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Evaluation of Urinary Retention in Women: Pelvic Floor Dysfunction or Primary Bladder Neck Obstruction

  • Voiding Dysfunction Evaluation (JT Anger, Section Editor)
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Abstract

Urinary retention in women is a condition resulting from various etiologies. Pelvic floor dysfunction and primary bladder outlet obstruction are two relatively common causes of bladder outlet obstruction (the major treatable cause of urinary retention). These two entities are treated in drastically different ways, making accurate diagnosis paramount. Urodynamic testing with fluoroscopic imaging remains the gold standard to accurately complete this evaluation. In this article, we review these conditions, their evaluation, and treatment.

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References

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

  1. Dmochowski R. Urinary retention in women. Appell R, editor. Voiding dysfunction: diagnosis and treatment. 2000.

  2. Drake M, Mevcha A. Etiology and management of urinary retention in women. Indian J Urol. 2010;26(2):230–5.

    Article  PubMed  Google Scholar 

  3. Brucker BM, Fong E, Shah S, Rosenblum N, Kelly C, Nitti VW. Urodynamic differences between dysfunctional voiding and primary bladder neck obstruction in women. Urology. 2012; Accepted for publication April 9.

    Google Scholar 

  4. Wein A, Barrett D. Voiding function and dysfunction. Chicago: Year Book Medical; 1988. p. 371.

    Google Scholar 

  5. Patel R, Nitti V. Bladder outlet obstruction in women: prevalence, recognition, and management. Curr Urol Rep. 2001;2(5):379–87.

    Article  PubMed  CAS  Google Scholar 

  6. Kuo H-C. Videourodynamic characteristics and lower urinary tract symptoms of female bladder outlet obstruction. Urology. 2005;66(5):1005–9.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  8. •• 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;4–20. This is a comprehensive work that standardizes terminology for clinicians and researchers working in the field of female pelvic floor dysfunction.

  9. Allen TD. The non-neurogenic neurogenic bladder. J Urol. 1977;117(2):232–8.

    PubMed  CAS  Google Scholar 

  10. Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, et al. The standardisation of terminology of lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Neurourol Urodyn. 2002;167–78.

  11. Deindl, Vodusek, Bischoff, Hofmann, Hartung. Dysfunctional voiding in women: which muscles are responsible? BJU Int. 1998;82(6):814–9.

    Article  CAS  Google Scholar 

  12. Hinman F. Nonneurogenic neurogenic bladder (the Hinman syndrome)–15 years later. J Urol. 1986;136(4):769–77.

    PubMed  Google Scholar 

  13. Sinha S. Dysfunctional voiding: a review of the terminology, presentation, evaluation and management in children and adults. Indian J Urol. 2011;27(4):437–47.

    Article  PubMed  Google Scholar 

  14. Groutz A, Blaivas J, Pies C. Learned voiding dysfunction (non-neurogenic, neurogenic bladder) among adults. Neurourol Urodyn. 2001;20:259–68.

    Article  PubMed  CAS  Google Scholar 

  15. Jørgensen T, Djurhuus J, Schrøder H. Idiopathic detrusor sphincter dyssynergia in neurologically normal patients with voiding abnormalities. Eur Urol. 1982;8(2):107–10.

    Google Scholar 

  16. Marion G. Surgery of the neck of the bladder. Br J Urol. 1933;5:351.

    Article  Google Scholar 

  17. Turner-Warwick R, Whiteside CG, Worth PH, Milroy EJ, Bates CP. A urodynamic view of the clinical problems associated with bladder neck dysfunction and its treatment by endoscopic incision and trans-trigonal posterior prostatectomy. Br J Urol. 1973;45(1):44–59.

    PubMed  CAS  Google Scholar 

  18. Diokno AC, Hollander JB, Bennett CJ. Bladder neck obstruction in women: a real entity. J Urol. 1984;132(2):294–8.

    PubMed  CAS  Google Scholar 

  19. Leadbetter GW, Leadbetter WF. Diagnosis and treatment of congenital bladder-neck obstruction in children. N Engl J Med. 1959;260(13):633–7.

    Article  PubMed  Google Scholar 

  20. Awad SA, Downie JW, Lywood DW, Young RA, Jarzylo SV. Sympathetic activity in the proximal urethra in patients with urinary obstruction. J Urol. 1976;115(5):545–7.

    PubMed  CAS  Google Scholar 

  21. Jin X-B, Qu H-W, Liu H, Li B, Wang J, Zhang Y-D. Modified transurethral incision for primary bladder neck obstruction in women: a method to improve voiding function without urinary incontinence. Urology. 2012;79(2):310–3.

    Article  PubMed  Google Scholar 

  22. Bellina JH, Schenck D, Millet AH, Denicola CM, Kelly R, Cook A. Outflow uropathy: occupational disorder? J La State Med Soc. 1999;151(8):414–9.

