Korean J Urol.  2006 Dec;47(12):1327-1333. 10.4111/kju.2006.47.12.1327.

The Characteristics of Voiding Difficulty in Women and the Effect of Tamsulosin

• Lee JH
• Kim HS
• Lee JY

• KMID: 2139779
• DOI: http://doi.org/10.4111/kju.2006.47.12.1327

Abstract

PURPOSE
The aim of this study was to define the characteristics of female voiding difficulty, and evaluate the effects of the alpha-blocker, tamsulosin, on the symptoms in those patients. MATERIAL AND METHODS: 148 patients, who complained of voiding difficulty between March 2002 and September 2004, were retrospectively evaluated. 32 patients with anatomical and neuropathic causes were excluded, with the remaining 116 assigned to 4 groups from their urodynamic evaluations: group I, bladder outlet obstruction (BOO) only; group II, BOO plus an overactive bladder (OAB); group III, detrusor underactivity (DU) only; and group IV, DU plus an OAB. After 2 weeks of observation, tamsulosin, 0.2mg/d, was prescribed in all groups, with the patients re-evaluated after 3 months.
RESULTS
58 (50%), 23 (19.8%), 20 (17.3%) and 15 (12.9%) of the 116 study subjects were placed into groups I, II, III and IV, respectively. In group I, 45 (77.5%) had symptomatic improvement after taking tamsulosin for 3 months, and in group II improvement was observed in 73.9% (17/23) of patients. In groups III and IV; however, improvements were seen in only 25 (5/20) and 13.3% (2/15) of cases, respectively. Dizziness, postural hypotension and urinary incontinence occurred in some patients, but these disappeared after the medication was discontinued.
CONCLUSIONS
81 patients (69.8%) had a bladder outlet obstruction, without detrusor underactivity, and 62 (76.5%) of these exhibited a voiding improvement after taking tamsulosin for three months. However, in patients with detrusor underactivity, the response rate was very low (20%).

Keyword

Urination disorders; Adrenergic alpha-blockers; Female

MeSH Terms

Adrenergic alpha-Antagonists
Dizziness
Female
Humans
Hypotension, Orthostatic
Retrospective Studies
Urinary Bladder Neck Obstruction
Urinary Bladder, Overactive
Urinary Incontinence
Urination Disorders
Urodynamics
Adrenergic alpha-Antagonists

Reference

1. Chassagne S, Bernier PA, Haab F, Roehrborn CG, Reisch JS, Zimmern PE. Proposed cutoff values to define bladder outlet obstruction in women. Urology. 1998. 51:408–411.

2. Groutz A, Blaivas JG, Chaikin DC. Bladder outlet obstruction in women: definition and characteristics. Neurourol Urodyn. 2000. 19:213–220.

3. Yamanishi T, Yasuda K, Kamai T, Tsujii T, Sakakibara R, Uchiyama T, et al. Combination of a cholinergic drug and an alpha-blocker is more effective than monotherapy for the treatment of voiding difficulty in patients with underactive detrusor. Int J Urol. 2004. 11:88–96.

4. Abrams P, Blaivas JG, Stanton SL, Anderson JT. The standardization of terminology of lower urinary tract function recommended by The International Continence Society. Int Urogynecol Pelvic Floor Dysfunct. 1990. 1:45–46.

5. Quesada EM, Scott FB, Cardus D. Functional classification of neurogenic bladder dysfunction. Arch Phys Med Rehabil. 1968. 49:692–697.

6. Wein AJ. Classification of neurogenic voiding dysfunction. J Urol. 1981. 125:605–609.

7. Groutz A, Blaivas JG. Non-neurogenic female voiding dysfunction. Curr Opin Urol. 2002. 12:311–316.

8. Mayo ME, Lloyd-Davies RW, Shuttleworth KE, Tighe JR. The damaged human detrusor: functional and electron microscopic changes in disease. Br J Urol. 1973. 45:116–125.

9. Groutz A, Gordon D, Wolman I, Jaffa A, Kupferminc MJ, Lessing JB. Persistent postpartum urinary retention in contemporary obstetric practice. Definition, prevalence and clinical implications. J Reprod Med. 2001. 46:44–48.

