International Continence Society Subcommittee on Standardisation of Terminology of Pressure-Flow Studies flow studies in many different sections. This report is a revision and expansion of Sections 4.2 and 4.3 and parts of Sections 6.2 and 7 of the 1988 report. It contains a recommendation for a provisional standard method for defining obstruction on the basis of pressure-flow data. 2. Evaluation of Micturition 2.1. Pressure-Flow Studies At present, the best method of analysing voiding function quantitatively is the pressure-flow study of micturition, with simultaneous recording of abdominal, intravesical and detrusor pressures and flow rate (Fig. A.1.6.1). Direct inspection of the raw pressure and flow data before, during and at the end of micturition is essential, because it allows artefacts and untrustworthy data to be recognised and eliminated. More detailed analyses of pressure-flow relationships, described below, are advisable to aid diagnosis and to quantify data for research studies. The flow pattern in a pressure-flow study should be representative of free flow studies in the same patient. It is important to eliminate artefacts and unrepresentative studies before applying more detailed analyses. Pressure-flow studies contain information about the behaviour of the urethra and the behaviour of the detrusor. Section 2.2 deals with the urethra. Detrusor function is considered in Section 2.3. 2.1.1. Pressure and Flow Rate Parameters Definitions See Fig. A.1.6.1 and Table II; see also Table II Appendix 1, Part 2. Maximum flow rate is the maximum measured value of the flow rate. Symbol Qmax Maximum pressure is the maximum value of the pressure measured during a pressure-flow study. Note that this may be attained at a moment when the flow rate is zero. Symbols: P abd, max, P ves, max, P det, max. Pressure at maximum flow is the pressure recorded at maximum measured flow rate. If the same maximum value is attained more than once or if it is sustained for a period of time, then the point of maximum flow is taken to be where the detrusor pressure has its lowest value for this flow rate; abdominal, intravesical and detrusor pressures at maximum flow are all read at this same point. Flow delay (see Section 2.1.2) may have a significant influence and should be considered. Symbols: P abd, Qmax, P ves, Qmax, P det, Qmax .

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Detrusor wall thickness decreases continuously while the bladder fills to 50% of its capacity and then remains constant until 100%. Therefore, detrusor wall measurements were performed in patients when the bladder was filled to maximum capacity only. Mean detrusor wall thickness for unobstructed (n = 14), equivocal (n=23) and obstructed patients (n=33) were 1.33, 1.62 and 2.4 mm, respectively (P <0.001). With increasing CHESS letters and CHESS numbers, the thickness of the detrusor wall increased as well (P< 0.001). The positive predictive value of detrusor wall measurement (95.5% for a cut-off value greater than or equal to 2 mm) was superior to all other predictors investigated. The thickness of the detrusor wall increases depending on the extent of BOO. Both constrictive and compressive BOO lead to an increase in detrusor wall thickness. BOO is found in 95.5% of men with a detrusor wall thickness greater than or equal to 2 mm. Measuring the thickness of the detrusor wall can be used as a screening test to detect BOO.

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DWT remains stable at a bladder filling of 250 ml. At this state of bladder filling, DWT between different groups are comparable. Men have to be evaluated separately from women.

Objective To assess the tolerability and eBcacy of propicontrast to groups 2 and 3, only patients in group 1 showed increasing tolerability during the treatment verine and oxybutynin in patients with urgency and urge incontinence in a randomized, double-blind pla-(from V1 to V4). These tolerability results were further supported by the overall tolerability assessment ('very cebo-controlled clinical trial. Patients and methods In all, 366 patients (149 on propivgood' or 'good' tolerability in 67% of group 1, in 59% of group 2 and in 83% of group 3). The urodynamic erine, 145 oxybutynin and 72 placebo, ratio 25251) with urgency and urge incontinence were recruited in assessment of eBcacy (comparing V0 and V4) showed a statistically significant increase in the mean (sd) 32 study centres. Propiverine (group 1, 15 mg three times daily), oxybutynin (group 2, 5 mg twice daily) or maximal cystometric bladder capacity in group 1, being 222 (77) mL at V0 and 311 (125) mL at V4, an placebo (group 3) were administered for 4 weeks, using the double-dummy technique. The dosages were selecincrease of 89 (108) mL, and in group 2, at 226 (75) mL and 322 (123) mL, an increase of 96 ted specifically to compare the tolerability profile of propiverine with the commonly used therapeutic dosage (106) mL, compared with group 3, at 211 (77) mL and 263 (93) mL, an increase of only 52 (92) mL. The of oxybutynin. Tolerability was assessed by directly questioning the patients about adverse events at four cystometric bladder capacity at first desire to void also increased in group 1 (93 to 160 mL) and group 2 (89 visits (V-1 before and V0 after a 1-week 'washout' period, V1 after 1 week and V4 after 4 weeks of to 160 mL), whereas in group 3 there were only minor changes (93 to 120 mL). Changes in the residual urine treatment) during a 5-week surveillance period, and by tolerability ratings of the physicians. EBcacy was volume within and between the treatment groups were minimal and clinically irrelevant. The overall assessassessed using urodynamics at V0 and V4, evaluating the cystometric bladder capacity at maximal and first ment of eBcacy showed significant diCerences between the drugs when compared with placebo. desire to void, and postvoid residual urine, according to the criteria of the International Continence Society.Conclusion Propiverine is a safe and eCective drug in the treatment of urgency and urge incontinence; it is Additionally, a voiding protocol, overall assessment of clinical symptomatology and eBcacy ratings by the as eCective as oxybutynin, but the incidence of dry mouth and its severity is less with propiverine than physicians were documented. Results A remarkably high percentage of adverse events with oxybutynin. The availability of alternative pharmacotherapeutics such as propiverine should reduce was reported in the washout period (VO: 13%, 16% and 18% in groups 1-3, respectively). At V4, the the therapeutic failure rate and improves the success rate in the treatment of patients suCering from urgency clinically most r...

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