UT Southwestern study analyzes frequency of bladder obstruction in women

May 09, 2000

A number of incontinent women diagnosed with "overactive bladder" may have bladder obstructions their doctors miss, a study by UT Southwestern Medical Center at Dallas urologists showed.

In the June issue of the Journal of Urology released today, Dr. Gary Lemack, assistant professor of urology, and Dr. Philippe Zimmern, associate professor of urology, analyzed 87 women who had experienced lower urinary-tract symptoms, including incontinence, and concluded one fifth had obstructions. The doctors put the women through a series of diagnostic tests to more closely evaluate their bladder function.

"By measuring bladder pressure and urinary outflow, we determined figures that allow us to predict which women might be obstructed," Lemack said. "Twenty percent of the women in the study were found to have bladder obstruction, which is considerably higher than what has previously been believed."

Urinary symptoms in men are frequently caused, at least in part, by an obstruction -- most frequently an enlarged prostate. The prostate gland surrounds the urethra. If it becomes enlarged, it constricts the urethra and the flow of urine.

But in women, urinary symptoms are most commonly attributed to infection, prolapse or a condition called overactive bladder.

"We normally don't suspect outlet obstruction in women and as a result, often we don't look for it," Lemack said. "For physicians, this means that when women with lower urinary-tract symptoms such as urinary frequency and urgency don't respond to traditional treatments, a urodynamics evaluation might be helpful in determining the actual etiology responsible for the urinary complaints."

Urodynamics involves filling the bladder with water and then measuring pressure within the bladder during filling and as the patient voids. A simultaneous assessment of the urinary sphincter, the muscles responsible for maintaining continence, provides further insight into the mechanisms responsible for the development of incontinence and lower urinary-tract symptoms.

"Urodynamics testing is clearly not indicated in all women with urinary-tract symptoms," Lemack said. "But now, with established parameters to work with, we can more quickly identify the subset of women that will benefit from more specialized forms of treatment."
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