 1 year and 78% at 5 years. Urethral dilation has a 6% success rate. Long-term followup is mandatory. Treatment should be individualized.

Female functional bladder outlet obstruction: treatment with α-blockers

Voiding difficulties in women are common but are often overlooked. The diagnosis of bladder outlet obstruction is difficult to establish due to a lack of consensus on diagnostic criteria. Published studies suggest that α-blockers, both α1 and α1A selective, alleviate voiding symptoms in women with functional bladder outlet obstruction and achieve improvements in objective outcomes such as detrusor pressure, urine flow and postvoid residual urine. Tolerability of treatment was good. Nevertheless, recommendations are impossible to make as existing trials have used different diagnostic criteria, treatment regimens and outcomes. High-quality, randomized controlled trials are needed to clearly establish the efficacy and safety of using α-blockers in female populations with bladder outlet obstruction.

Identification of lower urinary tract voiding dysfunction in females by using video-urodynamic study

To assess the value of video-urodynamic study (VUD) in the identification of lower urinary tract voiding dysfunction in female. A total of 126 female patients with sign and symptoms of lower urinary tract voiding dysfunction underwent VUD from December 2008 to January 2011 in Beijing Chaoyang Hospital. The causes of voiding dysfunction were analyzed based on VUD findings. Neurogenic voiding dysfunction was found in 30 patients (23.8%), non-neurogenic voiding dysfunction was found in 96 patients (76.2%). The 72 patients suffered from recurrent urinary tract infection (57.1%) and 23 patients suffered from hydronephrosis (18.3%). Based on special characteristics of video-urodynamic study, a total of 126 patients were classified as: (1) Bladder outlet obstruction (BOO) was found in 65 patients. Of them, bladder neck obstruction in 40 patients (61.5%), their VUD showed "high pressure-low flow" obstructive curve and synchronic image showed bladder neck did not open in a funnel shape and no contrast was found in urethra. Distal urethral stricture in 22 patients (33.8%), VUD showed "high pressure-low flow" obstructive curve and synchronic image showed bladder neck open in a funnel shape, proximal urethra dilated and no contrast was found in distal urethral. Urethral sphincter obstruction in 3 patients (including detrusor-sphincter dyssynergia in 1 and sphincterismus in 2 patients), VUD showed "high pressure-low flow" obstructive curve and synchronic image showed bladder neck open in a funnel shape, sphincteric urethra did not open, proximal urethra dilated and no contrast was found in distal urethral. (2) Detrusor areflexia (DA) was found in 39 patients (2 patients with hydronephrosis), the VUD finding was: no voluntary detrusor contraction in voiding phase, and abdominal pressure voiding pattern. (3) OAB was found in 3 patients, which VUD findings was frequent involuntary detrusor contraction at storage period with or without urine leakage. (4) Low compliance bladder was found in 17 patients (13.5%), 16 patients with hydronephrosis, the VUD showed that increased bladder storage pressure with significantly decreased bladder safe capacity and compliance, appearance of the bladder as "Christmas tree", with or without ureteral reflux. (5) And stress urinary incontinence (SUI) was in 2. The main causes of female BOO may be non-neurogenic conditions or organic obstruction. VUD would offer valuable information for confirmed diagnosis of voiding dysfunction in female patients.

Ultrasound assessment of bladder detrusor wall thickness for non-invasive diagnosis of female bladder outlet obstruction

Objective To evaluate the diagnostic accuracy of ultrasound bladder detrusor wall thickness (DWT) measurement for female bladder outlet obstruction (FBOO) and investigate the application of this non-invasive method for diagnosis of FBOO. Methods DWT was measured by linear ultrasound (7.5 MHz) either at a filling volume of 50％ of cystometric capacity or at 250 ml filling in 93 women undergoing pressure flow study (PFS) for lower urinary tract symptoms (LUTS).FBOO was defined as maximal flow rate (Qmax) of less than 12 ml/s combined with a detrusor pressure at maximal flow rate (Pdet Qmax)greater than 25 cm H2O.All the patients were divided into 2 groups according to FBOO and non-FBOO.The age,urodynamic parameters and DWT of the 2 groups were compared.Meanwhile DWT was evaluated for diagnosing BOO through receiver operating characteristic (ROC) curve. Results The age (61.2 ± 8.3 vs 59.9 ± 7.7 years,P =0.44) and maximal cystometric capacity (292.2 ± 82.3 vs 308.1 ± 87.5 ml,P =0.37 ) between the 2 groups had no significant difference.DWT was significantly higher ( P =0.00 ) in FBOO group (42 cases,DWT 1.8 ±0.3 mm) compared to non-FBOO group (51 cases,1.4 ±0.2 mm).Furthermore maximal detrusor pressure (43.1 ± 11.2 vs 16.2 ± 7.1 cm H2O,P =0.00),Pdet Qmax (34.3 ±8.2 vs 13.1 ±7.8 cm n2O,P =0.00),Qmax(7.4 ±3.2 vs 17.4 ±4.1 ml/s,P =0.00),voided volume (157.1 ±63.7 vs 251.2 ±77.4 ml,P=0.00) and post-void residual volume (117.5 ±71.3 vs 37.7 ± 18.1 ml,P =0.00) had significant differences between the 2 groups.For a diagnosis of FBOO,DWT of 1.9 mm or greater had a positive predictive value of 100％,a negative predictive value of 62％,specificity of 100％ and sensitivity of 38％.ROC analysis revealed that DWT had a high predictive value for FBOO with an area under the curve of 0.88 ± 0.06. Conclusions Ultrasound DWT measurement for FBOO is non-invasive,convenient and reliable.DWT 1.9 mm or greater assessed by ultrasound has a high predictive value and specificity for FBOO and can replace PFS in some extent.However,this cutoff value needs to be validated in multiple center and larger population study. Key words: Ultrasonography; Detrusor wall thickness; Urinary bladder neck obstruction; Female; Urodynamics

