bladder outlet obstruction in women - diagnostics and therapy
TRANSCRIPT
BLADDER OUTLET OBSTRUCTION IN WOMEN – DIAGNOSTICS AND
THERAPY
Valenčić M, Maričić A, Oguić R, Sotošek S, Španjol J, Markić D, Fučkar Ž
Department for UrologyClinical Hospital Centre Rijeka
Bladder outlet obstruction in woman
• The precise cause of PBOO has not been clearly elucidated.
• The true prevalence of PBOO in the male and female populations is not known.
Bladder outlet obstruction – 43 women ( 2000 – 2010 )
• Primary BOO 37 patients (84%)
• Neurogenic bladder 6 patients (16%)
Bladder outlet obstruction estimating parameters
• Maximal urine flow Qmax < 12 ml/s
• Detrusor contraction Pdet.Qmax > 20 cm H2O
Bladder outlet obstruction estimating nomogram
Lemack GE. Nat Clin Pract Urol. 2006;3(1):38-44
Patients age
Mean age Range
42,3 years 21 – 78 years
Bladder outlet obstruction diagnosis
• Patient’s history
• Postvoid residual urine
• Pressure/flow studies
• Urethral calibration
• Cystoskopy
Preoperative frequency and nocturia
• Frequency 5 – 15, mean 8,9
• Nocturia 0 – 7, mean 2,9
• 6 patients with complete urinary retention ( 37% )
Preoperative postvoiding residual urine
• 16 patients ( 37% )
• 70 - 500 ml
Preoperative mean maximal uroflow rate
• 8 +/- 7 ml per second
Treatment for bladder outlet obstruction in women
Transurethral bladder neck incision with needle electrode at 5 and 7 o’clock
Transurethral bladder neck incision in woman
Transurethral bladder neck incision in woman
Transurethral bladder neck incision in woman
Transurethral incision for bladder outlet obstruction in women - results
Follow up 6 Mo – 7 Y ( mean 3,8 Y )
Very satisfying 21 patients ( 49% )
Satisfying 11 patients ( 25% )
Unsatisfying 11 patients ( 26% )
Reinterventions
• 5 patients 1 x
• 1 patient 2 x
• 1 patient 3 x
Postoperative frequency and nocturia
• Frequency 3 – 10, mean 6,5
• Nocturia 0 – 4
Postoperative postvoiding residual urine
• 9 patients ( 21% )
• 30 - 200 ml
Postoperative maximal urine flow
• 24 +/- 8 ml per second
• 3 patients ( 7% ) with persistent completeurinary retention
Conclusion
Transurethral bladder neck incision for bladder outlet obstruction in woman is a safe and effective simple surgical procedure, good knowledge of pelvic floor anatomy in women and correct diagnosis presumed.
Thank you for your attention!