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World J Clin Urol. Mar 24, 2016; 5(1): 29-36
Published online Mar 24, 2016. doi: 10.5410/wjcu.v5.i1.29
Diagnosis of voiding dysfunction by pressure-flow study in women
Juan Pablo Valdevenito, Annerleim Walton-Diaz
Juan Pablo Valdevenito, Annerleim Walton-Diaz, Urodynamics Unit, Department of Urology, Hospital Clinico Universidad de Chile, Santiago 8380456, Chile
Author contributions: Valdevenito JP and Walton-Diaz A contributed equally to this manuscript.
Conflict-of-interest statement: Authors have no conflict of interest to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Juan Pablo Valdevenito, MD, Associate Professor of Urology, Urodynamics Unit, Department of Urology, Hospital Clinico Universidad de Chile, Santos Dumont 999, Santiago 8380456, Chile. jpvaldevenito@yahoo.com
Telephone: +56-02-29788503 Fax: +56-02 -2070768
Received: May 28, 2015
Peer-review started: June 1, 2015
First decision: August 25, 2015
Revised: November 7, 2015
Accepted: December 1, 2015
Article in press: December 2, 2015
Published online: March 24, 2016
Processing time: 295 Days and 15.8 Hours
Abstract

Pressure-flow study (PFS) of micturition is the best method to quantitatively analyse voiding function. It allows us to distinguish voiding lower urinary tract symptoms and low urine flow rate caused by bladder outlet obstruction (BOO) from those caused by detrusor underactivity (DU). Voiding dynamics are significantly different in men and women and the established criteria for urodynamic diagnosis in men do not apply to women. Basic principles of voiding mechanics and voiding patterns in asymptomatic women are analyzed. Although attempts have been made to establish a consensus for diagnosis of BOO in women with pressure-flow cutoff, video-urodynamics criteria and nomograms, currently there is no consensus. There is no standard urodynamic test to diagnose and quantify DU in women for which further investigations are needed. Modified projected isovolumetric pressure (to assess detrusor contraction strength) and pressure-flow cutoff criteria have been used. The diagnosis of voiding dysfunction in women is challenging, requiring PFS with very good quality control and often involves integrating clinical and radiographic data to make the final assessment.

Keywords: Bladder outlet obstruction; Pressure-flow studies; Urodynamics; Women; Detrusor underactivity

Core tip: Pressure-flow study of micturition is the best method to quantitatively analyze voiding function. Voiding dynamics differ significantly between men and women and the established criteria for urodynamic diagnosis in men do not apply to women. Although attempts have been made to establish a consensus for diagnosis of bladder outlet obstruction in women with pressure-flow cutoff, video-urodynamics criteria and nomograms, currently there is no consensus. There is no standard urodynamic test to diagnose detrusor underactivity in women for which further investigations are needed. The diagnosis of voiding dysfunction in women is challenging and often involves consideration of clinical and radiographic data to make the final assessment.