顧明軒¹、范玉華^{1, 2, 3}、林登龍^{1, 2, 3}、陳光國^{1, 2, 3}

臺北榮民總醫院 泌尿部¹；國立陽明大學醫學院泌尿學科²；書田泌尿科學研究中心³

 

 

Ming-Hsuan Ku¹, Yu-Hua Fan ^1,2,3, Alex T.L. Lin ^1,2,3, Kuang-Kuo Chen ^1,2,3

¹ Department of Urology, Taipei Veterans General Hospital;

² School of Medicine and ³Shu-Tien Urological Institute, National Yang-Ming University, Taiwan

 

        A 79-year-old female has the history of hypertension and hyperlipidemia. She denied having any urinary tract or gynecologic surgery before. She visited our outpatient department with the chief complaint of urinary frequency about 8 times per day, nocturia about 2 to 3 times per night, as well as weak stream and voiding difficulties. She had also experienced occasional urge urinary incontinence. Urine routine reported no pyruia nor hematuria. Videourodynamic study demonstrated a filling defect over bladder neck and caused bladder neck obstruction during voiding phase (PdetQmax: 44mmH2O, Qmax: 12.8 mmH2O). Further abdominal sonogram and CT scan revealed a 2.3cm lobulated polypoid mass over bladder neck. Transurethral resection of the bladder tumor (TUR-Bt) was performed. A non-papillary tumor with a stalk over trigone near bladder neck was seen during the operation. Pathology report was urothelial carcinoma, pTa, low grade. The patient currently was under our OPD follow-up for about 3 months. Urinary symptoms such as frequency, nocturia, and weak stream all improved after the surgery.

 

To diagnose bladder outlet obstruction (BOO) in female is harder than in male. There are many causes for female BOO, which could be divided into two major groups: anatomic (e.g., pelvic organ prolapse, urinary tract malignancies, strictured disease) and functional (e.g., dysfunctional voiding, primary bladder neck obstruction, Fowler’s syndrome). Since 1988, there are more than 15 criteria proposed to define female BOO. Since there is no highly prevalent condition as in men (Benign prostate hyperplasia), nomogram for female BOO is more difficult to establish. Besides absolute pressure and flow value, radiographic or clinical evidence of obstruction is also necessary for diagnosis of female BOO. The prevalence varies widely from 2.7% to 23%, possibly due to lack of consensus of diagnostic criteria, or different likelihood for patients to seek treatments in each studies. Mixed storage and empty symptoms were present in 57% of all patients, and only half of urodynamically obstructed women have voiding symptoms. Treatment is based on the etiologies. Either medical or surgical intervention, pessary use, clean intermittent catheterization or pelvic floor physical therapy could be effective. Our case demonstrated a bladder tumor at trigone causing bladder outlet obstruction, with good urinary functional improvement after TUR-Bt.