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Female bladder neck dysfunction— A video ‐urodynamic diagnosis among women with voiding dysfunction
Author(s) -
Ong Hueih Ling,
Lee ChengLing,
Kuo HannChorng
Publication year - 2020
Publication title -
luts: lower urinary tract symptoms
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.451
H-Index - 15
eISSN - 1757-5672
pISSN - 1757-5664
DOI - 10.1111/luts.12318
Subject(s) - medicine , urology , neck of urinary bladder , lower urinary tract symptoms , bladder outlet obstruction , urination , urinary bladder , urinary system , prostate , cancer
Abstract Objective To investigate bladder neck dysfunction (BND) in women with voiding dysfunction by video‐urodynamic study (VUDS) and to examine the therapeutic results of different BND subtypes. Materials and Methods We retrospectively reviewed consecutive women who had undergone VUDS for investigation of voiding dysfunction at our institution. The diagnosis of BND was made based on a nonfunneling bladder neck with or without high voiding detrusor pressure. Patients diagnosed as BND were retrieved, and the urodynamic parameters were compared with patients with dysfunctional voiding (DV) and other bladder outlet obstructions (BOO). Results Among 810 women with bladder outlet dysfunction, BND was noted in 100 (12.3%), poor pelvic floor relaxation in 336 (41.5%), DV in 325 (40.1%), cystocele in 19 (2%), and urethral stricture in 30 (4%). Compared with the normal tracing group, BND patients had a significantly smaller volume of bladder filling sensation (included first sensation of filling, full sensation and cystometric bladder capaicity) and a greater BOO index (BOOI) (all P < .05). Detrusor overactivity was noted in 46 (46%) BND patients. These urodynamic parameters in BND were not significantly different from patients with DV or other BOO. High‐pressure BND had a greater BOOI, but low‐pressure BND had a lower voiding efficiency. Both alpha‐blocker therapy and transurethral incision of the bladder neck improved uroflow parameters in BND patients. Conclusions BND includes 12.3% of women with bladder outlet dysfunction. High‐pressure BND can cause anatomical BOO, whereas low‐pressure BND is likely to affect micturition through inhibiting detrusor contractility. VUDS is the mainstay diagnostic tool to diagnose BND in women.