BLADDER OUTLET OBSTRUCTION IN WOMEN – DIAGNOSTICS AND

THERAPY

Valenčić M, Maričić A, Oguić R, Sotošek S, Španjol J, Markić D, Fučkar Ž

Department for UrologyClinical Hospital Centre Rijeka

Bladder outlet obstruction in woman

• The precise cause of PBOO has not been clearly elucidated.

• The true prevalence of PBOO in the male and female populations is not known.

Bladder outlet obstruction – 43 women ( 2000 – 2010 )

• Primary BOO 37 patients (84%)

• Neurogenic bladder 6 patients (16%)

Bladder outlet obstruction estimating parameters

• Maximal urine flow Qmax < 12 ml/s

• Detrusor contraction Pdet.Qmax > 20 cm H2O

Bladder outlet obstruction estimating nomogram

Lemack GE. Nat Clin Pract Urol. 2006;3(1):38-44

Patients age

Mean age Range

42,3 years 21 – 78 years

Bladder outlet obstruction diagnosis

• Patient’s history

• Postvoid residual urine

• Pressure/flow studies

• Urethral calibration

• Cystoskopy

Preoperative frequency and nocturia

• Frequency 5 – 15, mean 8,9

• Nocturia 0 – 7, mean 2,9

• 6 patients with complete urinary retention ( 37% )

Preoperative postvoiding residual urine

• 16 patients ( 37% )

• 70 - 500 ml

Preoperative mean maximal uroflow rate

• 8 +/- 7 ml per second

Treatment for bladder outlet obstruction in women

Transurethral bladder neck incision with needle electrode at 5 and 7 o’clock

Transurethral bladder neck incision in woman

Transurethral bladder neck incision in woman

Transurethral bladder neck incision in woman

Transurethral incision for bladder outlet obstruction in women - results

Follow up 6 Mo – 7 Y ( mean 3,8 Y )

Very satisfying 21 patients ( 49% )

Satisfying 11 patients ( 25% )

Unsatisfying 11 patients ( 26% )

Reinterventions

• 5 patients 1 x

• 1 patient 2 x

• 1 patient 3 x

Postoperative frequency and nocturia

• Frequency 3 – 10, mean 6,5

• Nocturia 0 – 4

Postoperative postvoiding residual urine

• 9 patients ( 21% )

• 30 - 200 ml

Postoperative maximal urine flow

• 24 +/- 8 ml per second

• 3 patients ( 7% ) with persistent completeurinary retention

Conclusion

Transurethral bladder neck incision for bladder outlet obstruction in woman is a safe and effective simple surgical procedure, good knowledge of pelvic floor anatomy in women and correct diagnosis presumed.

Thank you for your attention!