MANAGEMENT OF FUNCTIONAL BLADDER NECK OBSTRUCTION IN WOMEN: USE OF Α-Blockers AND PEDIATRIC RESECTOSCOPE FOR BLADDER NECK INCISION

Kumar, Anant; Mandhani, Anil; Gogoi, Sanjay; Srivastava, Aneesh

doi:10.1016/s0022-5347(05)68101-3

Cited by 58 publications

(44 citation statements)

References 18 publications

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“…In our series, tamsulosin, associated with an initial period of clean intermittent self-catheterization in those with a PVRl 1 100 ml, proved to be effective in more than 50% of the treated cases. This experience is similar to the one made by other authors [19] . Since there are theoretical and clinical arguments that ␣ -blockers may be useful in patients with functional bladder neck obstruction, we suggest this treatment as the fi rst therapeutic approach instead of bladder neck incision.…”

Section: Discussionsupporting

confidence: 92%

“…This method allows to detect the fl uoroscopic imaging of nonfunnelling or inadequate funnelling of the bladder neck. This diagnostic method provided us with data that did not differ from the ones obtained by other authors who used videourodynamics in similar studies [19] .…”

Section: Discussionsupporting

confidence: 57%

“…Although smooth muscles of female bladder neck and urethra are usually poorer in ␣ -receptors than the male ones [20] , a limited number of clinical trials showed that ␣ -blockers may determine an increase in urine fl ow and a decrease in PVR in women with bladder outfl ow obstruction or neurological bladder [21,22] . In the most recent experience, Kumar et al [19] , in 12 patients with bladder neck obstruction, verifi ed the therapeutic effi cacy of ␣ -blockers rather than choosing immediately endoscopic bladder neck incision. These authors showed an improvement in obstructive symptoms in 50% of their patients treated with ␣ -blockers.…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, some experiences using ␣ -blockers in women suffering from obstructed urine fl ow have been reported [21,22] . Kumar et al [19] reported the most interesting experience . These authors, using ␣ -blockers in a small group of patients with functional bladder neck obstruction, observed an improvement in symptoms and urodynamic parameters in about 50% of their cases [19] .…”

mentioning

confidence: 99%

“…The fl uoroscopic imaging highlights nonfunnelling or an inappropriate funnelling of the neck, while the urethra shows a normal caliber [2,8,16] -there may be postvoid residual urine (PVR) [4,18] . The most common treatment of functional bladder neck obstruction is bladder neck incision [2,9,19] .…”

mentioning

confidence: 99%

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Use of α<sub>1</sub>-Blockers in Female Functional Bladder Neck Obstruction

et al. 2005

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Introduction: Bladder outflow obstruction may cause obstructive or irritative symptoms. The diagnosis of female functional bladder neck obstruction requires a pressure/flow study and electromyography performed by videourodynamics. The treatment includes self-catheterization or bladder neck incision. We administered tamsulosin, an α₁A/α₁D-selective adrenergic antagonist, in women with functional bladder neck obstruction to evaluate its potential therapeutic effects. Patients andMethods: A group of 18 women affected by functional bladder neck obstruction was selected. The diagnosis was made by means of a pressure/flow study combined with electromyography and a fluoroscopic test. The diagnostic criteria were: high detrusor pressure with reduced maximum flow, silent electromyography activity, and bladder neck nonfunnelling during the fluoroscopic test. Tamsulosin 0.4 mg once daily was administered for at least 30 days. Patients with a postvoid residual urine volume ≧100 ml performed intermittent self-catheterization. Patients with a postvoid residual urine volume <100 ml performed self-catheterization every 7 days. After 30 days of therapy, all patients underwent a new pressure/flow study and a micturition fluoroscopic test. Results: 10 (56%) out of 18 treated patients showed a statistically significant improvement in symptoms, maximum flow, and postvoid residual urine volume (p < 0.01). Conclusion: The use of α₁-blockers may be an initial treatment option for female functional bladder neck obstruction, as this therapeutic option proved to be effective in more than 50% of our patients suffering from this voiding dysfunction.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 57%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Use of α<sub>1</sub>-Blockers in Female Functional Bladder Neck Obstruction

et al. 2005

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Surgical management of bladder outlet obstruction due to functional and anatomical etiologies in women

