Skip to main content
SpringerLink
Log in

Bladder Outlet Obstruction and Overactive Bladder in Females

  • Chapter
  • First Online:
Non-Neurogenic Bladder Dysfunctions

Part of the book series: Urodynamics, Neurourology and Pelvic Floor Dysfunctions ((UNPFD))

  • 331 Accesses

Abstract

BOO is a generic term that should be considered in patients with certain LUTS, including difficult voiding, abdominal straining during voiding or storage symptoms. The identification of BOO in female patients remains a complex issue as there are not strict urodynamic criteria to establish the diagnosis. The causes of BOO in females are several and can be divided into two major groups: functional and anatomic ones. It is important to correctly identify into which subtype that fits best patient’s BOO as management differs according to the cause, although all treatments share the common goals of preserving renal function and relieving symptoms. The management of female patients with concomitant bladder outlet obstruction may be pharmacological or surgical. Overactive bladder treatment must focus on control the OAB and resolve the bladder outlet obstruction. Management should be balanced between OAB and BOO. Indeed, the only treatment of OAB may cause the worsening of the BOO, and the only BOO management may not be resolutive of OAB.

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

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 59.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 79.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Abbreviations

BOO:

Bladder outlet obstruction

CIC:

Clean intermittent catheterization

CNS:

Central nervous system

DO:

Detrusor overactivity

EMG:

Electromyography

LUTS:

Lower urinary tract symptoms

MUI:

Mixed urinary incontinence

OAB:

Overactive bladder syndrome

PBNO:

Primary bladder neck obstruction

PVR:

Post void residual

QOL:

Quality of life

SUI:

Stress urinary incontinence

UI:

Urinary incontinence

UTI:

Urinary tract infection

UUI:

Urgency urinary incontinence

References

  1. Sereti M, Andersson K-E, Dmochowski R, Agrò EF, Heesakkers J, Iacovelli V, et al. Systematic review of combination drug therapy for non-neurogenic lower urinary tract symptoms. Eur Urol. 2019;75(1):129–68.

    Article  CAS  Google Scholar 

  2. Stewart WF, Van Rooyen JB, Cundiff GW, Abrams P, Herzog AR, Corey R, et al. Prevalence and burden of overactive bladder in the United States. World J Urol. 2003;20(6):327–36.

    Article  CAS  PubMed  Google Scholar 

  3. Milsom I, Abrams P, Cardozo L, Roberts RG, Thüroff J, Wein AJ. How widespread are the symptoms of an overactive bladder and how are they managed? A population-based prevalence study. BJU Int. 2001;87(9):760–6. https://doi.org/10.1046/j.1464-410x.2001.02228.x.

    Article  CAS  PubMed  Google Scholar 

  4. Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, et al. The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Urology. 2003;61(1):37–49.

    Article  PubMed  Google Scholar 

  5. Irwin DE, Milsom I, Hunskaar S, Reilly K, Kopp Z, Herschorn S, et al. Population-based survey of urinary incontinence, overactive bladder, and other lower urinary tract symptoms in five countries: results of the EPIC study. Eur Urol. 2006;50(6):1305–6.

    Article  Google Scholar 

  6. Hickling D, Aponte M, Nitti V. Evaluation and management of outlet obstruction in women without anatomical abnormalities on physical exam or cystoscopy. Curr Urol Rep. 2012;13(5):356–62.

    Article  PubMed  Google Scholar 

  7. 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. Int Urogynecol J. 2010;21(1):5–26.

    Article  PubMed  Google Scholar 

  8. Allen TD, Bright TC 3rd. Urodynamic patterns in children with dysfunctional voiding problems. J Urol. 1978;119(2):247–9.

    Article  CAS  PubMed  Google Scholar 

  9. 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 

  10. 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 

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

    CAS  Google Scholar 

  12. McGuire EJ, Savastano JA. Urodynamic studies in enuresis and the nonneurogenic neurogenic bladder. J Urol. 1984;132(2):299–302.

    Article  CAS  PubMed  Google Scholar 

  13. Hinman F, Baumann FW. Vesical and ureteral damage from voiding dysfunction in boys without neurologic or obstructive disease. J Urol. 1973;109(4):727–32.

