Dysfunctional voiding (DV) is characterized by an intermittent and/or fluctuating flow rate due to involuntary intermittent contractions of the peri-urethral striated or levator muscles during voiding in neurologically and anatomic normal women. This study investigated the clinical presentations and UD characteristics in female dysfunctional voiding.

: A total of 230 women with lower urinary tract symptoms (LUTS) were investigated with urodynamic studies (UDS) from 2012 to 2020.The clinical urinary symptoms and UD characteristics were analyzed. Antimuscarinic or alpha-blocker treatment according to the main complaint of storage or voiding LUTS was respectively given including clean intermittent catheterization.1

There were 16 women diagnosed with DV. Detrusor overactivity (DO)occurred in 63% of women with DV. Patients with DV had low cystometric bladder capacity, high detrusor pressure, low maximum flow rate and large post-void residual volume. A total of 8 patients had storage symptoms,4 had painful symptoms and 14 had voiding symptoms as their chief complaints among those with DV. Among them, difficult urination was the most common chief complaint, followed by urgency and urgency incontinence.

Our study showed high incidence of urodynamic DO (63%), small CBC,low Qmax,large postvoid residual volume and high Pdet in patients with DV. 
In our analysis, most women with DV presented with difficult urination as their main symptom. Urgency was also an associated symptom.
In our study, women with BOO complain of not only voiding symptoms but also storage symptoms. In that respect, UDS can provide essential information for differentiation of BOO from overactive bladder (OAB). Additionally, women with underactive bladder (UAV) usually have a high PVR  and  complain of  voiding symptoms. However, some of them have storage symptoms as the chief complaint. Without UDS  ,   an exact  diagnosis  cannot  be  made  in  this  situation.
Although uroflowmetry and residual volume are sometimes useful screening tools for voiding dysfunction, UDS is necessary for distinguishing the DV and providing the appropriate treatment.2
 The present study has some limitations. The first is its retrospective nature and the lack of a control group. In practice, conducting UDSs for normal subjects is difficult, thus we could not compare the UDS of control. Further, although we used a cut-off value for the UDS-based diagnosis of DV, there is a lack of established urodynamic criteria for the diagnosis of DV at present. In addition, we did not investigate the natural history or response to treatment in DV because of the retrospective characteristic of the study.

LUTS voiding symptoms and UD study features of BOO were present in most women with DV.UDS may be necessary for accurate diagnosis in women with voiding symptoms.

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Carlson KV, Rome S, Nitti VW. Dysfunctional voiding in women. J Urol. 2001; 165:143–147, discussion 147–148.