Urodynamic Differences Between Dysfunctional Voiding and Primary Bladder Neck Obstruction in Women

Brucker, Benjamin M.; Fong, Eva; Shah, Sagar; Kelly, Christopher E.; Rosenblum, Nirit; Νitti, Victor W.

doi:10.1016/j.urology.2012.04.011

Cited by 42 publications

(21 citation statements)

References 30 publications

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“…In their analysis, the authors found that EMG alone would have led to misdiagnosis in 20% of DV and 14.3% of PBNO patients. This data supports the use of fluoroscopy in diagnosing and differentiating DV and PBNO (148). It has been theorized that the etiology of PBNO is either morphologic (smooth-muscle hypertrophy or fibrosis) or neurogenic in nature (149).…”

Section: Physiologic Abnormalitiessupporting

confidence: 83%

Anatomy and Physiology of the Urinary Tract: Relation to Host Defense and Microbial Infection

Hickling

Sun

2015

Microbiol Spectr

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The urinary tract exits to a body surface area that is densely populated by a wide range of microbes. Yet, under most normal circumstances, it is typically considered sterile, i.e., devoid of microbes, a stark contrast to the gastrointestinal and upper respiratory tracts where many commensal and pathogenic microbes call home. Not surprisingly, infection of the urinary tract over a healthy person’s lifetime is relatively infrequent, occurring once or twice or not at all for most people. For those who do experience an initial infection, the great majority (70% to 80%) thankfully do not go on to suffer from multiple episodes. This is a far cry from the upper respiratory tract infections, which can afflict an otherwise healthy individual countless times. The fact that urinary tract infections are hard to elicit in experimental animals except with inoculum 3–5 orders of magnitude greater than the colony counts that define an acute urinary infection in humans (105 cfu/ml), also speaks to the robustness of the urinary tract defense. How can the urinary tract be so effective in fending off harmful microbes despite its orifice in a close vicinity to that of the microbe-laden gastrointestinal tract? While a complete picture is still evolving, the general consensus is that the anatomical and physiological integrity of the urinary tract is of paramount importance in maintaining a healthy urinary tract. When this integrity is breached, however, the urinary tract can be at a heightened risk or even recurrent episodes of microbial infections. In fact, recurrent urinary tract infections are a significant cause of morbidity and time lost from work and a major challenge to manage clinically. Additionally, infections of the upper urinary tract often require hospitalization and prolonged antibiotic therapy. In this chapter, we provide an overview of the basic anatomy and physiology of the urinary tract with an emphasis on their specific roles in host defense. We also highlight the important structural and functional abnormalities that predispose the urinary tract to microbial infections.

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Section: Physiologic Abnormalitiessupporting

confidence: 83%

Anatomy and Physiology of the Urinary Tract: Relation to Host Defense and Microbial Infection

Hickling

Sun

2015

Microbiol Spectr

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“…Further work-up including cystourethrography, videourodynamics and endoscopy is often necessary for women with low Q max and high voiding pressure. This observation may be explained by presence of different BOO forms, dysfunctional voiding and primary bladder neck obstruction being the most common [16]. Our nomogram cannot be used as a sole tool for qualifying to surgical treatment of BOO in women, since the type of the obstruction has to be well established first [17].…”

