Skip to main content

Advertisement

Log in

New Frontiers in Molecular and Imaging Research on Evaluation and Diagnosis of Bladder Outlet Obstruction in Women

  • Reconstructed Bladder Function & Dysfunction (M. Kaufman, Section Editor)
  • Published:
Current Bladder Dysfunction Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Diagnosis of bladder outlet obstruction (BOO) often presents a challenge in female patients. Traditional diagnostic elements such as symptom history and urodynamic data are rarely clear cut in women. Therefore, we sought to review the current literature on diagnosis of female BOO, focusing on new frontiers in the realm of molecular markers and imaging modalities.

Recent Findings

In addition to fluoroscopy in the setting of videourodynamics, ultrasound and MRI can augment the diagnosis and aid in therapeutic planning in certain etiologies of female BOO. Furthermore, multiple potential biomarkers (i.e., nerve growth factor, prostaglandins, ATP) that have been studied in correlation to BOO in animal models as well as human subjects hold promise for diagnostic applications.

Summary

These novel techniques may augment standard clinical and urodynamic evaluation of BOO in females. Future directions include further studies of each of these biomarkers in female patients with BOO compared to normal controls to test their feasibility as potential screening tools.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Kuo HC. Clinical symptoms are not reliable in the diagnosis of lower urinary tract dysfunction in women. J Formos Med Assoc. 2012;111(7):386–91.

    Article  PubMed  Google Scholar 

  2. Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn. 2010;29(1):4–20.

    PubMed  Google Scholar 

  3. Meier K, Padmanabhan P. Female bladder outlet obstruction: an update on diagnosis and management. Curr Opin Urol. 2016;26(4):334–41.

    Article  PubMed  Google Scholar 

  4. Fowler CJ, Griffiths D, de Groat WC. The neural control of micturition. Nat Rev Neurosci. 2008;9(6):453–66.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. de Groat WC, Griffiths D, Yoshimura N. Neural control of the lower urinary tract. Compr Physiol. 2015;5(1):327–96.

    PubMed  PubMed Central  Google Scholar 

  6. Steers WD, Ciambotti J, Erdman S, de Groat WC. Morphological plasticity in efferent pathways to the urinary bladder of the rat following urethral obstruction. J Neurosci. 1990;10(6):1943–51.

    CAS  PubMed  Google Scholar 

  7. Blaivas JG, Groutz A. Bladder outlet obstruction nomogram for women with lower urinary tract symptomatology. Neurourol Urodyn. 2000;19(5):553–64.

    Article  CAS  PubMed  Google Scholar 

  8. • Akikwala TV, Fleischman N, Nitti VW. Comparison of diagnostic criteria for female bladder outlet obstruction. J Urol. 2006;176(5):2093–7. This study evaluated the 5 widely accepted urodynamic definitions of BOO in females, applying them to a cohort of female patients and comparing them to each other as well as with clinical suspicion of BOO.

    Article  PubMed  Google Scholar 

  9. Chassagne S, Bernier PA, Haab F, Roehrborn CG, Reisch JS, Zimmern PE. Proposed cutoff values to define bladder outlet obstruction in women. Urology. 1998;51(3):408–11.

    Article  CAS  PubMed  Google Scholar 

  10. Lemack GE, Zimmern PE. Pressure flow analysis may aid in identifying women with outflow obstruction. J Urol. 2000;163(6):1823–8.

    Article  CAS  PubMed  Google Scholar 

  11. Defreitas GA, Zimmern PE, Lemack GE, Shariat SF. Refining diagnosis of anatomic female bladder outlet obstruction: comparison of pressure-flow study parameters in clinically obstructed women with those of normal controls. Urology. 2004;64(4):675–9. discussion 9-81

    Article  PubMed  Google Scholar 

  12. Nitti VW, Tu LM, Gitlin J. Diagnosing bladder outlet obstruction in women. J Urol. 1999;161(5):1535–40.

    Article  CAS  PubMed  Google Scholar 

  13. Rademakers K, Apostolidis A, Constantinou C, Fry C, Kirschner-Hermanns R, Oelke M, et al. Recommendations for future development of contractility and obstruction nomograms for women. ICI-RS 2014. Neurourol Urodyn. 2016;35(2):307–11.

