Testing in Women with Lower Urinary Tract Dysfunction

Pressure flow studies in men and women

There are well established pressure flow criteria and nomograms for urinary obstruction in men. The pressure flow criteria for female urinary obstruction are not well established due to differences in female voiding dynamics as compared to men. Typically, other information such as radiographic data and clinical symptoms are needed to facilitate the diagnosis. Detrusor underactivity remains a poorly studied clinical condition without definitive urodynamic diagnostic criteria. Modalities proposed for objective analysis of detrusor function such as power (watt) factor, linear passive urethral resistance relation and BCI nomogram were all developed to analyze male voiding dysfunction. Overall, further investigation is needed to establish acceptable urodynamic criteria for defining detrusor underactivity in women.

Fistula campaigns--are they of any benefit?

OBJECTIVE

Evaluation of the problems encountered during a voluntarily fistula campaign in a regional hospital of Niger (Africa).

MATERIALS AND METHODS

Women underwent basic gynecological examination, methylene blue testing, and/or direct cystoscopy as necessary. According to their clinical condition, women were informed and surgical options offered as appropriate. Operations were performed under spinal or epidural anesthesia. Immediate postoperative outcomes were followed during the stay of the surgical team in the country.

RESULTS

A total of 62 women were examined and 11 had causes of incontinence other than obstetric fistula. In 9.8% of the women, severe local infection precluding any surgical intervention was evident. In 58.8% of patients, the trigonal region and/or urethra were irreversibly damaged. A proportion of patients (9.8%) with large lesions and intact urethra that were offered vaginal layered closure refused the intervention. Of the women that were operated on (21.6%), six underwent vaginal layered closure with Martius fat flap and five women underwent a combined abdomino-vaginal approach.

CONCLUSION

It is extremely difficult to meet the needs of this global problem with short term programs and volunteers. Directing these efforts to specialist fistula centers and creating reliable scientific evidence should be the main goal.