Dysfunctional voiding

Abstract

In 2013, many diagnostic and therapeutic questions in female voiding dysfunction remain unsolved. However, some data began to emerge. Patients with FDV did not demonstrate a difference in effortful control (effortful control is the ability to regulate one's responses to external stimuli), but did demonstrate a higher rate of surgency (surgency is a trait aspect of emotional reactivity in which a person tends towards high levels of positive affect). Toilet training method in childhood does not seem to have any long-term correlation with FDV. Training with pelvic floor physiotherapy and biofeedback still represents the first-line treatment for FDV. In the management of other causes of female voiding dysfunction, sacral neuromodulation demonstrated a satisfying long-term efficacy in the treatment of nonobstructive urinary retention.

Therapeutic effect of urethral sphincter onabotulinumtoxinA injection for urethral sphincter hyperactivity

“…OnabotulinumtoxinA urethral sphincter injection decreases urethral pressure, increased Qmax, reduced PVR volume, and reduces autonomic dysreflexia . Neurogenic or non‐neurogenic dysfunctional voiding usually results in early termination of detrusor contraction and a large PVR volume . A higher detrusor pressure provides a higher voiding efficiency after urethral sphincter onabotulinumtoxinA injection and decrease of urethral resistance.…”

“…Non‐neurogenic voiding dysfunction due to dysfunctional voiding is one of the therapeutic challenges urologists face. Dysregulated urethral function with spastic or a non‐relaxing external urethral sphincter is thought to be a possible cause of dysfunctional voiding and results in voiding symptoms, slow urinary flow, and large PVR volume . The actual mechanism of the dysfunctional voiding is not well understood.…”

Can we improve our management of dysfunctional voiding in children and adults: International Consultation on Incontinence Research Society; ICI‐RS2018?

“…Variable definitions and diagnostic criteria have been used in the literature . Despite the ICS definition, it also has been described as a ‘learned behavioral dysfunction’ characterized by increased activity of the external urethral sphincter (EUS) . DV has been differentiated from poor relaxation of the external sphincter (PRES) …”

“…Repeated uroflows with EMG and postvoid residual urines are needed to verify the diagnosis in children . In adults, symptoms and noninvasive evaluation alone may not be able to diagnose or differentiate DV from other causes of VD . Although voiding symptoms or even urinary retention may be expected in DV patients, storage symptoms, usually due to detrusor overactivity, can be quite common and a significant proportion of patients present with mixed LUTS …”

Do we assess urethral function adequately in LUTD and NLUTD? ICI‐RS 2015

“…The reliably and consistently assessed variation of the flow can, in a person with LUTS, be attributed to abnormal urethral function, abnormal bladder function or both. Despite an accepted definition of DFV, usually managed by physiotherapy and biofeedback, there is a lack of research using validated objective outcomes, conducted in patient groups characterised by precisely defined aetiologies of DFV …”