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Female Voiding Dysfunction Cause and Diagnosis

Female Voiding Dysfunction Cause and Diagnosis. 가톨릭대학교 김수진 . Female Voiding Dysfunction. Condition in which the bladder fails to empty completely and easily after micturation. Stanton et al. Obstet Gynecol 1983. Prevalence : 2 – 25 % Storage symptoms in women (51.3 %)

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Female Voiding Dysfunction Cause and Diagnosis

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  1. Female Voiding DysfunctionCause and Diagnosis 가톨릭대학교 김수진

  2. Female Voiding Dysfunction Condition in which the bladder fails to empty completely and easily after micturation Stanton et al. Obstet Gynecol 1983

  3. Prevalence: 2 – 25 % • Storage symptoms in women (51.3 %) 25 % of men and 19.5 % of women ▶ Voiding symptoms • Symptoms of BOO in women can be quite varied The absence of this symptom does not rule out BOO Irwin DE et al. Eur Urol 2006

  4. Cause ? • Bladder : Decreased bladder contractility • Urethra : Increased outlet resistance

  5. Decreased Bladder Contractility

  6. Age ▶ Detrusor degeneration and increased collagen ▶ Decrease in muscarinic receptor- mediated activation of contraction • Bladder Over-Distension ▶Regional anesthesia ▶ Pelvic or abdominal surgery ▶ Labor and Delivery ▶ Anticholinergic medication ▶ Idiopathic

  7. Increased Outlet Resistance

  8. Anatomical obstruction

  9. Functional obstruction Primary bladder neck obstruction Dysfunctional voiding Detrusor-sphincter dyssynergia

  10. Diagnosis

  11. Medical and surgical history taking • Evaluation of LUTS • Parity • Urinalysis • Voiding diary • Physical examination

  12. Uroflowmetry Bladder or urethral cause ? • Qmax < 15 ml/s or RU > 150 cc

  13. Urodynamic evaluationDetrusor hypocontractility or Outflow obstruction ?

  14. Detrusor hypocontractility • Qmax ≤ 15 ml/s • PdetQmax < 20 cmH2O

  15. Bladder Outlet Obstruction • Qmax ≤ 15 ml/s and PdetQmax ≥ 20 cmH2O • Qmax ≤ 11 ml/s and PdetQmax ≥ 21 cmH2O • Qmax ≤ 12 ml/s and PdetQmax ≥ 20 cmH2O • Qmax ≤ 10 ml/s and PdetQmax ≥ 25 cmH2O Chassagne et al. Urology 1998 Lemark GE and Zimmern PE. J Urol 2000 Grouts et al. Neurourol Urodyn 2000 Dafreitas et al. Urology 2004

  16. Bladder Outlet Obstruction • Qmax ≤ 12 ml/s and PdetQmax ≥ 30 cmH2O • Qmax ≤ 15 ml/s and PdetQmax ≥ 20 cmH2O Kim et al. Korean J Urol 2001 Lee et al. Korean J Urol 2006

  17. Videourodynamic evaluation Nitti et al. J Urol 1999

  18. Blaivas-Groutz nomogram

  19. Conclusion • Attention for the female voiding dysfunction • Screening test ▶ Uroflowmetry

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