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  15. Yalla SV, Resnick NM. Initiation of voiding in humans: the nature and temporal relationship of urethral sphincter responses. J Urol. 1997;157(2):590–5.

    Article  CAS  PubMed  Google Scholar 

  16. Crowe R, Noble J, Robson T, Soediono P, Milroy EJ, Burnstock G. An increase of neuropeptide Y but not nitric oxide synthase-immunoreactive nerves in the bladder neck from male patients with bladder neck dyssynergia. J Urol. 1995;154(3):1231–6.

    Article  CAS  PubMed  Google Scholar 

  17. 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  CAS  PubMed  PubMed Central  Google Scholar 

  18. Amarenco G, Raibaut P, Ismael SS, Rene-Corail P, Haab F. Evidence of occult dysautonomia in Fowler’s syndrome: alteration of cardiovascular autonomic function tests in female patients presenting with urinary retention. BJU Int. 2006;97(2):288–91.

    Article  PubMed  Google Scholar 

  19. Dongol A, Joshi KS. Renal impairment among patients with pelvic organ prolapse in a tertiary care center. Kathmandu Univ Med J (KUMJ). 2013;11(41):71–4.

    CAS  Google Scholar 

  20. Brubaker L, Norton PA, Albo ME, Chai TC, Dandreo KJ, Lloyd KL, et al. Adverse events over two years after retropubic or transobturator midurethral sling surgery: findings from the Trial of Midurethral Slings (TOMUS) study. Am J Obstet Gynecol. 2011;205(5):498.e1–6.

    Article  Google Scholar 

  21. Albo ME, Richter HE, Brubaker L, Norton P, Kraus SR, Zimmern PE, et al. Burch colposuspension versus fascial sling to reduce urinary stress incontinence. N Engl J Med. 2007;356(21):2143–55.

    Article  CAS  PubMed  Google Scholar 

  22. Peyronnet B, Mironska E, Chapple C, Cardozo L, Oelke M, Dmochowski R, et al. A comprehensive review of overactive bladder pathophysiology: on the way to tailored treatment. Eur Urol. 2019;75(6):988–1000.

    Article  PubMed  Google Scholar 

  23. Drake MJ, Mills IW, Gillespie JI. Model of peripheral autonomous modules and a myovesical plexus in normal and overactive bladder function. Lancet (London). 2001;358(9279):401–3.

    Article  CAS  Google Scholar 

  24. Hulls CM, Lentle RG, King QM, Reynolds GW, Chambers JP. Spatiotemporal analysis of spontaneous myogenic contractions in the urinary bladder of the rabbit: timing and patterns reflect reported electrophysiology. Am J Physiol Renal Physiol. 2017;313(3):F687–98.

    Article  CAS  PubMed  Google Scholar 

  25. Kushida N, Fry CH. On the origin of spontaneous activity in the bladder. BJU Int. 2016;117(6):982–92. https://doi.org/10.1111/bju.13240.

    Article  CAS  PubMed  Google Scholar 

  26. Hubeaux K, Deffieux X, Desseaux K, Verollet D, Damphousse M, Amarenco G. Stand up urgency: is this symptom related to a urethral mechanism? Prog Urol J Assoc Urol Soc Urol. 2012;22(8):475–81.

    CAS  Google Scholar 

  27. Petros PEP, Woodman PJ. The integral theory of continence. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19(1):35–40.

    Article  PubMed  Google Scholar 

  28. Kirschner-Hermanns R, Anding R, Rosier P, Birder L, Andersson KE, Djurhuus JC. Fundamentals and clinical perspective of urethral sphincter instability as a contributing factor in patients with lower urinary tract dysfunction—ICI-RS 2014. Neurourol Urodyn. 2016;35(2):318–23.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Al Afraa T, Campeau L, Mahfouz W, Corcos J. Urodynamic parameters evolution after artificial urinary sphincter implantation for post-radical prostatectomy incontinence with concomitant bladder dysfunction. Can J Urol. 2011;18(3):5695–8.