    Article  PubMed  Google Scholar 

  14. Fowler CJ, Kirby RS, Harrison MJ. Decelerating burst and complex repetitive discharges in the striated muscle of the urethral sphincter, associated with urinary retention in women. J Neurol Neurosurg Psychiatry. 1985;48(10):1004–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. FitzGerald MP, Blazek B, Brubaker L. Complex Repetitive discharges during urethral sphincter EMG: clinical correlates. Neurourol Urodyn. 2000;19(5):577–83.

    Article  CAS  PubMed  Google Scholar 

  16. Tawadros C, Burnett K, Derbyshire LF, Tawadros T, Clarke NW, Betts CD. External urethral sphincter electromyography in asymptomatic women and the influence of the menstrual cycle. BJU Int. 2015;116(3):423–31.

    Article  CAS  PubMed  Google Scholar 

  17. •• Larson K, Scott L, Cunningham TD, Zhao Y, Abuhamad A, Takacs P. Two-dimensional and three-dimensional transperineal ultrasound findings in women with high-pressure voiding after midurethral sling placement. Female Pelvic Med Reconstr Surg. 2017;23:141. This study identified transperineal ultrasound findings that correlated with high pressure voiding in women with lower urinary tract symptoms after mid-urethral sling placement.

    Article  PubMed  Google Scholar 

  18. Tunitsky-Bitton E, Unger CA, Barber MD, Goldman HB, Walters MD. Ultrasound evaluation of midurethral sling position and correlation to physical examination and patient symptoms. Female Pelvic Med Reconstr Surg. 2015;21(5):263–8.

    Article  PubMed  Google Scholar 

  19. Hegde A, Nogueiras M, Aguilar VC, Davila GW. Dynamic assessment of sling function on transperineal ultrasound: does it correlate with outcomes 1 year following surgery? Int Urogynecol J. 2016;

  20. Sarnelli G, D’Urso L, Muto G. Tension-free vaginal tape (TVT) for the treatment of female stress urinary incontinence (SUI): evaluating perineal ultrasound (PU) findings in postoperative voiding obstructive complaints. Archivio italiano di urologia, andrologia: organo ufficiale [di] Societa italiana di ecografia urologica e nefrologica. 2008;80(3):92–4.

    Google Scholar 

  21. Rautenberg O, Kociszewski J, Welter J, Kuszka A, Eberhard J, Viereck V. Ultrasound and early tape mobilization--a practical solution for treating postoperative voiding dysfunction. Neurourol Urodyn. 2014;33(7):1147–51.

    Article  PubMed  Google Scholar 

  22. Takacs P, Larson K, Scott L, Cunningham TD, DeShields SC, Abuhamad A. Transperineal sonography and urodynamic findings in women with lower urinary tract symptoms after sling placement. J Ultrasound Med. 2017;36(2):295–300.

    Article  PubMed  Google Scholar 

  23. Guzel O, Aslan Y, Balci M, Tuncel A, Keten T, Erkan A, et al. Can bladder wall thickness measurement be used for detecting bladder outlet obstruction? Urology. 2015;86(3):439–44.

    Article  PubMed  Google Scholar 

  24. Manonai J, Rostaminia G, Denson L, Shobeiri SA. Clinical and ultrasonographic study of patients presenting with transvaginal mesh complications. Neurourol Urodyn. 2016;35(3):407–11.

    Article  PubMed  Google Scholar 

  25. Galica V, Toska E, Saldutto P, Galatioto GP, Vicentini C. Use of transvaginal ultrasound in females with primary bladder neck obstruction. A preliminary study. Archivio italiano di urologia, andrologia: organo ufficiale [di] Societa italiana di ecografia urologica e nefrologica. 2015;87(2):158–60.

    Article  Google Scholar 

  26. Nitti VW. Primary bladder neck obstruction in men and women. Rev Urol. 2005;7(Suppl 8):S12–7.

    PubMed  PubMed Central  Google Scholar 

  27. Kim B, Hricak H, Tanagho EA. Diagnosis of urethral diverticula in women: value of MR imaging. AJR Am J Roentgenol. 1993;161(4):809–15.

    Article  CAS  PubMed  Google Scholar 

  28. Hyland MA, Lawson JT, O’Doherty A, Kennedy J, Biggart D. MRI findings in a rare cause of bladder outlet obstruction. Ulster Med J. 1996;65(1):81–3.

    CAS  PubMed  PubMed Central  Google Scholar 

  29. Rivlin ME, McGehee RP, Patel RB, Meeks GR. Acute urinary retention due to a free-standing broad ligament leiomyoma. J Miss State Med Assoc. 1992;33(10):355–7.

