A significant workforce shortage of urologists available to serve the US population has been projected to occur over the next decade. Accordingly, much of the management of urologic patients will need to be assumed by other specialties and practitioners. Since primary care physicians are often first evaluate common urologic complaints, it makes sense that these physicians are in an excellent position to intervene in the management of these patients when appropriate. One of the most common complaints in urology is voiding dysfunction. The incidence of voiding dysfunction increases with age, with conservative estimates showing that over 50% of elderly patients suffer. Despite this high prevalence and its negative impact on quality of life, however, few seek or receive treatment, as many do not readily disclose these impactful yet personal symptoms. We sought to summarize the typical presentation, evaluation, assessment and therapeutic options for both male and female patients presenting with voiding dysfunction.
1. NASSAU, D., J. GERBER, AND J. WEISS, The Prevalence and Treatment of Voiding Dysfunction in the Elderly. 2014, Springer US: Current Geriatrics Reports. p. 33-41.
2. SHAMLIYAN, T.A., et al., Male urinary incontinence: prevalence, risk factors, and preventive interventions. Rev Urol, 2009. 11(3): p. 145-65.
3. WU, J.M., et al., Prevalence and trends of symptomatic pelvic floor disorders in U.S. women. Obstet Gynecol, 2014. 123(1): p. 141-8.
4. HU, T.W., et al., Costs of urinary incontinence and overactive bladder in the United States: a comparative study. Urology, 2004. 63(3): p. 461-5.
5. PRUTHI, R.S., et al., Recent trends in the urology workforce in the United States. Urology, 2013. 82(5): p. 987-93.
6. HAYLEN, B.T., et al., An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J, 2010. 21(1): p. 5-26.
7. RADADIA, K.D., et al., Management of Postradical Prostatectomy Urinary Incontinence: A Review. Urology, 2018. 113: p. 13-19.
8. THÜROFF, J.W., et al., EAU guidelines on urinary incontinence. Eur Urol, 2011. 59(3): p. 387-400.
9. CHUNG, E., D.J. KATZ, AND C. LOVE, Adult male stress and urge urinary incontinence - A review of pathophysiology and treatment strategies for voiding dysfunction in men. Aust Fam Physician, 2017. 46(9): p. 661-666.
10. FLORATOS, D.L., et al., Biofeedback vs verbal feedback as learning tools for pelvic muscle exercises in the early management of urinary incontinence after radical prostatectomy. BJU Int, 2002. 89(7): p. 714-9.
11. TIENFORTI, D., et al., Efficacy of an assisted low-intensity programme of perioperative pelvic floor muscle training in improving the recovery of continence after radical prostatectomy: a randomized controlled trial. BJU Int, 2012. 110(7): p. 1004-10.
12. DEMAAGD, G.A. AND T.C. DAVENPORT, Management of urinary incontinence. P T, 2012. 37(6): p. 345-361H.
13. LEE, S.W., et al., Treatment outcomes of transurethral macroplastique injection for postprostatectomy incontinence. Korean J Urol, 2014. 55(3): p. 182-9.
14. CHUNG, E., Contemporary surgical devices for male stress urinary incontinence: a review of technological advances in current continence surgery. Transl Androl Urol, 2017. 6(Suppl 2): p. S112-S121.
15. KIM, S.P., et al., Long-term durability and functional outcomes among patients with artificial urinary sphincters: a 10-year retrospective review from the University of Michigan. J Urol, 2008. 179(5): p. 1912-6.
16. LEPOR, H., Pathophysiology of lower urinary tract symptoms in the aging male population. Rev Urol, 2005. 7 Suppl 7: p. S3-S11.
17. WEI, J.T., E. CALHOUN, AND S.J. JACOBSEN, Urologic diseases in America project: benign prostatic hyperplasia. J Urol, 2005. 173(4): p. 1256-61.
18. BLANKSTEIN, U., B. VAN ASSELDONK, AND D.S. ELTERMAN, BPH update: medical versus interventional management. Can J Urol, 2016. 23(Suppl 1): p. 10-5.
