Objective: The aim of this systematic review was to evaluate the benefits and harms of therapeutic interventions for the management of BOO in women.
Evidence acquisition: This systematic review was conducted in accordance with the PRISMA statement. The study protocol was registered with PROSPERO
(CRD42020183839). A systematic literature search was performed and updated by a research librarian in May 2021. The study population consisted of adult female patients diagnosed with BOO and who underwent treatment.
Evidence synthesis: Out of 6344 records, we identified 33 studies enrolling 1222
participants, of which only six RCTs were found. One placebo-controlled cross-over randomized trial assessed the role of baclofen in 60 female patients with dysfunctional voiding. The trial met its primary endpoint with a significantly greater decrease in the number of voids/day in the baclofen group (-5.53 vs. -2.70; p=0.001). The adverse events were mild and comparable in both groups (25% vs. 20%). One placebo controlled cross-over randomized trial assessed the role of sildenafil in 20 women with Fowler’s syndrome. There were significant improvements from baseline in Qmax, IPSS, and post-void residual (PVR) but with no statistically significant difference when compared with placebo. In a large RCT including 197 female patients with functional BOO, the alpha-blocker alfusozin significantly improved IPSS, Qmax and PVR compared to baseline but the differences compared to the placebo group were not statistically significant. Several small single arm prospective series reported improvement of BOO related symptoms and voiding parameters with urethroplasty, sling revision, urethral dilation, vaginal pessary and pelvic organ prolapse repair. Conclusion: Evidence to support the use of conservative, pharmacological and surgical treatments for BOO are scarce.
- bladder outlet obstruction
- systematic review