[Contribution of investigations to the diagnosis of bladder outlet obstruction in women]

Abstract

Objective: To study the intrinsic diagnostic value of the exams performed to explore bladder outlet obstruction in women.

Methods: Review of literature (PubMed, Embase, Cochrane Database) using following keywords: female, bladder outlet obstruction, post-void residual, uroflowmetry, flow pattern, cystoscopy, MRI, retrograde cystography, bladder wall thickness, bladder trabeculation, urinary retention, voiding cystometry, pressure flow studies, electromyography. Among 2660 articles (animal and anatomical studies have been excluded), 40 have been selected because they focused on the evaluation of the intrinsic value of exams.

Results: The concomitant recording of bladder and abdominal pressure during voiding (pressure flow study) is useful to diagnose an hypocontractile detrusor, abdominal pressure efforts during voiding and obstruction (low voiding flow associated with a high bladder pressure). The reproducibility of pressure flow studies seems to be very good in the literature. Nomograms have been described to assess a possible obstruction, but some studies show no correlation between the severity of symptoms of bladder outlet obstruction and results on the main nomogram (nomogram of Blaivas). The measurement of the thickness of the bladder wall appears correctly correlated to the diagnosis of obstruction but measures vary significantly depending on the abdominal or vaginal ultrasonographic approach.

Conclusion: In literature, only methods of measurement of maximum urinary flow rate and post-void residual volume have been extendedly studied.