Do we understand voiding dysfunction in women? Current understanding and future perspectives: ICI-RS 2017

Urinary retention in women is poorly understood, compared to the equivalent condition in men, and was the subject of a dedicated session organized at the International Consultation on Incontinence Research Society (ICI-RS) in Bristol, United Kingdom, 2017.

The current understanding of the pathophysiological correlates of idiopathic voiding dysfunction in women, the role of urodynamics, neurophysiology, and non-invasive tests in characterizing functional bladder outlet obstruction due to a non-relaxing urethral sphincter, and poorly defined diagnosis of detrusor underactivity were reviewed.

Putative factors underlying the pathogenesis of urinary retention following urinary tract infections were discussed. Further research is required to explore the association between bladder wall inflammation and alterations in detrusor contractile functions. The complex interrelationship between urinary retention and psychological co-morbidities and sexual trauma were explored, and the overlap between these and psychological co-morbidities and functional neurological problems with functional urological problems were recognized. Understanding the mechanism of action of sacral neuromodulation, often a successful treatment for urinary retention, would provide insight into the underlying factors that may be responsible for urinary retention. Specifically, there is a need to understand the role of the endogenous enkephalinergic system in the pathogenesis of urinary retention and to identify predictors of successful treatment with sacral neuromodulation. Based on current understanding and potential directions of research in the future, an algorithm for the evaluation of women with voiding dysfunction was proposed.

In the future, recommendations for research should lead to a better understanding of urinary retention in women and its treatment.

Neurourology and urodynamics. 2018 Jun [Epub]

Jalesh N Panicker, Ralf Anding, Salvador Arlandis, Bertil Blok, Caroline Dorrepaal, Chris Harding, Tom Marcelissen, Kevin Rademakers, Paul Abrams, Apostolos Apostolidis

Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery and UCL Institute of Neurology, Queen Square, London, United Kingdom., Neurourology, Department of Urology and Pediatric Urology, University Hospital Bonn, Bonn, Germany., Department of Urology, Hospital Universitario y Politécnico La Fe, Valencia, Spain., Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands., Astellas Pharma Europe B.V., Leiden, The Netherlands., Department of Urology, Freeman Hospital, Newcastle Upon-Tyne, United Kingdom., Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands., Department of Urology, University of Bristol, Bristol, United Kingdom., 2nd Department of Urology, Aristotle University of Thessaloniki, Thessaloniki, Greece.