Skip to main content
Top
Published in: Current Urology Reports 5/2012

01-10-2012 | Voiding Dysfunction and Lower Urinary Tract Symptoms (GH Badlani and HB Goldman, Section Editors)

Evaluation and Management of Outlet Obstruction in Women Without Anatomical Abnormalities on Physical Exam or Cystoscopy

Authors: Duane Hickling, Margarita Aponte, Victor Nitti

Published in: Current Urology Reports | Issue 5/2012

Login to get access

Abstract

Bladder outlet obstruction (BOO) in women can be either anatomic or functional. Anatomic causes for BOO are often readily apparent by history and physical exam. On the other hand, causes for functional obstruction, including dysfunctional voiding, primary bladder neck obstruction, and detrusor-external sphincter dyssynergia, are more difficult to establish. Because the appropriate treatment for functional obstruction drastically varies according to etiology, making an accurate diagnosis is paramount. Videourodynamics, interpreted in the context of individual clinical symptoms, remains the diagnostic gold standard in women with functional obstruction.
Literature
1.
go back to reference Groutz A, Blaivas JG, Pies C, Sassone AM. Learned voiding dysfunction (non-neurogenic, neurogenic bladder) among adults. Neurourol Urodyn. 2001;20(3):259–68.PubMedCrossRef Groutz A, Blaivas JG, Pies C, Sassone AM. Learned voiding dysfunction (non-neurogenic, neurogenic bladder) among adults. Neurourol Urodyn. 2001;20(3):259–68.PubMedCrossRef
2.
go back to reference Farrar DJ, Osborne JL, Stephenson TP, Whiteside CG, Weir J, Berry J, et al. A urodynamic view of bladder outflow obstruction in the female: factors influencing the results of treatment. Br J Urol. 1975;47(7):815–22.PubMedCrossRef Farrar DJ, Osborne JL, Stephenson TP, Whiteside CG, Weir J, Berry J, et al. A urodynamic view of bladder outflow obstruction in the female: factors influencing the results of treatment. Br J Urol. 1975;47(7):815–22.PubMedCrossRef
3.
go back to reference Rees DL, Whitfield HN, Islam AK, Doyle PT, Mayo ME, Wickham JE. Urodynamic findings in adult females with frequency and dysuria. Br J Urol. 1975;47(7):853–60.PubMedCrossRef Rees DL, Whitfield HN, Islam AK, Doyle PT, Mayo ME, Wickham JE. Urodynamic findings in adult females with frequency and dysuria. Br J Urol. 1975;47(7):853–60.PubMedCrossRef
4.
go back to reference Massey J. Obstructed Voiding in the Female. Br J Urol 1988. Massey J. Obstructed Voiding in the Female. Br J Urol 1988.
5.
go back to reference Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, et al. The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Am J Obstet Gynecol. 2002;187(1):116–26.PubMedCrossRef Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, et al. The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Am J Obstet Gynecol. 2002;187(1):116–26.PubMedCrossRef
6.
go back to reference Abrams P. The assessment of prostatic obstruction from urodynamic measurements and from residual urine. Br J Urol 1979. Abrams P. The assessment of prostatic obstruction from urodynamic measurements and from residual urine. Br J Urol 1979.
7.
go back to reference Schäfer W. Principles and clinical application of advanced urodynamic analysis of voiding function. Urol Clin North Am. 1990;17(3):553–66.PubMed Schäfer W. Principles and clinical application of advanced urodynamic analysis of voiding function. Urol Clin North Am. 1990;17(3):553–66.PubMed
8.
go back to reference Nitti V, Tu L. Diagnosing bladder outlet obstruction in women. J Urol 1999. Nitti V, Tu L. Diagnosing bladder outlet obstruction in women. J Urol 1999.
9.
go back to reference Patel R, Nitti V. Bladder outlet obstruction in women: prevalence, recognition and management. Curr Urol Rep 2001. Patel R, Nitti V. Bladder outlet obstruction in women: prevalence, recognition and management. Curr Urol Rep 2001.