    CAS  PubMed  Google Scholar 

  30. Pavlica P, Bartolone A, Gaudiano C, Barozzi L. Female paraurethral leiomyoma: ultrasonographic and magnetic resonance imaging findings. Acta Radiol (Stockholm, Sweden: 1987). 2004;45(7):796–8.

    CAS  Google Scholar 

  31. Hwang JH, Lee JK, Oh MJ, Lee NW, Hur JY, Lee KW. A leiomyoma presenting as an exophytic periurethral mass: a case report and review of the literature. J Minim Invasive Gynecol. 2009;16(4):507–9.

    Article  PubMed  Google Scholar 

  32. Matsushima M, Asakura H, Sakamoto H, Horinaga M, Nakahira Y, Yanaihara H. Leiomyoma of the bladder presenting as acute urinary retention in a female patient: urodynamic analysis of lower urinary tract symptom; a case report. BMC Urol. 2010;10:13.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Nishizawa K, Matsuoka T, Watanabe Y, Wani Y, Terai A. Urinary retention in a female patient caused by a urethral venous thrombus with massive edema. Int J Urol. 2013;20(8):842–4.

    Article  PubMed  Google Scholar 

  34. Hruz P, Lovblad KO, Nirkko AC, Thoeny H, El-Koussy M, Danuser H. Identification of brain structures involved in micturition with functional magnetic resonance imaging (fMRI). J Neuroradiol Journal de neuroradiologie. 2008;35(3):144–9.

    Article  CAS  PubMed  Google Scholar 

  35. •• Shy M, Fung S, Boone TB, Karmonik C, Fletcher SG, Khavari R. Functional magnetic resonance imaging during urodynamic testing identifies brain structures initiating micturition. J Urol. 2014;192(4):1149–54. In this study, women with anatomic BOO were shown to have higher urinary NGF/Cr levels compared to age-matched controls; the NGF levels decreased after treatment of BOO, suggesting use in both diagnosis and monitoring resonse to therapy.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Kavia R, Dasgupta R, Critchley H, Fowler C, Griffiths D. A functional magnetic resonance imaging study of the effect of sacral neuromodulation on brain responses in women with Fowler’s syndrome. BJU Int. 2010;105(3):366–72.

    Article  PubMed  Google Scholar 

  37. Cruz CD. Neurotrophins in bladder function: what do we know and where do we go from here? Neurourol Urodyn. 2014;33(1):39–45.

    Article  CAS  PubMed  Google Scholar 

  38. Steers WD, Kolbeck S, Creedon D, Tuttle JB. Nerve growth factor in the urinary bladder of the adult regulates neuronal form and function. J Clin Invest. 1991;88(5):1709–15.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Liu HT, Kuo HC. Urinary nerve growth factor levels are increased in patients with bladder outlet obstruction with overactive bladder symptoms and reduced after successful medical treatment. Urology. 2008;72(1):104–8. discussion 8

    Article  PubMed  Google Scholar 

  40. Ha US, Park EY, Kim JC. Effect of botulinum toxin on expression of nerve growth factor and transient receptor potential vanilloid 1 in urothelium and detrusor muscle of rats with bladder outlet obstruction-induced detrusor overactivity. Urology. 2011;78(3):721.e1–6.

    Article  Google Scholar 

  41. Goi Y, Tomiyama Y, Yokoyama A, Tatemichi S, Maruyama K, Kobayashi M, et al. Effect of silodosin, a selective alpha(1A)-adrenoceptor antagonist, on voiding behavior and bladder blood flow in a rat model of bladder outlet obstruction. Eur J Pharmacol. 2015;764:489–96.

    Article  CAS  PubMed  Google Scholar 

  42. Chan R, Munoz A, Wenker EP, Stewart J, Boone T, Khavari R. The association of urinary nerve growth factor levels with bladder outlet obstruction in women. Female Pelvic Med Reconstr Surg. 2015;21(2):111–5.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Kim JC, Park EY, Seo SI, Park YH, Hwang TK. Nerve growth factor and prostaglandins in the urine of female patients with overactive bladder. J Urol. 2006;175(5):1773–6. discussion 6

    Article  CAS  PubMed  Google Scholar 

  44. Mikhailidis DP, Jeremy JY, Dandona P. Urinary bladder prostanoids—their synthesis, function and possible role in the pathogenesis and treatment of disease. J Urol. 1987;137(3):577–82.

