Diagnosis and management of outlet obstruction in the female:

Bladder outlet obstruction is associated with bladder oversensitivity in women

INTRODUCTION AND HYPOTHESIS

Bladder outlet obstruction (BOO) in women might be associated with significant lower urinary tract storage symptoms such as increased frequency, urgency, and incontinence. This prospective study was designed to assess whether there is an objective association between BOO and abnormal parameters during filling cystometry in women.

METHODS

A total of 169 consecutive women (mean age 56 ± 14 years) who were referred for urodynamic investigation were prospectively recruited. Comprehensive medical, obstetric, and gynecological histories were recorded. All patients underwent physical examination, renal and bladder ultrasound, and filled out the International Prostate Symptoms Score (IPSS) questionnaire. The cohort was divided into obstructed and un-obstructed groups based on pressure flow results (Obstruction: Q_max <12 ml/s and P_det @ Q_max >25 cmH₂O).

RESULT

There was no significant difference in the frequency of detrusor overactivity between the obstructed and non-obstructed group (37% vs 32%, p = 0.71). All bladder sensation volumes were significantly lower in obstructed women than non-obstructed women in univariate and multivariate logistic regression analyses. Of the sensation parameters, first desire to void (FDV) had the highest area under the curve (AUC = 0.75, 95% CI = 0.672-0.837, p < 0.001) for predicting BOO. FDV < 105 ml showed a strong association with BOO with OR = 9.84 (95% CI 4.122-23.508, p < 0.0001). On univariate and multivariate analyses adjusted to 50 cc reduction in sensation volume, all sensation parameters, were associated with bladder outlet obstruction.

CONCLUSION

Our results suggest that there might be a strong association between bladder oversensitivity and BOO in women. This may shed light on the pathophysiological connection between obstruction and enhanced afferent signaling from the bladder.

Female urethral condyloma causing bladder outlet obstruction

In women, urethral condyloma rarely leads to a bladder outlet obstruction. A 39-year-old woman who presented with frequency, urgency, and residual urine sensation was found to have a condyloma in her urethral meatus. Urodynamic study indicated bladder outlet obstruction. After condyloma excision, she returned to normal voiding, and the free maximum flow rate improved. In women, excision of urethral condylomas that cause obstruction can be an effective treatment with early recovery of voiding function.

Bladder contractility and urethral resistance relation: what does a pressure flow study tell us?

Hydrodynamic analysis of a pressure flow study is the only reliable method to determine the presence or absence of a bladder outlet obstruction, especially benign prostatic obstruction. To interpret the results of pressure flow study in benign prostatic obstruction, understanding the outlines of the basic theory about evaluation of the relationship between bladder contractility and urethral resistance relation is of paramount importance. In contrast, hydrodynamic analysis of pressure flow study in conditions other than benign prostatic obstruction is complicated by the limits of theories about the hydrodynamics of the lower urinary tract. In this review, the proposed hydrodynamic theories about the relationship between bladder contractility and urethral resistance relation are outlined. Then, problems encountered in the application of hydrodynamic analysis of pressure flow study to diseases other than benign prostatic obstruction are discussed.

The clinical characteristics of uterine tumor-related bladder outlet obstruction

INTRODUCTION AND HYPOTHESIS

The aim of this study was to assess the clinical characteristics of bladder outlet obstruction caused by uterine tumors.

METHODS

We collected and analyzed data for eight patients who visited our urologic clinic due to voiding difficulty or acute urinary retention in the early morning and whose final, corroborated diagnoses were uterine tumors. Another eight patients with uterine tumor but without voiding symptoms were included as the controls.

RESULTS

In group 1, six patients experienced acute early-morning urinary retention and two patients experienced severe early-morning voiding difficulty. This voiding difficulty lessened significantly during the day. All patients in group 1 received urodynamic studies which indicated a high detrusor voiding pressure (median, 28.5 cmH(2)O). The uroflowmetry test performed during the day showed a good maximal flow rate (median, 27 ml/s). Seven patients in group 1 who underwent surgery no longer had early-morning emptying symptoms. All tumors were located in the posterior uterine wall, in contrast to the control group whose tumors were located in fundus or anterior wall.

CONCLUSIONS

Early-morning urinary retention or voiding difficulty can be considered as an important symptom of a uterine tumor obstructing the bladder outlet.