Benefits and Harms of Conservative, Pharmacological, and Surgical Management Options for Women with Bladder Outlet Obstruction: A Systematic Review from the European Association of Urology Non-neurogenic Female LUTS Guidelines Panel

Benoit Peyronnet* (Corresponding Author), Marie Carmela M. Lapitan, Lazaros Tzelves, Eabhann O'Connor, Aisling Nic An Ríogh, Margarida Manso, Cathy Yuhong Yuan, Salvador Arlandis, Kari Bø, Elisabetta Costantini, Fawzy Farag, Jan Groen, Arjun K Nambiar, Véronique Phé, Huub van der vaart, Muhammad Imran Omar, Chris Harding

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Context: While the management of bladder outlet obstruction (BOO) in men has been a topic of several systematic reviews and meta-analysis, no such evidence base exists for female BOO.
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.
Original languageEnglish
Number of pages22
JournalEuropean Urology Focus
Early online date23 Oct 2021
DOIs
Publication statusE-pub ahead of print - 23 Oct 2021

Keywords

  • bladder outlet obstruction
  • female
  • systematic review
  • treatment
  • urodynamic
  • women

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