    Google Scholar 

  30. Li Marzi V, Morseli S, Mormile N, Serni S. Defunctionalized bladder and renal transplantation. In: Balzarro M, Li Marzi V, editors. Non neurogenic bladder dsynfunction. New York, NY: Springer; 2020.

    Google Scholar 

  31. Griffiths D, Tadic SD. Bladder control, urgency, and urge incontinence: evidence from functional brain imaging. Neurourol Urodyn. 2008;27(6):466–74.

    Article  PubMed  Google Scholar 

  32. Uren AD, Cotterill N, Harding C, Hillary C, Chapple C, Klaver M, et al. Qualitative exploration of the patient experience of underactive bladder. Eur Urol. 2017;72(3):402–7.

    Article  PubMed  Google Scholar 

  33. Rademakers KL, Drossaerts JM, van Kerrebroeck PE, Oelke M, van Koeveringe GA. Prediction of sacral neuromodulation treatment success in men with impaired bladder emptying-time for a new diagnostic approach. Neurourol Urodyn. 2017;36(3):808–10.

    Article  PubMed  Google Scholar 

  34. Vrijens D, Drossaerts J, van Koeveringe G, Van Kerrebroeck P, van Os J, Leue C. Affective symptoms and the overactive bladder – a systematic review. J Psychosom Res. 2015;78(2):95–108.

    Google Scholar 

  35. Klausner AP, Steers WD. Corticotropin releasing factor: a mediator of emotional influences on bladder function. J Urol. 2004;172(6 Pt 2):2570–3.

    Article  CAS  PubMed  Google Scholar 

  36. de Groat WC. Influence of central serotonergic mechanisms on lower urinary tract function. Urology. 2002;59(5 Suppl 1):30–6.

    Article  PubMed  Google Scholar 

  37. Hanna-Mitchell AT, Robinson D, Cardozo L, Everaert K, Petkov GV. Do we need to know more about the effects of hormones on lower urinary tract dysfunction? ICI-RS 2014. Neurourol Urodyn. 2016;35(2):299–303.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Lee K-C. Changes of muscarinic receptors and connexin-43 expression as a mechanism of overactive bladder in ovariectomized rats. World J Urol. 2015;33(11):1875–9.

    Article  CAS  PubMed  Google Scholar 

  39. Portman DJ, Gass MLS. Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women’s Sexual Health and the North American Menopause Society. Menopause. 2014;21(10):1063–8.

    Article  PubMed  Google Scholar 

  40. Aragón IM, Herrera-Imbroda B, Queipo-Ortuño MI, Castillo E, Del Moral JS-G, Gómez-Millán J, et al. The urinary tract microbiome in health and disease. Eur Urol Focus. 2018;4(1):128–38.

    Article  PubMed  Google Scholar 

  41. Thomas-White KJ, Hilt EE, Fok C, Pearce MM, Mueller ER, Kliethermes S, et al. Incontinence medication response relates to the female urinary microbiota. Int Urogynecol J. 2016;27(5):723–33.

    Article  PubMed  Google Scholar 

  42. Kaplan SA, Dmochowski R, Cash BD, Kopp ZS, Berriman SJ, Khullar V. Systematic review of the relationship between bladder and bowel function: implications for patient management. Int J Clin Pract. 2013;67(3):205–16.

    Article  CAS  PubMed  Google Scholar 

  43. Persson R, Wensaas K-A, Hanevik K, Eide GE, Langeland N, Rortveit G. The relationship between irritable bowel syndrome, functional dyspepsia, chronic fatigue and overactive bladder syndrome: a controlled study 6 years after acute gastrointestinal infection. BMC Gastroenterol. 2015;15:66.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  44. Matsumoto S, Hashizume K, Wada N, Hori J, Tamaki G, Kita M, et al. Relationship between overactive bladder and irritable bowel syndrome: a large-scale internet survey in Japan using the overactive bladder symptom score and Rome III criteria. BJU Int. 2013;111(4):647–52.

    Article  PubMed  Google Scholar 

  45. Abrams P, Cardozo L, Wagg A, Wein A. Initial assessment of urinary incontinence in adult male and female patients. 6th international consultation on incontinence, Tokyo September 2016. Incontinence 6th ed. Tokyo: Japanese Red Cross Medical Center; 2017. p. 497–517.

