Voiding dysfunction in women: How to manage it correctly

Arab J Urol. 2013 Dec;11(4):319-30. doi: 10.1016/j.aju.2013.07.005. Epub 2013 Aug 29.


Introduction: Of women aged >40 years, 6% have voiding dysfunction (VD), but the definition for VD in women with respect to detrusor underactivity (DU) and bladder outlet obstruction (BOO) is not yet clear. In this review we address the current literature to define the diagnosis and treatment of VD more accurately.

Methods: We used the PubMed database (1975-2012) and searched for original English-language studies using the keywords 'female voiding dysfunction', 'detrusor underactivity', 'acontractile detrusor' and 'bladder outlet obstruction and urinary retention in women'. We sought studies including the prevalence, aetiology, pathogenesis, diagnosis and treatment of female VD.

Results: In all, 20 original studies were identified using the selected search criteria, and another 45 were extracted from the reference lists of the original papers. All studies were selected according to their relevance to the current topic and the most pertinent reports were incorporated into this review.

Conclusion: Female VD might be related to DU or/and BOO. Voiding and storage symptoms can coexist, making the diagnosis challenging, with the need for a targeted clinical investigation, and further evaluation by imaging and urodynamics. To date there is no universally accepted precise diagnostic criterion to diagnose and quantify DU and BOO in women. For therapy, a complete cure might not be possible for patients with VD, therefore relieving the symptoms and minimising the long-term complications associated with it should be the goal. Treatment options are numerous and must be applied primarily according to the underlying pathophysiology, but also considering disease-specific considerations and the abilities and needs of the individual patient. The treatment options range from behavioural therapy, intermittent (self-)catheterisation, and electrical neuromodulation and neurostimulation, and up to urinary diversion in rare cases.

Keywords: ApBO, acute prolonged bladder overdistension; BTA, botulinum toxin A; Bladder diary; CIC, clean intermittent self-catheterisation; DM, diabetes mellitus; DO, detrusor overactivity; DSD, detrusor sphincter dyssynergia; DU, detrusor underactivity; DV, dysfunctional voiding; EMG, electromyography; IVES, intravesical electrical stimulation; MUS, mid-urethral sling; PFM, pelvic floor muscles; PFS, pressure-flow study; POP, pelvic organ prolapse; PVR measurement; PVR, postvoid residual urine volume; Pdet, detrusor pressure; PdetQmax, Pdet at Qmax; Pdetmax, maximum Pdet; Qmax, maximum urinary flow rate; SNM, sacral neuromodulation; TVT, tension-free vaginal tape; US, ultrasonography; Uroflowmetry; VCUG, voiding cysto-urethrogram; VD, voiding dysfunction; Women.

Publication types

  • Review