Voiding dysfunction.

Voiding dysfunction in women results from either a failure of the bladder to contract appropriately or a failure of the urethra or bladder neck to relax during attempts at micturition. Complaints of urinary frequency and urgency most often accompany voiding dysfunction. Associated symptoms, which are not always present, include postvoid fullness, poor flow, hesitancy, and complete urinary retention. Obstructive uroflowmetry and elevated residual urine are suggestive screening tests; however, complete multichannel urodynamic evaluation is necessary to arrive at a specific diagnosis. Once a diagnosis has been made, therapy will be directed at either increasing vesical contractility or reducing bladder outlet obstruction. Acute urinary retention should be dealt with initially by bladder decompression via catheterization. Regardless of the cause of the voiding dysfunction, if further therapy is unsuccessful, clean intermittent self-catheterization may prove to be the best alternative. This can ensure maintenance of relatively low intravesical pressure and residual urine, thus reducing the risk of urinary infection.