Modified Transurethral Incision for Primary Bladder Neck Obstruction in Women: A Method to Improve Voiding Function Without Urinary Incontinence

To describe the modified surgical technique and report the long-term outcomes of modified transurethral incision for the treatment of primary bladder neck obstruction in women. A total of 30 women were diagnosed with primary bladder neck obstruction from the videourodynamic study findings according to the Blaivas-Groutz nomogram for female bladder outlet obstruction. Patients with neurogenic, traumatic, anatomic, or iatrogenic causes of obstruction were excluded. The transurethral incision of the bladder neck was performed in all patients, with the modification of incising at 4 different sites on the bladder neck, at the 3-, 6-, 9-, and 12-o'clock positions. The urodynamic results and clinical improvement in voiding symptoms were assessed before surgery and 3, 48, and 60 months after treatment. Follow-up data were available for 30 (100%), 28 (93%), and 25 (83%) of the 30 patients at 3, 48, and 60 months postoperatively, respectively. During the 5-year follow-up, the mean International Prostate Symptom Score decreased from 23.3 to 5.9. The mean quality of life scores decreased from 4.4 to 2.1. The mean peak urinary flow rate increased from 7.61 to 17.53 mL/s. The mean postvoid residual urine volume decreased from 185.11 to 28.75 mL. The mean voiding detrusor pressure decreased from 62.12 to 21.92 cm H2O. All 25 patients had improvement in both objective and subjective voiding functions 5 years after this modified treatment. Only 1 woman (3%) had mild stress incontinence postoperatively and was cured after the patient performed levator ani exercises. The modified transurethral bladder neck incision is effective in the long term in relieving voiding difficulties owing to primary bladder neck obstruction in women without urinary incontinence.

The effect of urethral calibration on female primary bladder outlet obstruction

While primary bladder outlet obstruction (BOO) in women has become an increasingly recognized entity over the past few years, the optimal management for such condition is yet to be defined. We assessed the effect of urethral calibration in the treatment of female BOO. A retrospective review of female patients undergoing urethral calibration with urethral dilator for BOO from 2000 to 2009 was performed. BOO was defined as a maximum flow rate (Qmax) of less than 15 ml/s together with a detrusor pressure at maximum flow rate (PdetQmax) of more than 20 cmH(2)O in urodynamic studies in the absence of neurological disorders or mechanical causes. Pre-calibration and post-calibration urodynamic studies were compared. Twenty women were diagnosed of BOO on urodynamic criteria (mean age 56 ± 14 years). Sixty percent of the patients had obstructive symptoms, while 50% of them had irritative symptoms. Reassessment urodynamic studies were performed 6 months after urethral calibration. Although there was no significant change in Qmax and post-void residual urine after urethral calibration (9.6 ± 2.8 vs 9.7 ± 4.0 ml/s, p = 0.869 and 246 ± 196 vs 263 ± 198 ml, p = 0.753, respectively), PdetQmax significantly improved (72.2 ± 39 vs 50.2 ± 30.5 cmH(2)O, p = 0.013). Only one patient developed urinary tract infection after the procedure. No complication of incontinence had been observed. Among the 20 patients, 13 patients (65%) had a second urethral calibration after the reassessment urodynamic study for persistent symptoms. Female patients with bladder outlet obstruction showed improvement in the urodynamic parameters after urethral calibration. However, its durability is not certain yet. Future studies concerning clinical symptoms correlation with urodynamic parameters would help further delineate the role of urethral calibration in the management of bladder outlet obstruction in women.

