Voiding dysfunction

Voiding dysfunction in women is common, but is frequently undiagnosed until the patient presents with symptoms. The aetiology of voiding dysfunction i ncludes the following, any of which may lead to acute or chronic disorders: obstructive causes; postsurgical conditions; neurological disorders; overd istension; inflammatory, pharmacological, psychogenic causes and learned vo iding dysfunction; detrusor myopathy and urethral sphincter hypertrophy. Cl inical assessment should include history, and general, neurological and pel vic examinations, Investigations may include uroflowmetry, ultrasound for r esidual urine and upper urinary tract dilatation, urodynamic assessment and electromyography. New surgical techniques to identify vesical branches of the pelvic nerves intraoperatively during radical hysterectomy have been sh own to help prevent voiding dysfunction postoperatively. If acute retention occurs, then bladder drainage is the most important measure. Suprapubic ca theters are superior to transurethral catheters if long-term voiding diffic ulties are expected. Whenever possible, patients with chronic retention sho uld be taught clean intermittent self-catheterization. Depending on the cau se, other possible treatment options include urethral dilatation, insertion of an intraurethral device, and neuromodulation. Voiding dysfunction in wo men is still poorly understood. Prompt management of acute retention is ess ential, and clean intermittent self-catheterization remains the most effect ive therapy for chronic retention. (C) 2001 Lippincott Williams & Wilkins.