10. Stanton SL, Ozsoy C, Hilton P. Voiding difficulties in the female: prevalence, clinical and urodynamic review. Obstet Gynecol. 1983. 61:144–147.

11. Dwyer PL, Desmedt E. Impaired bladder emptying in women. Aust N Z J Obstet Gynaecol. 1994. 34:73–78.

12. Clarke B. The role of urodynamic assessment in the diagnosis of lower urinary tract disorders. Int Urogynecol J Pelvic Floor Dysfunct. 1997. 8:196–199.

13. Groutz A, Gordon D, Lessing JB, Wolman I, Jaffa A, David MP. Prevalence and characteristics of voiding difficulties in women: are subjective symptoms substantiated by objective urodynamic data? Urology. 1999. 54:268–272.

14. Haylen BT. Voiding difficulty in women. Int Urogynecol J Pelvic Floor Dysfunct. 2000. 11:1–3.

15. Haylen BT, Law MG, Frazer MI, Sculz S. Urine flow rates and residual urine volumes in urogynecology patients. Int Urogynecol J Pelvic Floor Dysfunct. 1999. 10:378–383.

16. Costantini E, Mearini E, Pajoncini C, Biscotto S, Bini V, Porena M. Uroflowmetry in female voiding disturbances. Neurourol Urodyn. 2003. 22:569–573.

17. Axelrod SL, Blaivas JG. Bladder neck obstruction in women. J Urol. 1987. 137:497–499.

18. Massey JA, Abrams PH. Obstructed voiding in the female. Br J Urol. 1988. 61:36–39.

19. Kim HS, Lee U, Lee MH, Choo MS. Cut-off value for bladder outlet obstruction in pressure-flow study in female: a prospective study. Korean J Urol. 2001. 42:1146–1151.

20. O'Riordan JI, Doherty C, Javed M, Brophy D, Hutchinson M, Quinlan D. Do α-blockers have a role in lower urinary tract dysfunction in multiple sclerosis? J Urol. 1995. 153:1114–1116.

21. Chess-Williams R. The use of alpha-adrenoceptor antagonists in lower urinary tract disease. Expert Opin Pharmacother. 2002. 3:167–172.

22. Mobley DF. Phenoxybenzamine in the management of neurogenic vesical dysfunction. J Urol. 1976. 116:737–738.

23. Sakakibara R, Hattori T, Uchiyama T, Suenaga T, Takahashi H, Yamanishi T, et al. Are alpha-blockers involved in lower urinary tract dysfunction in multiple system atrophy? A comparison of prazosin and moxisylyte. J Auton Nerv Syst. 2000. 79:191–195.

24. Schulte-Baukloh H, Michael T, Miller K, Knispel HH. Alfuzosin in the treatment of high leak-point pressure in children with neurogenic bladder. BJU Int. 2002. 90:716–720.

25. Ek A, Alm P, Andersson KE, Persson CG. Adrenergic and cholinergic nerves of the human urethra and urinary bladder: a histochemical study. Acta Physiol Scand. 1977. 99:345–352.

26. Kawabe K, Niijima T. Use of an alpha 1-blocker, YM-12617, in micturition difficulty. Urol Int. 1987. 42:280–284.

27. Kumar A, Mandhani A, Gogoi S, Srivastava A. Management of functional bladder neck obstruction in women: use of alpha-blockers and pediatric resectoscope for bladder neck incision. J Urol. 1999. 162:2061–2065.

28. Hieble JP, Bylund DB, Clarke DE, Eikenburg DC, Langer SZ, Lefkowitz RJ, et al. International Union of Pharmacology. X. Recommendation for nomenclature of alpha 1-adrenoceptors: consensus update. Pharmacol Rev. 1995. 47:267–270.

29. Schwin DA. The role of α1-adrenergic receptor subtypes in lower urinary tract symptoms. BJU Int. 2001. 88:Suppl 2. 27–34.

30. Lyseng-Williamson KA, Jarvis B, Wagstaff AJ. Tamsulosin: an update of its role in the management of lower urinary tract symptoms. Drugs. 2002. 62:135–167.