Urodynamic Differences Between Dysfunctional Voiding and Primary Bladder Neck Obstruction in Women (original) (raw)
Related papers
Neurourology and Urodynamics, 2007
AimsTo evaluate whether bladder outlet obstruction index (BOOI), a mathematical index of outlet resistance, in association with maximal flow rate (Qmax) obtained during multichannel urodynamics (UDS) or detrusor pressure at maximal flow rate (PdetQmax) could help the identification of obstruction in women.To evaluate whether bladder outlet obstruction index (BOOI), a mathematical index of outlet resistance, in association with maximal flow rate (Qmax) obtained during multichannel urodynamics (UDS) or detrusor pressure at maximal flow rate (PdetQmax) could help the identification of obstruction in women.MethodsFrom January 2004 to February 2005, 401 women were assessed in our urodynamic unit. Of these, 133 were neurologically intact women, referred symptoms suggestive of voiding disorders and had an abnormal non-intubated uroflussometry (NIF) (BOO group). A normal NIF was defined as a bell-shaped curve in presence of a Qmax >15 ml/sec and a PVR <50 ml. Symptoms of voiding disorders were ascertained by interview and rated positive if they occurred more than occasionally. Thirty-seven women were enrolled as unobstructed if they presented a normal NIF and symptoms suggestive of voiding disorders less than occasionally (unobstructed group).From January 2004 to February 2005, 401 women were assessed in our urodynamic unit. Of these, 133 were neurologically intact women, referred symptoms suggestive of voiding disorders and had an abnormal non-intubated uroflussometry (NIF) (BOO group). A normal NIF was defined as a bell-shaped curve in presence of a Qmax >15 ml/sec and a PVR <50 ml. Symptoms of voiding disorders were ascertained by interview and rated positive if they occurred more than occasionally. Thirty-seven women were enrolled as unobstructed if they presented a normal NIF and symptoms suggestive of voiding disorders less than occasionally (unobstructed group).ResultsROC curve demonstrated similar diagnostic accuracy in the diagnosis of urodynamic obstruction for Qmax obtained during UDS (AUC = 0.908; P < 0.0001; CI99% = 0.831 to 0.985) and BOOI (AUC = 0.879; P < 0.0001; CI99% = 0.794 to 0.918) and the least was seen for PdetQmax (AUC = 0.706; P = 0.001; CI99% = 0.620 to 0.830). A Qmax obtained during UDS cut-off ≤15 ml/sec provides specificity of 85.9% and sensitivity of 78.9%. A BOOI cut-off ≥−8 provides a sensitivity of 80.8% and specificity of 86.1%. The weakest sensitivity (64.2%) and specificity (64.6%) was recorded for PdetQmax ≥28 cmH2O.ROC curve demonstrated similar diagnostic accuracy in the diagnosis of urodynamic obstruction for Qmax obtained during UDS (AUC = 0.908; P < 0.0001; CI99% = 0.831 to 0.985) and BOOI (AUC = 0.879; P < 0.0001; CI99% = 0.794 to 0.918) and the least was seen for PdetQmax (AUC = 0.706; P = 0.001; CI99% = 0.620 to 0.830). A Qmax obtained during UDS cut-off ≤15 ml/sec provides specificity of 85.9% and sensitivity of 78.9%. A BOOI cut-off ≥−8 provides a sensitivity of 80.8% and specificity of 86.1%. The weakest sensitivity (64.2%) and specificity (64.6%) was recorded for PdetQmax ≥28 cmH2O.ConclusionsBOOI and Qmax obtained during UDS appears to be the most discriminating urodynamic parameters of female BOO. The use of these cutoff might facilitate the identification of women with functional and anatomical obstruction. Neurourol. Urodynam. 26:247–253, 2007. © 2007 Wiley-Liss, Inc.BOOI and Qmax obtained during UDS appears to be the most discriminating urodynamic parameters of female BOO. The use of these cutoff might facilitate the identification of women with functional and anatomical obstruction. Neurourol. Urodynam. 26:247–253, 2007. © 2007 Wiley-Liss, Inc.
