Urodynamic Assessment of Voiding Dysfunction and Dysfunctional Voiding in Girls and Women |
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Authors: | K Everaert E Van Laecke M De Muynck H Peeters P Hoebeke |
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Institution: | (1) University Hospital of Ghent, Ghent, Belgium, BE |
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Abstract: | Voiding dysfunction is defined as impaired bladder emptying, and presents with a mixture of lower urinary tract symptoms.
Dysfunctional voiding is a condition in which there is a lack of coordination between the sphincter and detrusor during emptying
in a patient without overt uropathy or neuropathy. Assessment of voiding dysfunction is important in women and girls in the
prevention and treatment of urinary incontinence, retention, urinary tract infection and subsequent kidney damage. Accurate
diagnosis is essential in order to select the correct treatment. Screening can be done by history-taking: symptom scores can
help to guide the screening. More objective measures are uroflowmetry, ultrasonography and videourodynamics. The latter is
the gold standard for the diagnosis of voiding dysfunction and consists of simultaneous registration of pressure in the bladder
and rectum and external sphincter behavior, either by electromyographic recording of pelvic floor activity or by pressure
recording at the external sphincter, during the whole bladder cycle of filling and emptying. On fluoroscopy the bladder can
be visualized throughout the filling and emptying phase. In dysfunctional voiding, hypertonicity and instability of the external
urethral sphincter during filling cystometry and impaired external sphincter relaxation during emptying are pathognomonic
findings. Pressure–flow analysis reveals no obstruction and the detrusor contractility is low. |
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Keywords: | :Biofeedback – Dysfunctional voiding – Neuromodulation – Pelvic floor – Urodynamics – Voiding dysfunction |
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