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.