Význam diagnostiky a léčby ženské subvezikální obstrukce v klinické praxi

Importance of Diagnostics and Therapy of Female Subvesical Obstruction in Clinical Practice

Introduction and objective:
Female subvesical obstruction is frequently underestimated and its clinical importance is relativized. At the present time it is not defined precisely and most authors use the urodynamic method for diagnosis. The aim of the work was to evaluate the results of examination of subvesical obstruction by several diagnostic methods and to compare it with the results of therapy in symptomatic female patients with subvesical obstruction determined by calibration of urethra.

Material and Methods:
In the group of 31 patients with symptoms of lower urinary tract (urgent symptomatology, obstruction symptomatology, relapsing infection of lower urinary pathways), where the calibration determined the urethra lumen less than 22Ch, the analysis of voiding urethrocystography. The same examinations were also made three months after endoscopic operation therapy (urethrotomy, endoresection of the bladder neck) and the comparison is described. One year after the surgery the subjective satisfaction of the patients was evaluated and semi-objective parameters obtained by analysis of the micturion diaries as well.

Results:
Only three (9.68%) of patients of the cohort fulfilled all urodynamic criteria of obstruction according to Blaivas, only in four (12.9%) patients the pathological finding during voiding urethrocystography. In spite of that the deobstruction therapy reached a complete disappearance of the symptomatology in nine (29.0%) and a substantial improvement of the condition in 15 (28.4%) patients.

Conclusion:
In our opinion the clinical importance of subvesical obstruction in women is greater than generally presented. None of the urodynamic or imaging methods is able to reveal the obstruction safely and the calibration of urethra should be therefore a routine part of examination in women with symptoms of disorders in lower urinary tract. Uretrotomy is a simple and effective method in the therapy of subvesical obstruction in women with very good outcomes.

Key words:
calibration of urethra, urodynamic examination, voiding urethrocystography, dysfunction of lower urinary tract, urethrotomy