Iatrogenic Female Bladder Outlet Obstruction

Fig. 10.1

Urodynamics tracing for patient 1

Findings

The patient has an otherwise stable cystometrogram (filling phase) and tolerates a normal volume into her bladder (400 cm³). When given permission to void, she has a markedly elevated detrusor pressure (Pdet) of almost 100 cm H₂O with a low flow (5 mL/s). She empties the majority of her bladder with about 100 cm³ post-void residual. At present, there are no completely agreed-upon diagnostic criteria for female BOO. Many use cutoffs of voiding pressure of Pdet > 20 to 25 cm H₂O with a flow of less than 12 mL/s. Others advocate video fluoroscopic views of the outlet to demonstrate proximal urethral dilation with voiding and/or a cutoff or tight area in the mid-urethra corresponding to the location of the sling .

10.2.1.5 Treatment Options

This patient eventually underwent a sling incision. She began, after only a few days, improved flow and less obstructive voiding. Her urgency symptoms improved after a few weeks using some additional behavioral modifications.

10.2.2 Patient 2

10.2.2.1 History

A 66-year-old female presents 6 weeks after a retropubic synthetic sling procedure performed for stress urinary incontinence. Her main complaints are slow stream, straining to void, and hesitancy. She has already had two UTIs since surgery and spends an inordinate amount of time in the toilet trying to void. Her frequency is about every 30 min (up from preoperatively a baseline of every 3 h). Nocturia is new for her at three times a night now. She is increasingly frustrated, and her surgeon has stated to “give it time.” An empiric trial of an alpha-blocker was not helpful.