Diagnostic Tests for Female Bladder Outlet Obstruction: A Systematic Review from the European Association of Urology Non-neurogenic Female LUTS Guidelines Panel

Pang, Karl H.; Campi, Riccardo; Arlandis, Salvador; Bø, Kari; Chapple, Christopher R.; Costantini, Elisabetta; Farag, Fawzy; Groen, Jan; Karavitakis, Markos; Lapitan, Marie Carmela; Manso, Margarida; Nambiar, Arjun; Ríogh, Aisling U. Nic an; O’Connor, Eabhann; Osman, Nadir I.; Peyronnet, B.; Phé, Véronique; Sakalis, Vasileios; Sihra, Néha; Tzelves, Lazaros; Vaart, Huub van der; Yuan, Yuhong; Omar, Muhammad Imran; Harding, Christopher

doi:10.1016/j.euf.2021.09.003

Cited by 13 publications

(10 citation statements)

References 42 publications

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“…At times, it can be complicated by UTIs, or upper tract changes. Due to the non-specific presentation and the similarities to other clinical conditions, the diagnosis may be difficult and frequently involves specialized examinations such as urodynamics [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

The effect of pelvic floor muscle training in women with functional bladder outlet obstruction

Tzelves

Tsikopoulos

Vasileios

et al. 2023

Arch Gynecol Obstet

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Introduction and hypothesis Female voiding dysfunction is often due to bladder outlet obstruction (BOO). We investigated pelvic floor muscle training (PFMT) effectiveness in women with functional BOO. Methods This is a prospective study recruiting 63 women functionally obstructed, over 18yo, maximum flow rate (Qmax) less than 12 ml/sec, naïve of voiding treatment. Exclusion criteria were anatomical BOO, neurological condition, pelvic intervention, psychiatric or anticholinergic medication, diabetes mellitus and affected upper urinary tract. At baseline, women underwent uroflow, post void residual (PVR) measurement, cystoscopy, cystogram and urodynamic study (UDS) with pelvic electromyography (EMG). Blaivas-Groutz nomogram has been used to define obstruction. After diagnosis, patients underwent six-month PFMT. Re-evaluation was offered four weeks after end of treatment. Data were analyzed with SPSSv22.0. Results 63 women were recruited and 48 finally included. At baseline, 20 reported 3 urinary tract infections (UTIs) during last year, and 12 had one episode of urine retention. Median Qmax was 7.5 ml/sec and median PVR 110 ml. 40 women were obstructed. 16 (40%) had mild, 16 (40%) moderate and 8 (20%) severe obstruction. All subjects had an overactive pelvic floor on EMG. Obstructed women were re-evaluated. Median Qmax was 8.5 ml/sec, close to baseline ( p = 0.16). Median PVR was 65 ml, reduced to baseline ( p = 0.02). 33 (82.5%) remained obstructed, 22 (66.67%) with mild, 8 (24.24%) moderate and 3 (9.09%) severe obstruction. 7 (17.5%) were non-obstructed. 4 patients reported one UTI episode with no cases of retention. Conclusions A 6 month PFMT reduced UTIs and PVR in women with functional BOO. Additionally, most patients had a de-escalation to milder obstruction.

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Section: Discussionmentioning

confidence: 99%

The effect of pelvic floor muscle training in women with functional bladder outlet obstruction

Tzelves

Tsikopoulos

Vasileios

et al. 2023

Arch Gynecol Obstet

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“…The available evidence on diagnostic tests for female bladder outlet obstruction is limited and heterogeneous. The most common test used was found to be pressure-flow studies with or without fluoroscopy, which remains the current standard for diagnosing bladder outlet obstruction in women (10). Yet, as these methodologies frequently find blurred boundaries, are expensive, not widely available, and invasive, alternative or clarifying tests are needed.…”

Section: Discussionmentioning

confidence: 99%

Systematic review of urinary biomarkers of female bladder outlet obstruction (fBOO)