Section: Discussionmentioning

confidence: 99%

Pressure-flow nomogram for women with lower urinary tract symptoms

Dybowski¹,

Bres-Niewada²,

Radziszewski³

2014

aoms

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IntroductionResults of urodynamic studies performed in female patients are often difficult to interpret. The objective of the study was to develop a nomogram that would help in diagnosing functional bladder outlet obstruction (BOO) in neurologically intact women with any kind of lower urinary tract symptoms.Material and methodsFrom the urodynamic database adult women were chosen with maximal flow rate (Qmax) ≤ 12 ml/s in a pressure-flow study. Four criteria were used to identify a group of patients suspected of BOO: thickened bladder wall, presence of bladder diverticula, subjective improvement on α-blockers and improvement of voiding symptoms on any form of treatment. The line separating high and low pressure zones on the pressure-flow chart was established according to the position of patients who met at least one of them.ResultsSixty-seven patientswere investigated. Twenty-one women met at least one of the specified criteria. They had significantly higher voiding pressures (p det(Qmax) 35 cm H2O vs. 16.5 cm H2O; p = 0.002). A new nomogram with one separating line (p det(Qmax) = 1.5 × Q max+ 10) was proposed. The difference in the distribution of women fulfilling the criteria between high pressure zone and low pressure zone was highly significant (19/35 vs. 2/32; p < 0.0001). Sensitivity, specificity, positive and negative predictive values of our nomogram in identifying patients suspected of BOO was 90.5%, 65.2%, 54.3% and 94% respectively.ConclusionsThe new nomogram can be considered a screening test which efficiently excludes obstruction among women with low Q max in a pressure-flow study.

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“…In adults, symptoms and noninvasive evaluation alone may not be able to diagnose or differentiate DV from other causes of VD . Although voiding symptoms or even urinary retention may be expected in DV patients, storage symptoms, usually due to detrusor overactivity, can be quite common and a significant proportion of patients present with mixed LUTS …”

Section: How Well Do We Understand and Diagnose DV In Children And Admentioning

confidence: 99%

“…9,11,14,15 Although voiding symptoms or even urinary retention may be expected in DV patients, storage symptoms, usually due to detrusor overactivity, can be quite common and a significant proportion of patients present with mixed LUTS. 11,12,17,22,23 Most researchers use video-urodynamic studies (UDS) with or without a surface perineal EMG to diagnose DV in adults, which is the most comprehensive method to meet the requirements of the ICS definition. Alternatively, voiding cystourethrography (VCUG) with surface perineal EMG can be used.…”

Section: Understand and Diagnose DV In Children And Adults?mentioning

confidence: 99%

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Can we improve our management of dysfunctional voiding in children and adults: International Consultation on Incontinence Research Society; ICI‐RS2018?

Tarcan

Gontard

Apostolidis

et al. 2019

Neurourology and Urodynamics

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Aims: Dysfunctional voiding (DV) remains a poorly understood and a poorly managed problem, both in children and adults. The Think Tank (TT) discussed how to improve the management of DV in these two different age groups and in transitional care. Methods: During the 2018 International Consultation on Incontinence Research Society held in Bristol, a multidisciplinary TT on DV was created. The presentations and subsequent discussion, leading to research recommendations intended to improve the management of DV in children and adults are summarized. Results: To improve the management of DV in children and adults, the TT panel proposed: (1) to conduct reliable prevalence studies of DV; (2) to perform longitudinal studies to prospectively test the sequence hypothesis by answering the following questions: (a) Which, if any children show a progression from overactive bladder or voiding postponement to DV?; (b) Which children develop each disorder without precursors?; and (c) Is there a continuation of DV from childhood to adulthood, or are adult cases new-onset presentations?;(3) to obtain detailed information regarding psychopathology to understand which comorbid psychological disorders prevail and at which rate, in those suffering DV; (4) to develop and validate diagnostic tools specifically for DV; (5) to better establish urodynamic correlates of DV specific for different age groups; and (6) to generate prospective long-term data regarding the efficacy of different treatment options and management strategies. Conclusions: The future research recommendations of this TT may improve our management of DV in children and adults. K E Y W O R D S biofeedback, dysfunctional voiding, emptying symptoms, overactive bladder, urethral sphincter, urodynamics

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Urodynamic Differences Between Dysfunctional Voiding and Primary Bladder Neck Obstruction in Women

Cited by 42 publications

References 30 publications

Anatomy and Physiology of the Urinary Tract: Relation to Host Defense and Microbial Infection

Anatomy and Physiology of the Urinary Tract: Relation to Host Defense and Microbial Infection

Pressure-flow nomogram for women with lower urinary tract symptoms

Can we improve our management of dysfunctional voiding in children and adults: International Consultation on Incontinence Research Society; ICI‐RS2018?

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