    PubMed  CAS  Google Scholar 

  23. Carlson KV, Rome S, Nitti VW. Dysfunctional voiding in women. J Urol. 2001;165(1):143–7. discussion 147–8.

    Article  PubMed  CAS  Google Scholar 

  24. Athanasopoulos A, Gyftopoulos K, Giannitsas K, Perimenis P. Effect of alfuzosin on female primary bladder neck obstruction. Int Urogynecol J Pelvic Floor Dysfunct. 2009;20(2):217–22.

    Article  PubMed  CAS  Google Scholar 

  25. Akbal C, Genc Y, Burgu B, Ozden E, Tekgul S. Dysfunctional voiding and incontinence scoring system: quantitative evaluation of incontinence symptoms in pediatric population. J Urol. 2005;173(3):969–73.

    Article  PubMed  Google Scholar 

  26. Tuygun C, Sertcelik N, Bakirtas H, Cakici H, Cetin K, Imamoglu AM. Usefulness of a new dysfunctional voiding and incontinence scoring system in predicting treatment effect in children with voiding dysfunction. Urol Int. 2007;79(1):76–82.

    Article  PubMed  Google Scholar 

  27. Scarpero HM, Fiske J, Xue X, Nitti VW. American Urological Association Symptom Index for lower urinary tract symptoms in women: correlation with degree of bother and impact on quality of life. Urology. 2003;61(6):1118–22.

    Article  PubMed  Google Scholar 

  28. Groutz A, Blaivas JG, Rosenthal JE. A simplified urinary incontinence score for the evaluation of treatment outcomes. Neurourol Urodyn. 2000;19(2):127–35.

    Article  PubMed  CAS  Google Scholar 

  29. Rosenblum N, Scarpero H. Voiding dysfunction in young, nulliparous women: symptoms and urodynamic findings. Int Urogynecol. 2004;15(6):373–7.

    Google Scholar 

  30. Dupont M, Raz S. Urodynamics: contemporary evolution. In: Nitti V, editor. Practical urodynamics. 1st ed. Philadel: W.B. Saunders Company; 1998. p. 2–4.

    Google Scholar 

  31. Combs AJ, Grafstein N, Horowitz M, Glassberg KI. Primary bladder neck dysfunction in children and adolescents I: pelvic floor electromyography lag time—a new noninvasive method to screen for and monitor therapeutic response. J Urol. 2005;173(1):207–10. discussion 210–1.

    Article  PubMed  Google Scholar 

  32. Bradley CS, Smith KE, Kreder KJ. Urodynamic evaluation of the bladder and pelvic floor. Gastroenterol Clin North Am. 2008;37(3):539–52. vii.

    Article  PubMed  Google Scholar 

  33. Wein A, Barrett D. Etiologic possibilities for increased pelvic floor electromyography activity during cystometry. J Urol. 1982;127(5):949–52.

    PubMed  CAS  Google Scholar 

  34. Kirby AC, Nager CW, Litman HJ, FitzGerald MP, Kraus S, Norton P, et al. Perineal surface electromyography does not typically demonstrate expected relaxation during normal voiding. Neurourol Urodyn. 2011;30(8):1591–6.

    Google Scholar 

  35. Mahajan ST, Fitzgerald MP, Kenton K, Shott S, Brubaker L. Concentric needle electrodes are superior to perineal surface-patch electrodes for electromyographic documentation of urethral sphincter relaxation during voiding. BJU Int. 2006;97(1):117–20.

    Article  PubMed  Google Scholar 

  36. Kessler TM, Fowler CJ. Sacral neuromodulation for urinary retention. Nat Clin Pract Urol. 2008;5(12):657–66.

    Article  PubMed  Google Scholar 

  37. Fowler CJ, Christmas TJ, Chapple CR, Parkhouse HF, Kirby RS, Jacobs HS. Abnormal electromyographic activity of the urethral sphincter, voiding dysfunction, and polycystic ovaries: a new syndrome? BMJ. 1988;297(6661):1436–8.

    Article  PubMed  CAS  Google Scholar 

  38. Wiseman O, Kitchen N, Fowler C. Long-term results of sacral neuromodulation for women with urinary retention. BJU Int. 2004;335–337.

  39. Smith PP, Appell RA. Functional obstructed voiding in the neurologically normal patient. Curr Urol Rep. 2006;7(5):346–53.

    Article  PubMed  Google Scholar 

  40. Voorham-Van Der Zalm P, Pelger R, Stiggelbout A, Elzeveveir H, Nijeholt GAL. Effects of magnetic stimulation in the treatment of pelvic floor dysfunction. BJU Int. 2006;97:1035–8.

    Article  PubMed  Google Scholar 

  41. McKenna PH, Herndon CDA, Connery S, Ferrer FA. Pelvic floor muscle retraining for pediatric voiding dysfuntion using interactive computer games. J Urol. 1999;162(3):1056–62.

    Article  PubMed  CAS  Google Scholar 

  42. Barroso U, Lordêlo P, Lopes AA, Andrade J, Macedo A, Ortiz V. Nonpharmacological treatment of lower urinary tract dysfunction using biofeedback and transcutaneous electrical stimulation: a pilot study. BJU Int. 2006;98(1):166–71.