10.
go back to reference Lemack GE. Urodynamic assessment of bladder-outlet obstruction in women. Nat Clin Pract Urol. 2006;3(1):38–44.PubMedCrossRef Lemack GE. Urodynamic assessment of bladder-outlet obstruction in women. Nat Clin Pract Urol. 2006;3(1):38–44.PubMedCrossRef
11.
go back to reference Dmochowski RR. Bladder outlet obstruction: etiology and evaluation. Rev Urol MedRev LLC. 2005;7 Suppl 6:S3. Dmochowski RR. Bladder outlet obstruction: etiology and evaluation. Rev Urol MedRev LLC. 2005;7 Suppl 6:S3.
12.
go back to reference Farrar D, Warwick R. Outflow obstruction in the female. The Urologic clinics of North America; 1979. Farrar D, Warwick R. Outflow obstruction in the female. The Urologic clinics of North America; 1979.
13.
go back to reference Dwyer PL, Desmedt E. Impaired bladder emptying in women. Aust N Z J Obstet Gynaecol. 1994;34(1):73–8.PubMedCrossRef Dwyer PL, Desmedt E. Impaired bladder emptying in women. Aust N Z J Obstet Gynaecol. 1994;34(1):73–8.PubMedCrossRef
14.
go back to reference Chassagne S, Bernier PA, Haab F, Roehrborn CG, Reisch JS, Zimmern PE. Proposed cutoff values to define bladder outlet obstruction in women. Urology. 1998;51(3):408–11.PubMedCrossRef Chassagne S, Bernier PA, Haab F, Roehrborn CG, Reisch JS, Zimmern PE. Proposed cutoff values to define bladder outlet obstruction in women. Urology. 1998;51(3):408–11.PubMedCrossRef
15.
go back to reference Lemack GE, Zimmern PE. Pressure flow analysis may aid in identifying women with outflow obstruction. J Urol. 2000;163(6):1823–8.PubMedCrossRef Lemack GE, Zimmern PE. Pressure flow analysis may aid in identifying women with outflow obstruction. J Urol. 2000;163(6):1823–8.PubMedCrossRef
16.
go back to reference Defreitas GA, Zimmern PE, Lemack GE, Shariat SF. Refining diagnosis of anatomic female bladder outlet obstruction: comparison of pressure-flow study parameters in clinically obstructed women with those of normal controls. Urology. 2004;64(4):675–9. discussion679–81.PubMedCrossRef Defreitas GA, Zimmern PE, Lemack GE, Shariat SF. Refining diagnosis of anatomic female bladder outlet obstruction: comparison of pressure-flow study parameters in clinically obstructed women with those of normal controls. Urology. 2004;64(4):675–9. discussion679–81.PubMedCrossRef
17.
go back to reference Blaivas JG, Groutz A. Bladder outlet obstruction nomogram for women with lower urinary tract symptomatology. Neurourol Urodyn. 2000;19(5):553–64.PubMedCrossRef Blaivas JG, Groutz A. Bladder outlet obstruction nomogram for women with lower urinary tract symptomatology. Neurourol Urodyn. 2000;19(5):553–64.PubMedCrossRef
18.
go back to reference Akikwala TV, Fleischman N, Nitti VW. Comparison of diagnostic criteria for female bladder outlet obstruction. J Urol. 2006;176(5):2093–7.PubMedCrossRef Akikwala TV, Fleischman N, Nitti VW. Comparison of diagnostic criteria for female bladder outlet obstruction. J Urol. 2006;176(5):2093–7.PubMedCrossRef
19.
go back to reference •• Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn 2010. p. 4–20. This comprehensive work standardizes terminology for clinicians and researchers working in the field of female pelvic floor dysfunction. •• Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn 2010. p. 4–20. This comprehensive work standardizes terminology for clinicians and researchers working in the field of female pelvic floor dysfunction.
20.
go back to reference Jørgensen TM, Djurhuus JC, Schrøder HD. Idiopathic detrusor sphincter dyssynergia in neurologically normal patients with voiding abnormalities. Eur Urol. 1982;8(2):107–10.PubMed Jørgensen TM, Djurhuus JC, Schrøder HD. Idiopathic detrusor sphincter dyssynergia in neurologically normal patients with voiding abnormalities. Eur Urol. 1982;8(2):107–10.PubMed
