Voiding dysfunction in women: How to manage it correctly

Peer review under responsibility of Arab Association of Urology.

Figures & data

Table 1 The causes of female VD.

Condition	Type	Detail
(1) Abnormal detrusor activity (underactive/acontractile)	Neurogenic	Cerebral:
		Cerebrovascular stroke
		Multiple sclerosis
		Multiple system atrophy
		Hydrocephalus
		Tumour (brain, spinal cord)
		Spinal (sacral):
		Spinal cord injury
		Disc herniation
		Transverse myelitis
		Spina bifida
		Subsacral (peripheral):
		Pelvic nerve injury (iatrogenic – traumatic)
	Myogenic	Ageing
		ApBO
	Mixed	DM
	Other risk factors	Menopause
		Immobility
		Recurrent UTI
		Anaesthesia
		Post operative
		Drugs
		Psychological
(2) BOO	Anatomical	Iatrogenic obstruction:
		Anti-incontinence (sling) procedures
		Urethral procedures
		POP
		Anterior vaginal wall prolapse
		Apical prolapse (procedentia)
		Inflammatory process:
		Inflammation of urethra
		Urethral stricture
		Urethral diverticulum
		Miscellaneous:
		Bladder calculi/tumour
		Retroverted uterus
		Female genital tumours
	Functional	Dysfunctional voiding
		DSD
		Fowler’s syndrome

Figure 1 Results from a 44-year-old woman who underwent several urethrotomies and urethroplasty, and presented with severe voiding symptoms and a high PVR: (a) Uroflowmetry showed a prolonged fluctuating pattern with a decreased Q_max and a PVR of 670 mL. (b) The PFS showed a high PdetQ_max of 64 cm H₂O and a low Q_max of 4 mL/s. (c) VCUG showed a closed bladder neck due to functional and anatomical reasons.

Figure 2 A urodynamic study of a 91-year-old woman with mixed urgency and stress continence. (a) The urodynamic curves show DO with weak detrusor contractions, accompanied by increased EMG activity (she tries to hold on voluntarily when urgency occurs), at maximum cystometric bladder capacity only a minor increase of detrusor pressure, and voiding by abdominal straining. (b) On blocking the bladder neck with the inflated balloon of the urodynamic catheter, there is a good detrusor contraction with a detrusor pressure amplitude of 50 cm H₂O, indicating that with increased outlet resistance (e.g. after sling implantation), a detrusor contraction can occur.