Defining Voiding Dysfunction in Women: Bladder Outflow Obstruction Versus Detrusor Underactivity
International Neurourology Journal, 2021
Purpose: We aimed to develop urodynamic criteria to improve the accuracy of the diagnosis of bladder outlet obstruction (BOO) and detrusor underactivity (DU) in women with lower urinary tract symptoms (LUTS).Methods: Initially, in a group of 68 consecutive women with LUTS and increased postvoid residual (PVR) who had undergone urodynamic investigations, we examined the level of agreement between the operating physician’s diagnosis of BOO or DU and the diagnosis according to urodynamic nomograms/indices, including the Blaivas-Groutz (B-G) nomogram, urethral resistance factor (URA), bladder outlet obstruction index (BOOI), and bladder contractility index (BCI). Based on the initial results, we categorized 160 women into 4 groups using the B-G nomogram and URA (group 1, severe-moderate BOO; group 2, mild BOO and URA≥20; group 3, mild BOO and URA<20; group 4, nonobstructed) and compared the urodynamic parameters. Finally, we redefined women as obstructed (groups 1+2) and nonobstructe...
European Urology Focus, 2021
Context: Female bladder outlet obstruction (fBOO) is a relatively uncommon condition compared to its male counterpart. Several criteria have been proposed to define fBOO, but the comparative diagnostic accuracy of these remains uncertain. Objective: To identify and compare different tests to diagnose fBOO through a systematic review process. Evidence Acquisition: A systematic review of the literature was performed according to the Cochrane Handbook and PRISMA checklist. The EMBASE/MEDLINE/Cochrane databases were searched up to August 4 th 2020. Studies on women >18 years with suspected BOO involving diagnostic tests were included. Pressure-flow studies or fluoroscopy was used as the reference standard where possible. Two reviewers independently screened all articles, searched reference lists of retrieved articles and performed data extraction. The risk of bias was assessed using QUADAS-2. Evidence Synthesis: Overall, 28 non-randomised studies involving 10,248 patients were included in the qualitative analysis. There was significant heterogeneity regarding the characteristics of women included in BOO cohorts (i.e., mixed cohorts including both anatomical and functional BOO). Pressure-flow studies +/-fluoroscopy were evaluated in 25 studies. Transperineal doppler ultrasound was used to evaluate bladder neck dynamics in two studies. One study tested the efficacy of transvaginal ultrasound. The urodynamic definition of fBOO also varied amongst studies with different parameters and thresholds used, which precluded meta-analysis. Three studies derived nomograms using maximum flow rate (Qmax) and voiding detrusor pressure at Qmax. The sensitivity, specificity and overall accuracy range was 54.6-92.5%, 64.6-93.9%, and 64.1-92.2% respectively. Conclusion: The available evidence on diagnostic tests for fBOO is limited and heterogeneous. Pressure-flow studies +/-fluoroscopy remains the current standard for diagnosing fBOO.
A Predominant Urodynamic Diagnosis Can Hide a Minor One: Study in Non-Neurologic Women
Journal of Advances in Medicine and Medical Research
Aims: Voiding dysfunction is a common condition among women. Since voiding and storage symptoms can coexist, evaluation necessitates further investigations with urodynamic studies. Unfortunately, some predominant dysfunction can hide a minor one. The purpose of our study was to retrospectively review urodynamic records of non-neurologic women referred for evaluation of lower urinary tract dysfunction and to explain hidden concomitant urodynamic diagnoses that might have gone unnoticed without a thorough examination. Methods: Urodynamic tracings of 404 consecutive non-neurologic women referred for evaluation of lower urinary tract symptoms were reviewed. Initial urodynamic diagnosis had been proposed according with ICS/IUGA recommendations and a choice of specific urodynamic criteria. Concomitant urodynamic diagnoses were sought by analyzing the values of characteristic parameters which were hidden by predominant phenomenon. Results: Concomitant diagnoses were found for 120 (29.7%) w...