    Article  CAS  PubMed  Google Scholar 

  45. Aoki K, Hirayama A, Tanaka N, Yoneda T, Yoshida K, Fujimoto K, et al. A higher level of prostaglandin E2 in the urinary bladder in young boys and boys with lower urinary tract obstruction. Biomed Res (Tokyo, Japan). 2009;30(6):343–7.

    Article  CAS  Google Scholar 

  46. Vlaskovska M, Kasakov L, Rong W, Bodin P, Bardini M, Cockayne DA, et al. P2X3 knock-out mice reveal a major sensory role for urothelially released ATP. J Neurosci. 2001;21(15):5670–7.

    CAS  PubMed  Google Scholar 

  47. Shiina K, Hayashida KI, Ishikawa K, Kawatani M. ATP release from bladder urothelium and serosa in a rat model of partial bladder outlet obstruction. Biomedical Res (Tokyo, Japan). 2016;37(5):299–304.

    Article  CAS  Google Scholar 

  48. Silva-Ramos M, Silva I, Oliveira JC, Correia-de-Sa P. Increased urinary adenosine triphosphate in patients with bladder outlet obstruction due to benign prostate hyperplasia. Prostate. 2016;76(15):1353–63.

    Article  CAS  PubMed  Google Scholar 

  49. Lin WY, Chen CS, Wu SB, Lin YP, Levin RM, Wei YH. Oxidative stress biomarkers in urine and plasma of rabbits with partial bladder outlet obstruction. BJU Int. 2011;107(11):1839–43.

    Article  CAS  PubMed  Google Scholar 

  50. Lin WY, Hsieh CC, Yang TY, Chen ML, Huang LY, Lin YP, et al. Transient increase in circulating myeloid-derived suppressor cells after partial bladder outlet obstruction. J Urol. 2014;192(5):1569–73.

    Article  CAS  PubMed  Google Scholar 

  51. Clayton DB, Stephany HA, Ching CB, Rahman SA, Tanaka ST, Thomas JC, et al. F2-isoprostanes as a biomarker of oxidative stress in the mouse bladder. J Urol. 2014;191(5 Suppl):1597–601.

    Article  CAS  PubMed  Google Scholar 

  52. Brierly RD, Hindley RG, McLarty E, Harding DM, Thomas PJ. A prospective evaluation of detrusor ultrastructural changes in bladder outlet obstruction. BJU Int. 2003;91(4):360–4.

    Article  CAS  PubMed  Google Scholar 

  53. Wang A, Brammah S, Tse V, Chan L. Comparison of ultrastructural features in female and male bladder outlet obstruction—a potential role for diagnostic detrusor muscle biopsy. Am Urol Assoc. 2015;New Orleans, LA2015, 05/19/2015.

  54. Hughes FM Jr, Hill HM, Wood CM, Edmondson AT, Dumas A, Foo WC, et al. The NLRP3 inflammasome mediates inflammation produced by bladder outlet obstruction. J Urol. 2016;195(5):1598–605.

    Article  CAS  PubMed  Google Scholar 

  55. Michishita M, Yano K, Tomita KI, Matsuzaki O, Kasahara KI. Piezo1 expression increases in rat bladder after partial bladder outlet obstruction. Life Sci. 2016;166:1–7.

    Article  CAS  PubMed  Google Scholar 

  56. Chung HC, Lee CK, Park KH, Jeong SW. Bladder outlet obstruction causes up-regulation of nicotinic acetylcholine receptors in bladder-projecting pelvic ganglion neurons. Brain Res. 2015;1602:111–8.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

This study is supported by the National Institutes of Health Grant K12 DK0083014 and the Multidisciplinary K12 Urologic Research Career Development Program to Dolores J. Lamb from the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health (RK).

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Rose Khavari.

Ethics declarations

Conflict of Interest

Drs Martinez and Dr. Khavari have no conflicts of interests to disclose.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Reconstructed Bladder Function & Dysfunction

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Martinez, L., Khavari, R. New Frontiers in Molecular and Imaging Research on Evaluation and Diagnosis of Bladder Outlet Obstruction in Women. Curr Bladder Dysfunct Rep 12, 291–297 (2017). https://doi.org/10.1007/s11884-017-0429-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11884-017-0429-0

Keywords

Navigation