19. PORST, H., et al., Efficacy and safety of tadalafil once daily in the treatment of men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia: results of an international randomized, double-blind, placebo-controlled trial. Eur Urol, 2011. 60(5): p. 1105-13.
20. SIVARAJAN, G., et al., The Role of Minimally Invasive Surgical Techniques in the Management of Large-gland Benign Prostatic Hypertrophy. Rev Urol, 2015. 17(3): p. 140-9.
21. HAYLEN, B.T., et al., An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn, 2010. 29(1): p. 4-20.
22. CHUNG, A., et al., Voiding dysfunction in older men. Curr Opin Urol, 2016. 26(2): p. 177-83.
23. TUBARO, A., Defining overactive bladder: epidemiology and burden of disease. Urology, 2004. 64(6 Suppl 1): p. 2-6.
24. TSE, V., et al., Conjoint Urological Society of Australia and New Zealand (USANZ) and Urogynaecological Society of Australasia (UGSA) Guidelines on the management of adult non-neurogenic overactive bladder. BJU Int, 2016. 117(1): p. 34-47.
25. DMOCHOWSKI, R.R., A. GOMELSKY, Overactive bladder in males. Ther Adv Urol, 2009. 1(4): p. 209-21.
26. BURTON, C., A. SAJJA, P.M. LATTHE, Effectiveness of percutaneous posterior tibial nerve stimulation for overactive bladder: a systematic review and meta-analysis. Neurourol Urodyn, 2012. 31(8): p. 1206-16.
27. OSMAN, N.I., et al., Detrusor underactivity and the underactive bladder: a new clinical entity? A review of current terminology, definitions, epidemiology, aetiology, and diagnosis. Eur Urol, 2014. 65(2): p. 389-98.
28. OSMAN, N.I., F. ESPERTO,C.R. CHAPPLE, Detrusor Underactivity and the Underactive Bladder: A Systematic Review of Preclinical and Clinical Studies. Eur Urol, 2018. 74(5): p. 633-643.
29. JIANG, Y.H., H.C. KUO, Urothelial Barrier Deficits, Suburothelial Inflammation and Altered Sensory Protein Expression in Detrusor Underactivity. J Urol, 2017. 197(1): p. 197-203.
30. ALDAMANHORI, R., C.R. CHAPPLE, Underactive bladder, detrusor underactivity, definition, symptoms, epidemiology, etiopathogenesis, and risk factors. Curr Opin Urol, 2017. 27(3): p. 293-299.
31. CHAPPLE, C.R., et al., The underactive bladder: a new clinical concept? Eur Urol, 2015. 68(3): p. 351-3.
32. KIM, M., C.W. JEONG, S.J. OH, Effect of Preoperative Urodynamic Detrusor Underactivity on Transurethral Surgery for Benign Prostatic Hyperplasia: A Systematic Review and Meta-Analysis. J Urol, 2018. 199(1): p. 237-244.
33. GROSS, C., et al., Sacral neuromodulation for nonobstructive urinary retention: a meta-analysis. Female Pelvic Med Reconstr Surg, 2010. 16(4): p. 249-53.
34. RADEMAKERS, K.L., et al., Prediction of sacral neuromodulation treatment success in men with impaired bladder emptying-time for a new diagnostic approach. Neurourol Urodyn, 2017. 36(3): p. 808-810.
35. DELANCEY, J.O., Structural support of the urethra as it relates to stress urinary incontinence: the hammock hypothesis. Am J Obstet Gynecol, 1994. 170(6): p. 1713-20; discussion 1720-3.
36. NAKAMURA, R., et al., Outpatient mid-urethral tissue fixation system sling for urodynamic stress urinary incontinence: 3-year surgical and quality of life results. Int Urogynecol J, 2017. 28(11): p. 1733-1738.
37. CAVKAYTAR, S., et al., Effect of home-based Kegel exercises on quality of life in women with stress and mixed urinary incontinence. J Obstet Gynaecol, 2015. 35(4): p. 407-10.