Dequirez,

Wasserman,

Brucker

2024

Neurourology and Urodynamics

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IntroductionBladder outlet obstruction (BOO) in women includes functional and anatomic etiologies. Primary bladder neck obstruction (PBNO), Fowler's syndrome (FS), and dysfunctional voiding (DV) are some examples of functional obstructions, whereas pelvic organ prolapse (POP), periurethral masses, and intragenic causes are some of the anatomic causes.MethodsThis literature review describes the etiologies of female BOO, unique aspects of the workup and diagnosis, and the data for the standard surgical treatments and newer surgical techniques to treat women. Urethral stenosis and sling‐related obstruction are treated in the other articles of this series. Where possible the focus is the efficacy and outcomes.ResultsTreatment of PBNO using a transurethral incision of the bladder neck and injection of botulinum toxin in the bladder neck decreases the BOO. After the failure of conservative approaches, sacral neuromodulation (SNM) is effective for FS, while DV may benefit from SNM or botulinum toxin injections. Concerning POP, most surgeries have been reported to significantly improve a pre‐existent BOO but the level of evidence is low. Benign urethral and periurethral masses may provoke BOO, and surgical excision usually resolves this condition.ConclusionAlthough most surgical treatments of BOO for functional and benign anatomical etiologies in women seem to be effective, data are scarce even for more common conditions like POP. Further studies are required to give better advice on the choice of surgical technique for these patients.

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Outlet Obstruction in Women

Renninson

Mevcha

Parsons

2014

Bladder Dysfunction in the Adult

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Female voiding requires co-ordinated bladder contraction and outlet relaxation. Failure of the outlet to accommodate urine fl ow can occur in various circumstances in women. This chapter describes the diverse nature of the problem and its management, along with some of the limitations in the evidence base which make this a challenging clinical problem. Of these, one of the most important is the recognition that impairment of bladder contractility is common in older women [ 1 ] and this could cause overdiagnosis of bladder outlet obstruction (BOO). BOO may be asymptomatic, cause voiding LUTS, or complete obstruction resulting in inability to void (acute urinary retention-which is usually painful emergency). However, assessing the bladder contractility is diffi cult in women, and this hinders decisionmaking regarding diagnosis of BOO. Until the ability to agree defi nitions, and subsequently approaches to diagnosis, management of BOO in women will remain a clinical challenge.Retention in women results from a diverse set of conditions, which makes research into its epidemiology diffi cult. Most studies are small case series, or case reports with unusual causes. Part of the diffi culty in estimating prevalence rates of obstruction relates to the fact that unlike for men, there are no universally accepted or standardised criteria for diagnosing the condition in women. Voiding symptoms have been shown to have a poor predictive value for diagnosing female voiding dysfunction, rarely exist in isolation and often occur in association with storagerelated symptoms [ 2 -4 ]. The true prevalence of BOO in women is unknown, but estimates from large retrospective studies range from 3 to 8 % [ 3 -6 ]. A Scandinavian study revealed an incidence of AUR in women of seven per 100,000 population per year [ 7 ]. Defi ning Urinary ObstructionBOO can be diagnosed on the basis of urodynamic studies, as in men (see Chap. 4 ). BOO has been defi ned as detrusor pressure of 60 cm of water (cm H 2 O) or more, with a peak urine fl ow rate of less than 15 mL/s, though this was derived from measurements in a small number of women [ 8 ]. Another study derived criteria from evaluation of the videourodynamic studies of 261 women for non-neurogenic voiding function and defined BOO as radiographic evidence of obstruction between the bladder neck and the distal urethra in the presence of a

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MANAGEMENT OF FUNCTIONAL BLADDER NECK OBSTRUCTION IN WOMEN: USE OF Α-Blockers AND PEDIATRIC RESECTOSCOPE FOR BLADDER NECK INCISION

Cited by 58 publications

References 18 publications

Use of α<sub>1</sub>-Blockers in Female Functional Bladder Neck Obstruction

Use of α<sub>1</sub>-Blockers in Female Functional Bladder Neck Obstruction

Surgical management of bladder outlet obstruction due to functional and anatomical etiologies in women

Outlet Obstruction in Women

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