Weak stream in women: myth or reality?
Article published in Urologia Polska 2008/61/Supl. 1.

authors

Bartosz Dybowski, Piotr Radziszewski, Jacek Judycki, Igal Mor, Andrzej Borkowski

Katedra i Klinika Urologii Ogólnej, Onkologicznej i Czynnościowej Uniwersytetu Medycznego w Warszawie
Centrum Medyczne Wola w Warszawie

summary

Introduction.

Weak stream is a common symptom of men, but it is also reported by women. It may be caused by bladder outlet obstruction or detrusor insufficiency. However, evaluation of women with a weak stream is problematic because criteria for bladder outlet obstruction in female population are not defined. It is also unknown who needs to be treated and for whom it is only an accidental and insignificant finding.

Objectives.

The aim of the study was to assess incidence of weak stream in a population of women undergoing urodynamic evaluation. We also wanted to determine concomitant lower urinary tract symptoms and type of lower urinary tract dysfunction responsible for a weak stream.

Materials and methods.

Urodynamic databases from two centers were analyzed in a retrospective fashion. The urodynamic investigations were performed by two doctors. All investigations were searched for patients with maximum urinary flow equal or lower than 12 ml/s. In this subgroup lower urinary tract symptoms, pressure-flow parameters, important information from medical history and physical examination were collected. Diagnostic tests done before urodynamic study were also evaluated.

Results.

In years 1997-2006 in both centers urodynamic investigations of 1854 women were performed including 1260 (68%) patients with stress urinary incontinence. 130 patients with a weak stream were identified which accounts for 7% of all investigated women and 22% of patients without stress urinary incontinence. For technical

reasons 121 investigations were chosen for further analyses. Mean age of women with a weak stream was 48 (range 16 to 78). The most common symptoms were irritative symptoms and urge urinary incontinence (n=82; 67.8%). Other symptoms: obstructive symptoms (n=52; 43%), chronic pelvic pain syndrome (18;14.9%), recurrent urinary tract infection (n=14; 11.6%), stress urinary incontinence (n=4; 3.3%). Detrusor pressure at maximum flow in the range of 0-10 cm H2O was found in 18% of patients, 11-20 cmH2O in 28%, 21-30 cm H2O in 24%, 31-50 cm H2O in 22%, 51-75% in 7% and above 75 cmH2O in 2% of women. In the subgroup of patients with moderate or strong detrusor only 12% had an evident reason of obstruction (cystocoele, previous surgery, previous radiotherapy, urethral stricture). None of the women had voiding cystourethrography or cystoscopy and only 3 patients had a free flow studies done before urodynamic investigation.

Conclusions.

Weak stream is a frequent urodynamic observation in women with lower urinary tract symptoms and without stress urinary incontinence. Most of women do not notice this symptom and they seek medical advice for concomitant more troublesome symptoms. Usually urodynamic investigation does not allow to precisely diagnose the reason of low flow. There is no knowledge on natural history of bladder outlet obstruction and detrusor insufficiency in women which in turn makes very difficult establishing optimal diagnostic and treatment algorithm for women with a weak urine stream.