    Google Scholar 

  46. Segal J, Steele AC, Vassallo B, et al. Various surgical approaches to treat voiding dysfunction following anti-incontinence surgery. Int Urogynecol J. 2006;17:372–7.

    Article  Google Scholar 

  47. https://uroweb.org/guideline/urinary-incontinence/#3.

  48. Abrams P, Cardozo L, Wagg A, Wein A. Urodynamic testing. 6th international consultation on incontinence, Tokyo September 2016. Incontinence 6th ed. Tokyo: Japanese Red Cross Medical Center; 2017. p. 603–17.

    Google Scholar 

  49. Stoffel JT. Detrusor sphincter dyssynergia: a review of physiology, diagnosis, and treatment strategies. Transl Androl Urol. 2016;5(1):127–35.

    PubMed  PubMed Central  Google Scholar 

  50. Hoffman DS, Nitti VW. Female bladder outlet obstruction. Curr Urol Rep. 2016;17:31.

    Article  PubMed  Google Scholar 

  51. Aponte MM, Shah SR, Hickling D, et al. Urodynamics for clinically suspected obstruction after anti-incontinence surgery in women. J Urol. 2013;190:588–602.

    Article  Google Scholar 

  52. Nitti VW. Pressure flow urodynamic studies: the gold standard for diagnosing bladder outlet obstruction. Rev Urol. 2005;7(Suppl 6):S14–21.

    PubMed  PubMed Central  Google Scholar 

  53. Balzarro M, Rubilotta E, Goss C, et al. Counseling in urogynecology: a difficult task, or simply good surgeon-patient communication? Int Urogynecol J. 2018;29(7):943–8.

    Article  PubMed  Google Scholar 

  54. Balzarro M, Rubilotta E, Mancini V, et al. Impact of overactive bladder-wet syndrome on female sexual function: a systematic review and meta-analysis. Sex Med Rev. 2019;7(4):565–74.

    Article  PubMed  Google Scholar 

  55. Abrams P, Cardozo L, Wagg A, Wein A. Adult conservative management. 6th international consultation on incontinence, Tokyo September 2016. Incontinence 6th ed. Tokyo: Japanese Red Cross Medical Center; 2017. p. 1447–527.

    Google Scholar 

  56. Wyman J, Allen A, Hertsgaard L, Overson E, Allen S, Hatsukami D. Effect of smoking cessation on overactive bladder symptoms in adults: a pilot study. Neurourol Urodyn. 2014;33(6):866–7.

    Google Scholar 

  57. Wells MJ, Jamieson K, Markham TC, Green SM, Fader MJ. The effect of caffeinated versus decaffeinated drinks on overactive bladder: a double-blind, randomized, crossover study. J Wound Ostomy Continence Nurs. 2014;41(4):371–8.

    Article  PubMed  Google Scholar 

  58. Robinson D, Hanna-Mitchell A, Rantell A, et al. Are we justified in suggesting change to caffeine, alcohol, and carbonated drink intake in lower urinary tract disease? Report from the ICI-RS 2015. Neurourol Urodyn. 2017;36(4):876–81.

    Article  PubMed  Google Scholar 

  59. Milne JL. Behavioral therapies for overactive bladder. J Wound Ostomy Continence Nurs. 2008;35(1):93–101.

    Article  PubMed  Google Scholar 

  60. Soda T, Tashiro Y, Koike S, et al. Overactive bladder medication: persistence, drug switching, and reinitiation. Neurourol Urodyn. 2020;39:2527–34. https://doi.org/10.1002/nau.24527.

    Article  PubMed  Google Scholar 

  61. Stanton SL, Cardozo LD, Kerr-Wilson R. Treatment of delayed onset of spontaneous voiding after surgery for incontinence. Urology. 1979;13(5):494–6.

    Article  CAS  PubMed  Google Scholar 

  62. Jannelli ML, Wu JM, Plunkett LW. A randomized controlled trial of clean intermittent self-catheterization versus suprapubic catheterization after urogynecologic surgery. Am J Obstet Gynecol. 2007;187(1):72.e1–4.