21.
go back to reference Cameron AP, Gajewski JB. Bladder outlet obstruction in painful bladder syndrome/interstitial cystitis. Neurourol Urodyn. 2009;28(8):944–8.PubMedCrossRef Cameron AP, Gajewski JB. Bladder outlet obstruction in painful bladder syndrome/interstitial cystitis. Neurourol Urodyn. 2009;28(8):944–8.PubMedCrossRef
22.
go back to reference Pannek J, Einig E-M, Einig W. Clinical management of bladder dysfunction caused by sexual abuse. Urol Int. 2009;82(4):420–5.PubMedCrossRef Pannek J, Einig E-M, Einig W. Clinical management of bladder dysfunction caused by sexual abuse. Urol Int. 2009;82(4):420–5.PubMedCrossRef
23.
go back to reference Wood SK, Baez MA, Bhatnagar S, Valentino RJ. Social stress-induced bladder dysfunction: potential role of corticotropin-releasing factor. Am J Physiol Regul Integr Comp Physiol. 2009;296(5):R1671–8.PubMedCrossRef Wood SK, Baez MA, Bhatnagar S, Valentino RJ. Social stress-induced bladder dysfunction: potential role of corticotropin-releasing factor. Am J Physiol Regul Integr Comp Physiol. 2009;296(5):R1671–8.PubMedCrossRef
24.
go back to reference •• Minardi D, d'Anzeo G, Parri G, Polito M, Piergallina M, El Asmar Z, et al. The role of uroflowmetry biofeedback and biofeedback training of the pelvic floor muscles in the treatment of recurrent urinary tract infections in women with dysfunctional voiding: a randomized controlled prospective study. Urology. 2010;75(6):1299–304. This study establishes pelvic floor physiotherapy with biofeedback as the golden standard primary treatment for dysfunctional voiding. PubMedCrossRef •• Minardi D, d'Anzeo G, Parri G, Polito M, Piergallina M, El Asmar Z, et al. The role of uroflowmetry biofeedback and biofeedback training of the pelvic floor muscles in the treatment of recurrent urinary tract infections in women with dysfunctional voiding: a randomized controlled prospective study. Urology. 2010;75(6):1299–304. This study establishes pelvic floor physiotherapy with biofeedback as the golden standard primary treatment for dysfunctional voiding. PubMedCrossRef
25.
go back to reference Fan Y-H, Lin ATL, Wu H-M, Hong C-J, Chen K-K. Psychological profile of female patients with dysfunctional voiding. Urology. 2008;71(4):625–9.PubMedCrossRef Fan Y-H, Lin ATL, Wu H-M, Hong C-J, Chen K-K. Psychological profile of female patients with dysfunctional voiding. Urology. 2008;71(4):625–9.PubMedCrossRef
26.
go back to reference Castro-Diaz D, Taracena Lafuente JM. Detrusor-sphincter dyssynergia. Int J Clin Pract Suppl. 2006;151:17–21.PubMedCrossRef Castro-Diaz D, Taracena Lafuente JM. Detrusor-sphincter dyssynergia. Int J Clin Pract Suppl. 2006;151:17–21.PubMedCrossRef
27.
go back to reference Xu D, Qu C, Meng H, Ren J, Zhu Y, Min Z, et al. Dysfunctional voiding confirmed by transdermal perineal electromyography, and its effective treatment with baclofen in women with lower urinary tract symptoms: a randomized double-blind placebo-controlled crossover trial. BJU Int. 2007;100(3):588–92.PubMedCrossRef Xu D, Qu C, Meng H, Ren J, Zhu Y, Min Z, et al. Dysfunctional voiding confirmed by transdermal perineal electromyography, and its effective treatment with baclofen in women with lower urinary tract symptoms: a randomized double-blind placebo-controlled crossover trial. BJU Int. 2007;100(3):588–92.PubMedCrossRef
28.
go back to reference Rogalski MJ, Kellogg-Spadt S, Hoffmann AR, Fariello JY, Whitmore KE. Retrospective chart review of vaginal diazepam suppository use in high-tone pelvic floor dysfunction. Int Urogynecol J. 2010;21(7):895–9.PubMedCrossRef Rogalski MJ, Kellogg-Spadt S, Hoffmann AR, Fariello JY, Whitmore KE. Retrospective chart review of vaginal diazepam suppository use in high-tone pelvic floor dysfunction. Int Urogynecol J. 2010;21(7):895–9.PubMedCrossRef
