In commenting on this article, a gynaecologist well-versed in bladder function notes that gynaecological problems do not cause a hypotonic bladder. In women this follows a lower motor neurone lesion, or rarely a mechanical obstruction; sometimes it might result from infrequent voiding as a young girl, combined with recurrent infections which weaken the bladder wall. The commonest symptoms in women differ from those in men: they are hesitancy, poor stream, straining to void, and incomplete emptying. He also stresses the value of urodynamic assessment where frequent catheterisation and adjustment of fluid intake do not keep a patient dry.
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