Female bladder outlet obstruction (BOO) is challenging to diagnose due to its low prevalence and complex etiology.Dysfunctional voiding, characterized by the absence of anatomical abnormalities or neurological damage, is even more difficult to identify, with no established consensus on diagnostic criteria.This study aims to analyze the clinical characteristics of female patients with dysfunctional voiding to identify potential commonalities and differences in clinical symptoms and videourodynamic presentations.

We retrospectively collected data from adult female patients diagnosed with BOO at a single medical center between July 2022 and May 2025.Patients underwent free uroflowmetry and further videourodynamic studies, and those with detrusor-external sphincter dyssynergia (DESD) due to neurological deficits such as spinal cord disease or radical pelvic surgery were excluded.We analyzed patients' medical history, primary symptoms, initial uroflowmetry parameters, videourodynamic findings, and prescribed treatments using descriptive statistical methods.

A total of 63 female patients were initially included, with 48 patients meeting the criteria for dysfunctional voiding after exclusion.The mean age was 59 years and there were 27% aging < 50-year-old.The most common symptoms when initial visit involved both storage and voiding dysfunction (39%, 18/46) and there were 37% patients presenting with dominant storage symptom in initial presentation.The mean symptom duration was 38 months. Uroflowmetry showed a mean flow rate of 3.9 mL/sec and a maximum flow rate of 11.6 mL/sec. The most common uroflow pattern was flat (38%, 15/39), whereas the sawtooth pattern was observed in only 20% (8/39). The mean voiding efficiency was 66%. Videourodynamic studies revealed a mean maximum bladder capacity of 365 mL. Increased electromyography (EMG) activity was observed in 77% (37/48), and DESD Type 2 contractions were present in 45% (22/48).Fluoroscopy demonstrated obstruction of the external sphincter and pelvic floor level in 86.7% (39/45) and there were 69% patients presenting both abnormal EMG activity and evidence of obstruction on fluoroscopy The mean detrusor pressure at maximum flow (PdetQmax) was 19 cmH₂O, with a mean voiding efficiency of 25%. The female bladder outlet obstruction index ((BOOIf= PdetQmax- 2.2*Qmax) was ranging from 0.58 to 59.2. There were 22% patients with BOOIf > 18, 41.5% > 5 and 46.3% <0.

Dysfunctional voiding in female patients affects both younger and older individuals, with medical history providing limited diagnostic value. A comprehensive evaluation incorporating clinical symptoms, urinary flow rate, uroflow pattern, EMG activity, and fluoroscopic findings is essential for distinguishing dysfunctional voiding from other conditions. Female BOO index has low sensitivity in diagnosis of dysfunctional voiding. Further studies with larger cohorts are necessary to refine diagnostic criteria and identify more specific clinical patterns