29.
go back to reference Phelan MW, Franks M, Somogyi GT, Yokoyama T, Fraser MO, Lavelle JP, et al. Botulinum toxin urethral sphincter injection to restore bladder emptying in men and women with voiding dysfunction. J Urol. 2001;165(4):1107–10.PubMedCrossRef Phelan MW, Franks M, Somogyi GT, Yokoyama T, Fraser MO, Lavelle JP, et al. Botulinum toxin urethral sphincter injection to restore bladder emptying in men and women with voiding dysfunction. J Urol. 2001;165(4):1107–10.PubMedCrossRef
30.
go back to reference Fowler CJ, Betts CD, Christmas TJ, Swash M, Fowler CG. Botulinum toxin in the treatment of chronic urinary retention in women. Br J Urol. 1992;70(4):387–9.PubMedCrossRef Fowler CJ, Betts CD, Christmas TJ, Swash M, Fowler CG. Botulinum toxin in the treatment of chronic urinary retention in women. Br J Urol. 1992;70(4):387–9.PubMedCrossRef
31.
go back to reference Lee K-S, Han DH, Lee Y-S, Choo M-S, Yoo TK, Park HJ, et al. Efficacy and safety of tamsulosin for the treatment of non-neurogenic voiding dysfunction in females: a 8-week prospective study. J Korean Med Sci. 2010;25(1):117.PubMedCrossRef Lee K-S, Han DH, Lee Y-S, Choo M-S, Yoo TK, Park HJ, et al. Efficacy and safety of tamsulosin for the treatment of non-neurogenic voiding dysfunction in females: a 8-week prospective study. J Korean Med Sci. 2010;25(1):117.PubMedCrossRef
32.
go back to reference Roth TJ, Vandersteen DR, Hollatz P, Inman BA, Reinberg YE. Sacral neuromodulation for the dysfunctional elimination syndrome: a single center experience with 20 children. J Urol. 2008;180(1):306–11. discussion311.PubMedCrossRef Roth TJ, Vandersteen DR, Hollatz P, Inman BA, Reinberg YE. Sacral neuromodulation for the dysfunctional elimination syndrome: a single center experience with 20 children. J Urol. 2008;180(1):306–11. discussion311.PubMedCrossRef
33.
go back to reference Diokno AC, Hollander JB, Bennett CJ. Bladder neck obstruction in women: a real entity. J Urol. 1984;132(2):294–8.PubMed Diokno AC, Hollander JB, Bennett CJ. Bladder neck obstruction in women: a real entity. J Urol. 1984;132(2):294–8.PubMed
34.
go back to reference • Brucker BM, Fong EDM, Shah SR, Kelly C, Rosenblum N, Nitti VW. Urodynamic differences between dysfunctional voiding and primary bladder neck obstruction in women. Urology. 2012;1(80):55–60. This study highlights the importance of using fluoroscopy during urodynamics to accurately distinguish between DV and PBNO. CrossRef • Brucker BM, Fong EDM, Shah SR, Kelly C, Rosenblum N, Nitti VW. Urodynamic differences between dysfunctional voiding and primary bladder neck obstruction in women. Urology. 2012;1(80):55–60. This study highlights the importance of using fluoroscopy during urodynamics to accurately distinguish between DV and PBNO. CrossRef
35.
go back to reference Leadbetter G, Leadbetter W. Diagnosis and treatment of congenital bladder-neck obstruction in children. N Engl J Med. 1959;260(13):633–7.PubMedCrossRef Leadbetter G, Leadbetter W. Diagnosis and treatment of congenital bladder-neck obstruction in children. N Engl J Med. 1959;260(13):633–7.PubMedCrossRef
36.
go back to reference Kuo H-C. Videourodynamic characteristics and lower urinary tract symptoms of female bladder outlet obstruction. Urology. 2005;66(5):1005–9.PubMedCrossRef Kuo H-C. Videourodynamic characteristics and lower urinary tract symptoms of female bladder outlet obstruction. Urology. 2005;66(5):1005–9.PubMedCrossRef
37.
go back to reference Kessler TM, Studer UE, Burkhard FC. The effect of terazosin on functional bladder outlet obstruction in women: a pilot study. J Urol. 2006;176(4 Pt 1):1487–92.PubMedCrossRef Kessler TM, Studer UE, Burkhard FC. The effect of terazosin on functional bladder outlet obstruction in women: a pilot study. J Urol. 2006;176(4 Pt 1):1487–92.PubMedCrossRef