Urethral Distortion After Placement of Synthetic Mid Urethral Sling

We retrospectively compared preoperative characteristics in patients with new onset lower urinary tract symptoms after receiving a mid urethral sling who did (group 1) and did not (group 2) have radiographically confirmed urethral distortion during voiding. After receiving institutional review board approval we reviewed the charts of patients who underwent mid urethral sling excision for new onset lower urinary tract symptoms between January 2003 and July 2009. We collected demographic and questionnaire data, including the Urogenital Distress Inventory, Incontinence Impact Questionnaire and visual analog scale (score 0 to 10) for quality of life, and preoperative urodynamics data, including maximum flow, detrusor pressure at maximum flow and post-void residual urine. Lateral voiding cystourethrogram was done with the patient standing. Of 87 operable patients 23 were excluded from analysis due to lack of a voiding cystourethrogram (16) or of the voiding phase on voiding cystourethrogram (7). Groups 1 and 2 consisted of 51 and 13 patients, respectively. Age, time to sling excision, and Urogenital Distress Inventory, Incontinence Impact Questionnaire and quality of life scores were not significantly different between the groups. Preoperative urodynamic parameters in 37 group 1 and 7 group 2 patients revealed a mean detrusor pressure at maximum flow of 31.1 and 22.2 cm H(2)O, respectively (p = 0.25). Mean preoperative maximum flow was 13.4 and 15.4 ml per second (p = 0.59), and median post-void residual urine was 45.5 and 8.3, ml respectively (p = 0.16). Despite similar baseline symptoms and uroflow characteristics patients with urethral distortion had 50% higher detrusor pressure and greater post-void residual urine than those without urethral distortion. Flow rate alone may be insufficient to predict the impact of the mid urethral sling on bladder function in patients with new onset lower urinary tract symptoms.

Comparison of alpha-blocker, extracorporeal magnetic stimulation alone and in combination in the management of female bladder outlet obstruction

To determine the effects of alpha-blocker, extracorporeal magnetic innervations (ExMI) alone and combination treatment on female bladder outlet obstruction (BOO). Sixty women with BOO were divided into three groups according to the treatment. After 3 months, the clinical outcomes were evaluated by clinical examination, international prostatic symptom score (IPSS), quality of life (QOL), 3-day voiding diary, uroflowmetry and post-void residual. At 3 months, symptom improvement was 52.6% in alpha-blocker monotherapy (group I), 50.0% in ExMI monotherapy (group II), and 57.1% in combination therapy (group III). Maximum flow rate increased and total IPSS decreased significantly in all groups (p < 0.05). Storage symptom subscore was more reduced in groups II and III and QOL improved significantly in group III (p < 0.05) This study demonstrates that both alpha-blocker and ExMI were effective in female BOO, and ExMI may be more effective for improving storage symptoms.

Videourodynamic characteristics of female bladder outlet obstruction

Objective To analyze videourodynamic characteristics of female bladder outlet obstruction (BOO). Methods Retrospective analysis of videourodynamic characteristics were performed in 42 women with BOO. On the basis of the videourodynamic findings, women with BOO were categorized into five groups: bladder neck obstruction, middle urethra (urethral sphincter) obstruction, distal urethra obstruction, external orifice of urethra obstruction, high-grade pelvic organ prolapse. Data of five groups were compared in Qmax, maximum cystometric capacity, Pdet at Qmax, residual urine, detrusor instability and hydronephrosis. Data of all patients were analyzed by SPSS13 statistical software, measurement data by t-test and enumeration data by x2-test. Results Five groups had not significant deviation in the maximum cystometric capacity. however patients with bladder neck obstruction had significant deviation with others in Pdet at Qmax (78. 0 ± 23. 6)cm H2O, residual urine (120. 6±115.2)ml, Qmax (7.0±2.3)ml/s (P<0.05). There was significant deviation between middle urethra (urethral sphincter) obstruction(76.9%)and others in detrusor instability(P<0. 05). In all patients with hydronephrosis, bladder neck obstruction(57. 1 %) had significant deviation with others (P<0. 05). Conclusions Videourodynamic tests could assess lower urinary tract function, and may guide clinic management. The bladder neck obstruction was most serious and harmful to upper urinary tract. Key words: Female; Urodynamic; Bladder outlet obstruction

Urodynamic examination in diagnosis of female bladder outlet obstruction

Urodynamic examination in diagnosis of female bladder outlet obstruction

MP-17.12: A Study of Factors Predicting Female Bladder Outlet Obstruction Defined Using Pressure-flow Study

There is no standardized definition or established standards for urodynamic diagnosis of bladder outlet obstruction (BOO) for women. Particularly, on factors predicting female BOO in case the cause is not anatomical obstruction, there have been few studies. Thus, the present study purposed to evaluate the predictive factors for BOO defined using pressure-flow study in female patients without anatomical obstruction.