38. BUMP, R.C., et al., Assessment of Kegel pelvic muscle exercise performance after brief verbal instruction. Am J Obstet Gynecol, 1991. 165(2): p. 322-7; discussion 327-9.
39. KIRCHIN, V., et al., Urethral injection therapy for urinary incontinence in women. Cochrane Database Syst Rev, 2017. 7: p. CD003881.
40. FORD, A.A., et al., Mid-urethral sling operations for stress urinary incontinence in women. Cochrane Database Syst Rev, 2017. 7: p. CD006375.
41. STEWART, W.F., et al., Prevalence and burden of overactive bladder in the United States. World J Urol, 2003. 20(6): p. 327-36.
42. LIU, R.T., et al., Prevalence of overactive bladder and associated risk factors in 1359 patients with type 2 diabetes. Urology, 2011. 78(5): p. 1040-5.
43. DMOCHOWSKI, R.R., et al., Bladder-health diaries: an assessment of 3-day vs 7-day entries. BJU Int, 2005. 96(7): p. 1049-54.
44. WESSELMANN, U., Interstitial cystitis: a chronic visceral pain syndrome. Urology, 2001. 57(6 Suppl 1): p. 32-9.
45. NAZIF, O., J.M. TEICHMAN, G.F. GEBHART, Neural upregulation in interstitial cystitis. Urology, 2007. 69(4 Suppl): p. 24-33.
46. GRAHAM, E., T.C. CHAI, Dysfunction of bladder urothelium and bladder urothelial cells in interstitial cystitis. Curr Urol Rep, 2006. 7(6): p. 440-6.
47. HURST, R.E., et al., A deficit of chondroitin sulfate proteoglycans on the bladder uroepithelium in interstitial cystitis. Urology, 1996. 48(5): p. 817-21.
48. TEICHMAN, J.M., C.L. PARSONS, Contemporary clinical presentation of interstitial cystitis. Urology, 2007. 69(4 Suppl): p. 41-7.
49. POWELL-BOONE, T., et al., Menstrual cycle affects bladder pain sensation in subjects with interstitial cystitis. J Urol, 2005. 174(5): p. 1832-6.
50. O’LEARY, M.P., et al., The interstitial cystitis symptom index and problem index. Urology, 1997. 49(5A Suppl): p. 58-63.
51. CLEMENS, J.Q., et al., Validation of a modified National Institutes of Health chronic prostatitis symptom index to assess genitourinary pain in both men and women. Urology, 2009. 74(5): p. 983-7, quiz 987.e1-3.
52. FOSTER, H.E., et al., Effect of amitriptyline on symptoms in treatment naïve patients with interstitial cystitis/painful bladder syndrome. J Urol, 2010. 183(5): p. 1853-8.
53. HANNO, P.M., et al., AUA guideline for the diagnosis and treatment of interstitial cystitis/bladder pain syndrome. J Urol, 2011. 185(6): p. 2162-70.
54. DUNN, M., et al., Interstitial cystitis, treated by prolonged bladder distension. Br J Urol, 1977. 49(7): p. 641-5.
55. YAMADA, T., T. MURAYAMA, M. ANDOH, Adjuvant hydrodistension under epidural anesthesia for interstitial cystitis. Int J Urol, 2003. 10(9): p. 463-8; discussion 469.
56. KUO, H.C., et al., Intravesical botulinum toxin-A injections reduce bladder pain of interstitial cystitis/bladder pain syndrome refractory to conventional treatment - A prospective, multicenter, randomized, double-blind, placebo-controlled clinical trial. Neurourol Urodyn, 2016. 35(5): p. 609-14.
57. PETERS, K.M., K.M. FEBER, R.C. BENNETT, A prospective, single-blind, randomized crossover trial of sacral vs pudendal nerve stimulation for interstitial cystitis. BJU Int, 2007. 100(4): p. 835-9.
58. RÖSSBERGER, J., et al., Long-term results of reconstructive surgery in patients with bladder pain syndrome/interstitial cystitis: subtyping is imperative. Urology, 2007. 70(4): p. 638-42.