The comparison of urodynamic findings ?n women with various types of urinary ?ncontinence
International Braz J Urol, 2014
We aimed to determine the differences of the urodynamic findings of mix urinary incontinence (MUI), urge urinary incontinence (UUI), and stress urinary incontinence (SUI), and to evaluate the urodynamic findings in different groups by using bladder sensitivity index (BSI). Materials and Methods: The data of 99 patients who underwent urodynamic testing related to the suspicion of SUI, UUI or MUI were analysed. This analysis included a retrospective evaluation of patients' cards, voiding diaries, and urodynamic reports. At filling cystometry, the parameters of first sensation of bladder filling (FSBF), first desire to void (FDV), strong desire to void (SDV), and bladder capacity (V max), which were related to the bladder sensation, were determined. Subsequently, uroflowmetric findings were recorded during bladder emptying. BSI was defined as the ratio of V max / FDV. These results were statistically compared among the goups. Results: The sample included 35(35.5%) MUI, 33(33.3%) UUI and 31 (31.1%) SUI. The mean ages were similar in all groups (P = 0.868). The mean FSBF, FDV, SDV and Vmax values were significantly different among groups (p = 0.004, p < 0.001, p < 0.001, p < 0.001 respectively). Nevertheless, there was no statistically significant difference among the mean daily voiding accounts (P = 0.005). Although the mean maximum flow rate (Q max) values were similar (P = 0.428), the mean maximum detrusor pressure (Pdet max) values were significantly different (P = 0.021). The mean BSI values showed no significant differences (P = 0.097). Conclusions: It was concluded that while the use of urodynamic testing could contribute to the management of urinary incontinence, the indexes including BSI requere more detailed and comprehensive studies.
Neurourology and …, 2004
Aim: To assess the immediate (same testing period) and short-term (within 6 months) repeatability of urodynamic (UD) testing in asymptomatic healthy female volunteers. Materials and Methods: Twenty asymptomatic women with a mean age of 41.8 years (30^55) agreed to undergo a UD assessment which consisted of noninvasive uro£owmetry, post-void residual (PVR) measurement, medium-¢ll cystometry, and pressure £ow study with perineal surface electromyographic (EMG) electrodes. The UDS evaluation was repeated immediately without removing the catheters (a two-¢ll and void study). Sixteen women returned for an identical UD assessment 1^5 months later. Immediate and short-term repeatability of UD parameters was assessed by calculating the coe⁄cient of repeatability (COR). Results: The repeatability of certain parameters of immediate UD testing could not be calculated since there was an apparent in£uence of the ¢rst test on the second (i.e., an apparent accommodation noted in bladder ¢lling volumes). Other immediate UD values (maximum £ow, detrusor pressure at maximum £ow, voided volume) had high COR values, as did all UD values on short-term testing, indicating relatively poor repeatability. Picking the 'best' pressure £ow value (highest £ow rate with accompanying detrusor pressure) did not consistently improve the COR values. Conclusions: The lack of repeatability of UD studies likely stems from a combination of the true physiological £uctuations in bladder function and the inherent relative insensitivity of our instruments in conducting these testing. Knowledge of the limitations of current technology is essential in allowing us to better utilize these studies in evaluating our patients and further improving diagnostic strategies.
The Journal of Urology, 2011
Purpose: Noninvasive uroflowmetry with simultaneous electromyography is useful to triage cases of lower urinary tract symptoms into 4 urodynamically defined conditions, especially when incorporating short and long electromyography lag times in the analysis. We determined the prevalence of these 4 conditions at a single referral institution and the usefulness of uroflowmetry with simultaneous electromyography and electromyography lag time to confirm the diagnosis, guide treatment and monitor response. Materials and Methods: We retrospectively reviewed the records of 100 consecutive normal children who presented with persistent lower urinary tract symptoms, underwent uroflowmetry with electromyography as part of the initial evaluation and were diagnosed with 1 of 4 conditions based on certain uroflowmetry/electromyography features. The conditions included 1) dysfunctional voiding-active pelvic floor electromyography during voiding with or without staccato flow, 2a) idiopathic detrusor overactivity disorder-A-a quiet pelvic floor during voiding and shortened lag time (less than 2 seconds), 2b) idiopathic detrusor overactivity disorder-B-a quiet pelvic floor with a normal lag time, 3) detrusor underutilization disorder-volitionally deferred voiding with expanded bladder capacity but a quiet pelvic floor, and 4) primary bladder neck dysfunction-prolonged lag time (greater than 6 seconds) and a depressed, right shifted uroflowmetry curve with a quiet pelvic floor during voiding. Treatment was tailored to the underlying condition in each patient. Results: The group consisted of 50 males and 50 females with a mean age of 8 years (range 3 to 18). Dysfunctional voiding was more common in females (p Ͻ0.05) while idiopathic detrusor overactivity disorder-B and primary bladder neck dysfunction were more common in males (p Ͻ0.01). With treatment uroflowmetry parameters normalized for all types. Electromyography lag time increased in idiopathic detrusor overactivity disorder-A cases and decreased in primary bladder neck dysfunction cases. Conclusions: Noninvasive uroflowmetry with simultaneous electromyography offers an excellent alternative to invasive urodynamics to diagnose 4 urodynamically defined conditions. It identifies the most appropriate therapy for the specific condition and objectively monitors the treatment response.