Overactive bladder symptoms following urethrolysis procedures

Female bladder outlet obstruction following stress urinary incontinence surgery is well described but requires a high index of suspicion given that patients often present clinically with both overactive bladder (OAB) and voiding symptoms. Furthermore, only 25% of patients have frank urinary retention that requires indwelling or clean intermittent catheterization. Historically, urethrolysis and sling lysis procedures ameliorate obstructive voiding symptoms with a success rate approaching 85% to 90%. In reviewing the literature, it has been my experience as well as those of other experts that OAB symptoms remain refractory in a significant percentage of women, often leading to further invasive therapies and additional morbidity. This review describes the OAB symptom complex following urethrolysis procedures for outlet obstruction and discusses the incidence, pathophysiology, and management of this complex patient cohort.

Botulinum toxin: An emerging therapy in female bladder outlet obstruction

Introduction:We evaluated the utility of botulinum toxin in functional female bladder outlet obstruction.Materials and Methods:A total of 7 consecutive female patients with bladder outlet obstruction were included. Patients with neurogenic bladder were excluded. All were previously treated with periodic dilations. Diagnosis was based on symptomatology, cystometry, and micturating cystograms. A total of 2 patients had been in chronic retention with residual volumes more than 400 ml. All were managed with an injection of botulinum toxin, 100 units in 2 ml of saline injected with a flexible cystoscopic needle. The site of the injection was deep submucosally, 0.5 ml in each quadrant at the level of the most prominent narrowing seen endoscopically. All the procedures were done as day care procedures under local anaesthesia. After the procedure, no catheter was placed. Patients were followed up for changes in IPSS scores and post void residual urine measurements. In all cases, multiple injections were used.Results:The follow-up period ranged from 48–52 weeks. The IPSS reduced by an average of 12 points. Post void residual urine reduced by 62%. Improvements commenced 4.85 days (average) after the procedure and lasted for an average of 16.8 weeks (range: 10.8–28 weeks).Discussion:There is a gradual improvement in symptoms over time and the maximal effect occurred at 10–14 days. The duration of improvement was approximately 16.8 weeks. All patients were satisfied by the degree of improvement felt.Conclusions:Botulinum toxin proved successful in improving the voiding characteristics. It possibly acts at the zone of hypertonicity at the bladder neck or midurethra. The only disadvantage is the high cost of the drug.

Predictive Factors for Female Bladder Outlet Obstruction Defined by Pressure-Flow Study

Purpose: We investigated pre-urodynamic study parameters of bladder outlet obstruction (BOO) defined by pressure-flow study (PFS) in female patients without anatomical obstruction. Materials and Methods: The cohort of this study consisted of 320 women who did not have anatomical BOO in whom urodynamic study was conducted for lower urinary tract symptoms (LUTS). BOO was defined when the PFS maximal flow rate (Qmax) was ≤12 ml/sec and Pdet Qmax was ≥25 cmH2O. The main outcomes were the incidence of BOO and its predictive factors in our cohort. Results: Of the total patients, 39 (12.2%) were diagnosed with BOO in the PFS. Free Qmax and maximal voided volume (MVV) were significant predictors of BOO (p 15 ml/sec or MVV is >350 ml, PFS may be not essential. On the contrary, if free Qmax and MVV are below these levels, PFS may be indicated to evaluate the presence of BOO. (Korean J Urol 2009;50: 848-853) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

SCHU-02: The Role of Steroid Hormones in Female Bladder Outlet Obstruction and in a Rat Model

SCHU-02: The Role of Steroid Hormones in Female Bladder Outlet Obstruction and in a Rat Model

Female urethral stricture disease

Female urethral stricture disease is a rare entity. The most common etiologies are traumatic injury, iatrogenic injury, and inflammatory disease resulting in periurethral fibrosis. Hallmark symptoms are frequency and urgency, and may also be dysuria, hesitancy, slow stream, incontinence, and recurrent urinary tract infections. Female bladder outlet obstruction is a difficult entity to define, and the subset representing stricture disease may also be elusive. The diagnosis of female urethral stricture disease is usually based on symptoms, meatal appearance, and difficult instrumentation of the patient. Other testing, such as urodynamics, voiding urography, or cystoscopy, may be helpful. Treatment options are conservative management with dilatation, endoscopic treatment, or open repair with various tissue flaps or grafts. Considerable controversy surrounds the efficacy of urethral dilatation in women with voiding dysfunction.