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Urodynamic assessment of bladder-outlet obstruction in women

Nature Clinical Practice Urology volume 3, pages 38–44 (2006)Cite this article

Abstract

Bladder-outlet obstruction (BOO) in women has become an increasingly recognized entity over the past several years. This is partly because of the greater number of anti-incontinence surgeries being performed, which can infrequently result in iatrogenic obstruction; and partly because of improvements in the ability to diagnose and recognize BOO. In this review, the symptoms associated with BOO in women, and whether these symptoms can reliably predict the presence of BOO, will be discussed. The incidence of BOO following surgical anti-incontinence procedures and the urodynamic diagnosis of BOO in women, detailing the various criteria that have been proposed, are also reviewed.

Key Points

  • Bladder-outlet obstruction (BOO) in women is an increasingly recognized clinical entity in urology practices

  • Symptoms of BOO in women can be quite varied; while the most common complaint might be difficulty in voiding, the absence of this symptom does not rule out BOO

  • Although various criteria have been proposed to define BOO in women, none are universally accepted; most focus on combined pressure–flow criteria (differing from values in men), with or without fluoroscopic evidence of obstruction

  • Postsurgical BOO seems to be less common with tension-free anti-incontinence procedures, with overall less dramatic changes in pressure–flow values than have been noted following conventional sling procedures; it has not yet been unequivocally demonstrated if transobturator procedures are less obstructive than retropubic synthetic-sling procedures

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Figure 1: Receiver operating characteristic curves for maximum flow, and detrusor pressure at maximum flow.
Figure 2: A bladder-outlet obstruction nomogram for women.

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Authors and Affiliations

  1. Associate Professor and Residency Program Director in the Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Gary E Lemack

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  1. Gary E Lemack
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Correspondence to Gary E Lemack.

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Lemack, G. Urodynamic assessment of bladder-outlet obstruction in women. Nat Rev Urol 3, 38–44 (2006). https://doi.org/10.1038/ncpuro0378

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