38.
go back to reference Athanasopoulos A, Gyftopoulos K, Giannitsas K, Perimenis P. Effect of alfuzosin on female primary bladder neck obstruction. Int Urogynecol J Pelvic Floor Dysfunct. 2009;20(2):217–22.PubMedCrossRef Athanasopoulos A, Gyftopoulos K, Giannitsas K, Perimenis P. Effect of alfuzosin on female primary bladder neck obstruction. Int Urogynecol J Pelvic Floor Dysfunct. 2009;20(2):217–22.PubMedCrossRef
39.
go back to reference Turner-Warwick R, Whiteside CG, Worth PH, Milroy EJ, Bates CP. A urodynamic view of the clinical problems associated with bladder neck dysfunction and its treatment by endoscopic incision and trans-trigonal posterior prostatectomy. Br J Urol. 1973;45(1):44–59.PubMed Turner-Warwick R, Whiteside CG, Worth PH, Milroy EJ, Bates CP. A urodynamic view of the clinical problems associated with bladder neck dysfunction and its treatment by endoscopic incision and trans-trigonal posterior prostatectomy. Br J Urol. 1973;45(1):44–59.PubMed
40.
go back to reference Jonas U, Petri E, Hohenfellner R. Indication and value of bladder neck incision. Urol Int. 1979;34(4):260–5.PubMedCrossRef Jonas U, Petri E, Hohenfellner R. Indication and value of bladder neck incision. Urol Int. 1979;34(4):260–5.PubMedCrossRef
41.
go back to reference Grønbaek K, Struckmann J, Frimodt-Moller C. The treatment of female bladder neck dysfunction. Scand J Urol Nephrol. 1992;26(2):113–8.PubMed Grønbaek K, Struckmann J, Frimodt-Moller C. The treatment of female bladder neck dysfunction. Scand J Urol Nephrol. 1992;26(2):113–8.PubMed
42.
go back to reference Kumar A, Mandhani A, Gogoi S. Management of Functional Bladder Neck Obstruction in Women: Use of α-Blockers and Pediatric Resectoscope for Bladder Neck Incision. J Urol 1999. Kumar A, Mandhani A, Gogoi S. Management of Functional Bladder Neck Obstruction in Women: Use of α-Blockers and Pediatric Resectoscope for Bladder Neck Incision. J Urol 1999.
43.
go back to reference Peng C-H, Kuo H-C. Transurethral incision of bladder neck in treatment of bladder neck obstruction in women. Urology. 2005;65(2):275–8.PubMedCrossRef Peng C-H, Kuo H-C. Transurethral incision of bladder neck in treatment of bladder neck obstruction in women. Urology. 2005;65(2):275–8.PubMedCrossRef
44.
go back to reference Jin X-B, Qu H-W, Liu H, Li B, Wang J, Zhang Y-D. Modified transurethral incision for primary bladder neck obstruction in women: a method to improve voiding function without urinary incontinence. Urology. 2012;79(2):310–3.PubMedCrossRef Jin X-B, Qu H-W, Liu H, Li B, Wang J, Zhang Y-D. Modified transurethral incision for primary bladder neck obstruction in women: a method to improve voiding function without urinary incontinence. Urology. 2012;79(2):310–3.PubMedCrossRef
45.
go back to reference Ahmed HU, Shergill IS, Arya M, Shah PJR. Management of detrusor–external sphincter dyssynergia. Nat Clin Pract Urol. 2006;3(7):368–80.PubMedCrossRef Ahmed HU, Shergill IS, Arya M, Shah PJR. Management of detrusor–external sphincter dyssynergia. Nat Clin Pract Urol. 2006;3(7):368–80.PubMedCrossRef
46.
go back to reference Kim YH, Kattan MW, Boone TB. Bladder leak point pressure: the measure for sphincterotomy success in spinal cord injured patients with external detrusor-sphincter dyssynergia. J Urol. 1998;159(2):493–6. discussion496–7.PubMedCrossRef Kim YH, Kattan MW, Boone TB. Bladder leak point pressure: the measure for sphincterotomy success in spinal cord injured patients with external detrusor-sphincter dyssynergia. J Urol. 1998;159(2):493–6. discussion496–7.PubMedCrossRef
47.