    Article  Google Scholar 

  63. Ibrahim IK, Hameed MMA, Taher EM, et al. Efficacy of biofeedback-assisted pelvic floor muscle training in females with pelvic floor dysfunction. AJM. 2015;51(2):137–42.

    Google Scholar 

  64. Panicker J, Pakzad M, Fowler C. Fowler’s syndrome: a primary disorder of urethral sphincter relaxation. TOG. 2018;20(2):95–100.

    Article  Google Scholar 

  65. Arrom LM, Ferrer OM, Rubio LS, et al. Treatment response and complications after intradetrusor onabotulinumtoxina injection in male patients with idiopathic overactive bladder syndrome. J Urol. 2020;203(2):392–7.

    Article  Google Scholar 

  66. Panicker JN, Seth JH, Khan S, et al. Open-label study evaluating outpatient urethral sphincter injections of onabotulinumtoxinA to treat women with urinary retention due to a primary disorder of sphincter relaxation (Fowler’s syndrome). BJU Int. 2016;117(5):809–13.

    Article  CAS  PubMed  Google Scholar 

  67. Malanowska E, Starczewski A, Bielewicz W, Balzarro M. Assessment of overactive bladder after laparoscopic lateral suspension for pelvic organ prolapse. Biomed Res Int. 2019;2019:9051963.

    Article  PubMed  PubMed Central  Google Scholar 

  68. Balzarro M, Rubilotta E, Porcaro AB. Long-term follow-up of anterior vaginal repair: a comparison among colporrhaphy, colporrhaphy with reinforcement by xenograft, and mesh. Neurourol Urodyn. 2018;37(1):278–83.

    Article  CAS  PubMed  Google Scholar 

  69. Balzarro M, Rubilotta E, Antonelli A. Cystocele repair by a modified surgical technique of bilateral pubococcygeus plication: long-term surgical and functional results. J Clin Med. 2020;9(10):3318. https://doi.org/10.3390/jcm9103318.

    Article  PubMed Central  Google Scholar 

  70. Bazi T, Kerkhof MH, Takahashi SI, et al. Management of post-midurethral sling voiding dysfunction. International Urogynecological Association research and development committee opinion. Int Urogynecol J. 2018;29(1):23–8.

    Article  PubMed  Google Scholar 

  71. Rardin CR, Rosenblatt PL, Kohli N, et al. Release of tension-free vaginal tape for the treatment of refractory postoperative voiding dysfunction. Obstet Gynecol. 2002;100(5 Pt 1):898–902.

    CAS  PubMed  Google Scholar 

  72. Nguyen JN. Tape mobilization for urinary retention after tension-free vaginal tape procedures. Urology. 2005;66(3):523–6.

    Article  PubMed  Google Scholar 

  73. Goldman HB. Urethrolysis. Urol Clin N Am. 2011;38(1):31–7.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Urology, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy

    Matteo Balzarro & Emanuele Rubilotta

  2. Unit of Minimally Invasive, Robotic Urologic Surgery and Kidney Transplantation, Department of Experimental Medicine, Careggi Hospital, University of Florence, Florence, Italy

    Luca Gemma & Vincenzo Li Marzi

Authors
  1. Matteo Balzarro
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Emanuele Rubilotta
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Luca Gemma
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Vincenzo Li Marzi
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Urology, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy

    Matteo Balzarro

  2. Unit of Minimally Invasive, Robotic Urologic Surgery and Kidney Transplantation, Department of Experimental Medicine, Careggi Hospital, University of Florence, Florence, Italy

    Vincenzo Li Marzi

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Balzarro, M., Rubilotta, E., Gemma, L., Li Marzi, V. (2021). Bladder Outlet Obstruction and Overactive Bladder in Females. In: Balzarro, M., Li Marzi, V. (eds) Non-Neurogenic Bladder Dysfunctions. Urodynamics, Neurourology and Pelvic Floor Dysfunctions. Springer, Cham. https://doi.org/10.1007/978-3-030-57393-5_5

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-57393-5_5

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-57392-8

  • Online ISBN: 978-3-030-57393-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation