Rigi10™ Malleable Penile Prosthesis
Also Known As
Lower Urinary Tract Dysfunction (LUTD), Dysfunctional Voiding, Voiding Disorders, Bladder Emptying Disorders, Non-Neurogenic Voiding Dysfunction, Functional Voiding Disorder, Detrusor-Sphincter Dyscoordination
Definition
Voiding dysfunction is a broad term that describes abnormalities in the bladder emptying process, characterized by poor coordination between the bladder muscle and the urethral sphincter.1 It encompasses a spectrum of conditions affecting the storage and emptying phases of the micturition cycle, resulting in difficulties with urination.2 Voiding dysfunction can manifest as problems initiating urination, maintaining or stopping urine flow, or completely emptying the bladder.3 This condition occurs in the absence of neurological or anatomical abnormalities and can affect both children and adults of all genders, though presentation and underlying causes may differ.4 The etiology is multifactorial, potentially involving learned behaviors, persistent immature voiding patterns, psychological factors, and in some cases, genetic predispositions.5
Clinical Context
Voiding dysfunction presents with a diverse range of symptoms that can significantly impact quality of life. In the storage phase, patients may experience urinary frequency, urgency, urge incontinence, nocturia, and various forms of bladder pain.1 During the emptying phase, symptoms include hesitancy, straining to void, difficulty initiating urination, diminished urinary stream, sensations of incomplete bladder emptying, and in severe cases, urinary retention.2
The etiology of voiding dysfunction varies by age and gender. In children, it often manifests as dysfunctional voiding, where failure of the external sphincter-pelvic floor complex to relax during urination results in bladder outflow obstruction.3 This can lead to recurrent urinary tract infections, vesicoureteric reflux, and in severe cases, upper tract deterioration.3 In men, voiding dysfunction is frequently attributed to prostatic obstruction, though only approximately two-thirds of symptomatic men meet the diagnostic criteria for obstruction.1 Many also experience detrusor overactivity, impaired detrusor contractility, or other contributing factors.1 In women, the condition is often multifactorial, with causes including hormonal changes, childbirth effects, aging, and previous pelvic surgeries.1 Women experience a much lower incidence of urethral obstruction but a higher rate of sphincteric incontinence compared to men.1
Diagnosis typically involves a comprehensive approach including detailed medical history, physical examination, urinalysis, and specialized urodynamic testing.4 Non-invasive urodynamics, particularly uroflowmetry with or without electromyography (EMG), plays a crucial role in diagnosis and treatment monitoring.3 In complex cases, invasive urodynamic studies may be necessary to fully characterize the dysfunction.5
Treatment strategies are tailored to the specific type of voiding dysfunction and underlying causes. Conservative approaches include behavioral modifications, timed voiding schedules, pelvic floor therapy, and biofeedback training.3 Pharmacological interventions may include anticholinergics for overactive bladder symptoms, alpha-blockers to reduce outflow resistance, or other medications targeting specific aspects of the dysfunction.4 For refractory cases, more invasive options such as sacral neuromodulation, botulinum toxin injections, or surgical interventions may be considered.5 Treatment outcomes are generally favorable when the approach is based on the underlying pathophysiology rather than symptoms alone.1