59. NORDLING, J., J.G. BLAIVAS, Should urinary diversion for bladder pain syndrome/interstitial cystitis include cystectomy? No. J Urol, 2014. 191(2): p. 293-5.
60. CHASE, J., et al., The management of dysfunctional voiding in children: a report from the Standardisation Committee of the International Children’s Continence Society. J Urol, 2010. 183(4): p. 1296-302.
61. KUO, H.C., Videourodynamic characteristics and lower urinary tract symptoms of female bladder outlet obstruction. Urology, 2005. 66(5): p. 1005-9.
62. AKBAL, C., et al., Dysfunctional voiding and incontinence scoring system: quantitative evaluation of incontinence symptoms in pediatric population. J Urol, 2005. 173(3): p. 969-73.
63. AFSHAR, K., et al., Development of a symptom score for dysfunctional elimination syndrome. J Urol, 2009. 182(4 Suppl): p. 1939-43.
64. SINHA, S., Dysfunctional voiding: A review of the terminology, presentation, evaluation and management in children and adults. Indian J Urol, 2011. 27(4): p. 437-47.
65. KUO, H.C., Recovery of detrusor function after urethral botulinum A toxin injection in patients with idiopathic low detrusor contractility and voiding dysfunction. Urology, 2007. 69(1): p. 57-61; discussion 61-2.
66. BOWER, W.F., C.K. YEUNG, A review of non-invasive electro neuromodulation as an intervention for non-neurogenic bladder dysfunction in children. Neurourol Urodyn, 2004. 23(1): p. 63-7.
67. ROTH, T.J., et al., Sacral neuromodulation for the dysfunctional elimination syndrome: a single center experience with 20 children. J Urol, 2008. 180(1): p. 306-11; discussion 311.
68. CAPITANUCCI, M.L., et al., Long-term efficacy of percutaneous tibial nerve stimulation for different types of lower urinary tract dysfunction in children. J Urol, 2009. 182(4 Suppl): p. 2056-61.
69. NITTI, V.W., Primary bladder neck obstruction in men and women. Rev Urol, 2005. 7 Suppl 8: p. S12-7.
70. AWAD, S.A., et al., Sympathetic activity in the proximal urethra in patients with urinary obstruction. J Urol, 1976. 115(5): p. 545-7.
71. BATES, C.P., E.P. ARNOLD, D.J. GRIFFITHS, The nature of the abnormality in bladder neck obstruction. Br J Urol, 1975. 47(6): p. 651-6.
72. GRAFSTEIN, N.H., A.J. COMBS, K.I. GLASSBERG, Primary bladder neck dysfunction: an overlooked entity in children. Curr Urol Rep, 2005. 6(2): p. 133-9.
73. NITTI, V.W., et al., Lower urinary tract symptoms in young men: videourodynamic findings and correlation with noninvasive measures. J Urol, 2002. 168(1): p. 135-8.
74. NORLEN, L.J., J.G. BLAIVAS, Unsuspected proximal urethral obstruction in young and middle-aged men. J Urol, 1986. 135(5): p. 972-6.
75. COMBS, A.J., et al., Short pelvic floor electromyographic lag time: a novel noninvasive approach to document detrusor overactivity in children with lower urinary tract symptoms. J Urol, 2013. 189(6): p. 2282-6.
76. SMEY, P., L.R. KING, C.F. FIRLIT, Dysfunctional voiding in children secondary to internal sphincter dyssynergia: treatment with phenoxybenzamine. Urol Clin North Am, 1980. 7(2): p. 337-47.
77. KAPLAN, S.A., A.E. TE, B.Z. JACOBS, Urodynamic evidence of vesical neck obstruction in men with misdiagnosed chronic nonbacterial prostatitis and the therapeutic role of endoscopic incision of the bladder neck. J Urol, 1994. 152(6 Pt 1): p. 2063-5.
78. TROCKMAN, B.A., et al., Primary bladder neck obstruction: urodynamic findings and treatment results in 36 men. J Urol, 1996. 156(4): p. 1418-20.