    Article  PubMed  Google Scholar 

  43. • Minardi D, d'Anzeo G, Parri G, Polito M, Piergallina M, Asmar El Z, et al. The role of uroflowmetry biofeedback and biofeedback training of the pelvic floor muscles in the treatment of recurrent urinary tract infections in women with dysfunctional voiding: a randomized controlled prospective study. Urology. 2010;75(6):1299–304. This is a secondary analysis of EMG data from the SISTer trial (a multicenter trial for stress urinary incontinence). EMG activity measured by perineal surface patch electrodes did not measure the expected pelvic floor and urethral sphincter relaxation during voiding. This highlights that increased EMG activity needs to be interpreted in the appropriate clinical context.

    Article  PubMed  Google Scholar 

  44. Franco I, Landau-Dyer L, Isom-Batz G, Collett T, Reda EF. The use of botulinum toxin A injection for the management of external sphincter dyssynergia in neurologically normal children. J Urol. 2007;178(4, Supplement 1):1775–80.

    Google Scholar 

  45. Fan Y-H, Lin ATL, Wu H-M, Hong C-J, Chen K-K. Psychological profile of female patients with dysfunctional voiding. Urology. 2008;71(4):625–9.

    Article  PubMed  Google Scholar 

  46. Pannek J, Einig E-M, Einig W. Clinical management of bladder dysfunction caused by sexual abuse. Urol Int. 2009;82(4):420–5.

    Article  PubMed  Google Scholar 

  47. Fandel T, Tanagho EA. Neuromodulation in voiding dysfunction: a historical overview of neurostimulation and its application. Urol Clin North Am. 2005;32(1):1–10.

    Article  PubMed  Google Scholar 

  48. Roth TJ, Vandersteen DR, Hollatz P, Inman BA, Reinberg YE. Sacral neuromodulation for the dysfunctional elimination syndrome: a single center experience with 20 children. J Urol. 2008;180(1):306–11.

    Article  PubMed  Google Scholar 

  49. Xu D, Qu C, Meng H, Ren J, Zhu Y, Min Z, et al. Dysfunctional voiding confirmed by transdermal perineal electromyography, and its effective treatment with baclofen in women with lower urinary tract symptoms: a randomized double-blind placebo-controlled crossover trial. BJU Int. 2007;100(3):588–92.

    Article  PubMed  CAS  Google Scholar 

  50. Ayan S, Kaya K, Topsakal K, Kilicarslan H. Efficacy of tolterodine as a first-line treatment for non-neurogenic voiding dysfunction in children. BJU Int. 2005;96:411–4.

    Article  PubMed  CAS  Google Scholar 

  51. Ayan S, Topsakal K, Gokce G, Gultekin EY. Efficacy of combined anticholinergic treatment and behavioral modification as a first line treatment for nonneurogenic and nonanatomical voiding dysfunction in children: a randomized controlled trial. J Urol. 2007;177(6):2325–9.

    Article  PubMed  CAS  Google Scholar 

  52. Rogalski MJ, Kellogg-Spadt S, Hoffmann AR, Fariello JY, Whitmore KE. Retrospective chart review of vaginal diazepam suppository use in high-tone pelvic floor dysfunction. Int Urogynecol J Pelvic Floor Dysfunct. 2010;21(7):895–9.

    Article  Google Scholar 

  53. Heymen S, Scarlett Y, Jones K, Ringel Y, Drossman D, Whitehead WE. Randomized, controlled trial shows biofeedback to be superior to alternative treatments for patients with pelvic floor dyssynergia-type constipation. Dis Colon Rectum. 2007;50(4):428–41.

    Article  PubMed  Google Scholar 

  54. Padmanabhan P, Nitti VW. Primary bladder neck obstruction in men, women, and children. Curr Urol Rep. 2007;8(5):379–84.

    Article  PubMed  Google Scholar 

  55. Kumar A, Mandhani A, Gogoi S, Srivastava A. Management of functional bladder neck obstruction in women: use of alpha-blockers and pediatric resectoscope for bladder neck incision. J Urol. 1999;162(6):2061–5.

    Article  PubMed  CAS  Google Scholar 

  56. Kessler TM, Studer UE, Burkhard FC. The effect of terazosin on functional bladder outlet obstruction in women: a pilot study. J Urol. 2006;176(4):1487–92.

    Article  PubMed  CAS  Google Scholar 

  57. Peng C-H, Kuo H-C. Transurethral incision of bladder neck in treatment of bladder neck obstruction in women. Urology. 2005;65(2):275–8.

    Article  PubMed  Google Scholar 

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Brucker, B.M., Nitti, V.W. Evaluation of Urinary Retention in Women: Pelvic Floor Dysfunction or Primary Bladder Neck Obstruction. Curr Bladder Dysfunct Rep 7, 222–229 (2012). https://doi.org/10.1007/s11884-012-0146-7

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