Uroflowmetry in female voiding disturbances
Neurourology and Urodynamics, 2003
AimsThe clinical validity of uroflowmetry in women is attenuated by lack of absolute normal values. A peak flow <15 mL/sec and/or residual urine >50 mL with a minimum total bladder volume of 150 mL before voiding (volume voided+residual) (method A) and the 10th centile curve of the Liverpool Nomogram (method B) for the maximum urine flow rate have been identified as useful discriminants when diagnosing voiding difficulties in women. This study compares the two methods and analyses the validity of uroflowmetry in female voiding disturbances.The clinical validity of uroflowmetry in women is attenuated by lack of absolute normal values. A peak flow <15 mL/sec and/or residual urine >50 mL with a minimum total bladder volume of 150 mL before voiding (volume voided+residual) (method A) and the 10th centile curve of the Liverpool Nomogram (method B) for the maximum urine flow rate have been identified as useful discriminants when diagnosing voiding difficulties in women. This study compares the two methods and analyses the validity of uroflowmetry in female voiding disturbances.MethodsA total of 348 women underwent a full urogynaecologic work-up. Evaluable results of uroflowmetry (229 with method A and 224 with method B) were analysed and compared in terms of the following clinical variables: age, parity, previous urogynaecologic surgery, prolapse grade, symptoms, postvoid residue, and incontinence. Uroflowmetry results were compared with pressure/flow study results as indicated by four different cut-offs.A total of 348 women underwent a full urogynaecologic work-up. Evaluable results of uroflowmetry (229 with method A and 224 with method B) were analysed and compared in terms of the following clinical variables: age, parity, previous urogynaecologic surgery, prolapse grade, symptoms, postvoid residue, and incontinence. Uroflowmetry results were compared with pressure/flow study results as indicated by four different cut-offs.ResultsThe odds ratio that a subject with voiding difficulty has abnormal flow is 3.7 (95% CI, 1.9–7) in the patients analysed with method A and 2.8 (95% CI, 1.6–5.2) with method B. A good accordance emerged between the two methods in flowmetry results. Uroflowmetry has a specificity of >70% and a sensitivity of 50 to 100% depending on the cut-offs. Uroflowmetry results in women can be analysed by using either of the methods.The odds ratio that a subject with voiding difficulty has abnormal flow is 3.7 (95% CI, 1.9–7) in the patients analysed with method A and 2.8 (95% CI, 1.6–5.2) with method B. A good accordance emerged between the two methods in flowmetry results. Uroflowmetry has a specificity of >70% and a sensitivity of 50 to 100% depending on the cut-offs. Uroflowmetry results in women can be analysed by using either of the methods.ConclusionsUroflowmetry has a good specificity, a high negative predictive value, and a good diagnostic capacity such as to make it useful as the first diagnostic approach in urogynaecologic patients. Neurourol. Urodynam. 22:569–573, 2003. © 2003 Wiley-Liss, Inc.Uroflowmetry has a good specificity, a high negative predictive value, and a good diagnostic capacity such as to make it useful as the first diagnostic approach in urogynaecologic patients. Neurourol. Urodynam. 22:569–573, 2003. © 2003 Wiley-Liss, Inc.