Bladder emptying difficulty in the female can be cured by uterosacral ligament repair, preferably using posterior slings

Aim. To analyse bladder emptying difficulty with reference to the descriptions of 'Underactive Bladder' (UAB) syndrome, 'obstructive micturition' and Posterior Fornix Syndrome in the female. Methods. A comparative analysis of UAB and 'obstructive micturition' was performed against evidence from surgical correction of uterine/apical prolapse in patients with symptoms of 'posterior fornix syndrome' (PFS). PFS comprises 4 grouped symptoms, micturition difficulties/post-void residual, urge/ frequency, nocturia, chronic pelvic pain. Results. Other than chronic pelvic pain, the expanded characteristics of UAB as recently defined are identical with those of PFS: micturition difficulties/ post-void residual, urge/frequency, nocturia. These were cured in up to 80% of cases by surgical repair of the cardinal/uterosacral ligament complex, using native or posterior sling techniques. Native tissue ligament repair worked well in younger women but not in older women, because of collagen leaching with age. Posterior ligament slings which create new collagen for ligament repair were required for older women. Conclusions. Surgical cure of UAB and renders definitions implying detrusor muscle pathogenesis invalid. Valid definitions are important, as they are the guidelines for treatment, diagnosis, research. Altering UAB to 'bladder emptying difficulties' allows compatibility with surgical treatment and removes the obstacles with detrusor pathogenesis presents for ongoing research.