go back to reference Abdul-Rahman A, Ismail S, Hamid R, Shah J. A 20-year follow-up of the mesh wallstent in the treatment of detrusor external sphincter dyssynergia in patients with spinal cord injury. BJU Int. 2010;106(10):1510–3.PubMedCrossRef Abdul-Rahman A, Ismail S, Hamid R, Shah J. A 20-year follow-up of the mesh wallstent in the treatment of detrusor external sphincter dyssynergia in patients with spinal cord injury. BJU Int. 2010;106(10):1510–3.PubMedCrossRef
48.
go back to reference Chen S-L, Bih L-I, Huang Y-H, Tsai S-J, Lin T-B, Kao Y-L. Effect of Single Botulinum Toxin a Injection to the External Urethral Sphincter for Treating Detrusor External Sphincter Dyssynergia in Spinal Cord Injury. Medical Journals Limited; 2008. Chen S-L, Bih L-I, Huang Y-H, Tsai S-J, Lin T-B, Kao Y-L. Effect of Single Botulinum Toxin a Injection to the External Urethral Sphincter for Treating Detrusor External Sphincter Dyssynergia in Spinal Cord Injury. Medical Journals Limited; 2008.
49.
go back to reference Schurch B, Schmid DM, Knapp PA. An update on the treatment of detrusor–sphincter dyssynergia with botulinum toxin type A. Eur J Neurol Wiley Online Libr. 1999;6:s83–9. Schurch B, Schmid DM, Knapp PA. An update on the treatment of detrusor–sphincter dyssynergia with botulinum toxin type A. Eur J Neurol Wiley Online Libr. 1999;6:s83–9.
50.
go back to reference de Sèze M, Petit H, Gallien P, de Sèze M-P, Joseph P-A, Mazaux J-M, et al. Botulinum a toxin and detrusor sphincter dyssynergia: a double-blind lidocaine-controlled study in 13 patients with spinal cord disease. Eur Urol. 2002;42(1):56–62.PubMedCrossRef de Sèze M, Petit H, Gallien P, de Sèze M-P, Joseph P-A, Mazaux J-M, et al. Botulinum a toxin and detrusor sphincter dyssynergia: a double-blind lidocaine-controlled study in 13 patients with spinal cord disease. Eur Urol. 2002;42(1):56–62.PubMedCrossRef
51.
go back to reference Smith CP, Nishiguchi J, O’Leary M, Yoshimura N, Chancellor MB. Single-institution experience in 110 patients with botulinum toxin A injection into bladder or urethra. Urology. 2005;65(1):37–41.PubMedCrossRef Smith CP, Nishiguchi J, O’Leary M, Yoshimura N, Chancellor MB. Single-institution experience in 110 patients with botulinum toxin A injection into bladder or urethra. Urology. 2005;65(1):37–41.PubMedCrossRef
Metadata
Title
Evaluation and Management of Outlet Obstruction in Women Without Anatomical Abnormalities on Physical Exam or Cystoscopy
Authors
Duane Hickling
Margarita Aponte
Victor Nitti
Publication date
01-10-2012
Publisher
Current Science Inc.
Published in
Current Urology Reports / Issue 5/2012
Print ISSN: 1527-2737
Electronic ISSN: 1534-6285
DOI
https://doi.org/10.1007/s11934-012-0267-8

Other articles of this Issue 5/2012

Current Urology Reports 5/2012 Go to the issue

Voiding Dysfunction and Lower Urinary Tract Symptoms (GH Badlani and HB Goldman, Section Editors)

The Role of Neuromodulation in Patients with Neurogenic Overactive Bladder

Voiding Dysfunction and Lower Urinary Tract Symptoms (GH Badlani and HB Goldman, Section Editors)

Interstitial Cystitis and the Overlap With Overactive Bladder

Voiding Dysfunction and Lower Urinary Tract Symptoms (GH Badlani and HB Goldman, Section Editors)

When Are Urodynamics Indicated in Patients with Stress Urinary Incontinence?

Voiding Dysfunction and Lower Urinary Tract Symptoms (GH Badlani and HB Goldman, Section Editors)

Troubleshooting Sacral Neuromodulation Issues

Voiding Dysfunction and Lower Urinary Tract Symptoms (GH Badlani and HB Goldman, Section Editors)

Practical Use of the New American Urological Association Interstitial Cystitis Guidelines

Voiding Dysfunction and Lower Urinary Tract Symptoms (GH Badlani and HB Goldman, Section Editors)

The Treatment of Lower Urinary Tract Symptoms in Patients With Multiple Sclerosis: A Systematic Review