Silva

Dinis²,

Monteiro³

2022

Arch Ital Urol Androl

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Objective: Diagnosis of bladder outlet obstruction (BOO) in females is often challenging, not only because of the overlap in storage and voiding symptoms in women with various etiologies of lower urinary tract (LUT) dysfunction but also due to the lack of standardized urodynamic criteria to define the condition. There is an unmet need of biologic markers to evaluate BOO in females as an adjunct to other clinical criteria. We sought to elucidate the role of urinary biomarkers in female BOO. Material and methods: We performed a systematic review of studies involving urinary biomarkers in female BOO. The search was performed in PubMed. A total of 58 papers were retrieved and 2 were included for final analysis.Results: Currently, there are no validated biologic markers for female BOO available. Having a biomarker that can be obtained through a urine sample will be an invaluable tool to evaluate and counsel patients with LUT symptoms and possible BOO. The use of NGF as an indicator of BOO in female patients seems to be promising: NGF levels are elevated in women with BOO when compared with normal controls. Conclusions: We found that NGF levels may be applied as a useful biomarker in the diagnosis and evaluation of female patients with BOO symptoms. It will not completely replace other clinical diagnostic tools such as formal urodynamic testing but play a role as a supplement to it. Nevertheless, further studies should be conducted to establish NGF levels as a female BOO biomarker and a routine testing modality.

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“…At times, it can be complicated by UTIs, or upper tract changes. Due to the non-speci c presentation and the similarities to other clinical conditions, the diagnosis may be di cult and frequently involves specialized examinations such as urodynamics [11].…”

Section: Discussionmentioning

confidence: 99%

The effect of pelvic floor muscle training in women with functional bladder outlet obstruction

Tzelves

Tsikopoulos

Sakalis

et al. 2022

Preprint

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Introduction and Hypothesis Female voiding dysfunction is often due to bladder outlet obstruction (BOO). We investigated pelvic floor muscle training (PFMT) effectiveness in women with functional BOO. Methods This is a prospective study recruiting 63 women functionally obstructed, over 18yo, maximum flow rate (Qmax) less than 12ml/sec, naïve of voiding treatment. Exclusion criteria were anatomical BOO, neurological condition, pelvic intervention, psychiatric or anticholinergic medication, diabetes mellitus and affected upper urinary tract. At baseline, women underwent uroflow, post void residual (PVR) measurement, cystoscopy, cystogram and urodynamic study (UDS) with pelvic electromyography (EMG). Blaivas-Groutz nomogram has been used to define obstruction. After diagnosis, patients underwent six-month PFMT. Re-evaluation was offered four weeks after end of treatment. Data were analyzed with SPSSv22.0. Results 63 women were recruited and 48 finally included. At baseline, 20 reported 3 urinary tract infections (UTIs) during last year, and 12 had one episode of urine retention. Median Qmax was 7.5ml/sec and median PVR 110ml. 40 women were obstructed. 16 (40%) had mild, 16 (40%) moderate and 8 (20%) severe obstruction. All subjects had an overactive pelvic floor on EMG. Obstructed women were re-evaluated. Median Qmax was 8.5ml/sec, close to baseline (p= 0.16). Median PVR was 65ml, reduced to baseline (p= 0.02). 33 (82.5%) remained obstructed, 22 (66.67%) with mild, 8 (24.24%) moderate and 3 (9.09%) severe obstruction. 7 (17.5%) were non-obstructed. 4 patients reported one UTI episode with no cases of retention. Conclusions A six-month PFMT reduced UTIs and PVR in women with functional BOO. Additionally, most patients had a de-escalation to milder obstruction.

show abstract

Diagnostic Tests for Female Bladder Outlet Obstruction: A Systematic Review from the European Association of Urology Non-neurogenic Female LUTS Guidelines Panel

Cited by 13 publications

References 42 publications

The effect of pelvic floor muscle training in women with functional bladder outlet obstruction

The effect of pelvic floor muscle training in women with functional bladder outlet obstruction

Systematic review of urinary biomarkers of female bladder outlet obstruction (fBOO)

The effect of pelvic floor muscle training in women with functional bladder outlet obstruction

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