Assessment of noninvasive predictors of bladder detrusor underactivity in BPH/LUTs patients

Aims: The aim of our study was to investigate noninvasive predictors for detrusor underactivity (DUA) in male patients with lower urinary tract symptoms (LUTS) and benign prostatic enlargement (BPE).Methods: A consecutive series of patients aged 45 years or older with non-neurogenic LUTS were prospectively enrolled. Patients underwent standard diagnostic assessment including International Prostatic Symptoms Sco re, uroflowmetry, urodynamic studies (cystometry and pressure-flow studies), transrectal ultrasound of the prostate, and ultrasound measurements of the bladder wall thickness (BWT). Logistic regression analysis was used to investigate predictors of DUA, defined as a bladder contractility index < 100 mm H 2 O. A nomogram was developed based on the multivariable logistic regression model. Results: Overall 448 patients with a mean age of 66 ± 11 years were enrolled.In a multivariable logistic age-adjusted regression model BWT (odds ratio [OR]: 0.50 per mm; 95% confidence interval [CI], 0.30-0-66; P = .001) andQmax (OR: 0.75 per mL/s; 95% CI, 0.70-0.81; P = .001) were significant predictors for DUA. The nomogram based on the model presented good discrimination (area under the curve [AUC]: 0.82), good calibration (Hosmer-Lemeshow test, P > .05) and a net benefit in the range of probabilities between 10% and 80%. Conclusions: According to our results, BWT and Qmax can noninvasively predict the presence of DUA in patients with LUTS and BPE. Although our study should be confirmed in a larger prospective cohort, we present the first available nomogram for the prediction of DUA in patients with LUTS. K E Y W O R D S bladder wall thickness, detrusor underactivity, lower urinary tract symptoms, pressure flow studies 1116 | DE NUNZIO ET AL. Residual urine 40 (0/80); 64.5 ± 96.4 Urodynamic Qmax, mL/s 8 (7/12); 9.2 ± 5.3 PdetQmax, cm H 2 O 50 (36/71); 57 ± 28 Shaffer Class 2 (1/3); 2.3 ± 1.5 Bladder contractility index 105 (83/130); 108 ± 33 Bladder outlet obstruction index 32 (13/56); 36 ± 32 Note: Data are presented as median (IQR); mean ± SD. Abbreviations: BWT, bladder wall thickness; I-PSS, International Prostate Symptom Score; IQR, interquartile range; PdetQmax, pressure at maximum flow rate; Qmax, maximum flow rate. DE NUNZIO ET AL. | 1117 5 | CONCLUSION Our nomogram including BWT and Qmax shows good discrimination, calibration, and clinical benefit for the diagnosis of DUA. After external validation, the implementation of our nomogram could improve the management/counseling of patients with LUTS/BPH.

Section: Discussionsupporting

confidence: 66%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The role of bladder wall thickness in the evaluation of detrusor underactivity: Development of a clinical nomogram

Nunzio

Lombardo

Cicione

et al. 2020

“…Further mechanistic and epidemiologic classification of the factors which result in UAB need to be identified to improve the detection of DU and guide treatment. Existing noninvasive assessments of lower urinary tract function include PVR, uroflowmetry, detrusor wall thickness, near‐infrared spectroscopy, and penile compression release . While suggestive of BOO, there is a very limited assessment of these measures in a prospective approach to determine their ability to discriminate DU from BOO.…”

Section: Discussionmentioning

confidence: 99%

“…Existing noninvasive assessments of lower urinary tract function include PVR, uroflowmetry, detrusor wall thickness, near-infrared spectroscopy, and penile compression release. 23,24 While suggestive of BOO, there is a very limited assessment of these measures in a prospective approach to determine their ability to discriminate DU from BOO. Invasive urodynamic pressure-flow evaluation of voiding function remains the reference standard test used to diagnose BOO and DU.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous voiding is surprisingly recoverable via outlet procedure in men with underactive bladder and documented detrusor underactivity on urodynamics

Dobberfuhl

Chen

Alkaram

et al. 2019

Aims To identify clinical and urodynamic factors leading to spontaneous voiding in men with detrusor underactivity (DU) and suspected bladder outlet obstruction who underwent an outlet de‐obstruction procedure. Methods We identified 614 men who underwent an outlet procedure at our institution from 2005 to 2014. Men were stratified by bladder contractility index (BCI). The primary outcome was spontaneous voiding after surgery. Data were analyzed in Statistical analysis system software. Results Of the 131 men who underwent preoperative urodynamics, 122 (mean age 68 years) had tracings available for review. DU (BCI < 100) was identified in 54% (66 of 122), of whom only 68% (45 of 66) voided spontaneously before surgery, compared with 82% (46 of 56) of men with BCI ≥ 100. At a mean follow‐up of 6.4 months postoperatively, 79% (52 of 66) of men with DU were able to void spontaneously, compared with 96% (54 of 56) of men with BCI ≥ 100. In men with a BCI < 100 unable to void before surgery, 57% (12 of 21) recovered spontaneous voiding after surgery. On logistic regression for the outcome postoperative spontaneous voiding, significant preoperative characteristics, and urodynamic factors included preoperative spontaneous voiding (odds ratio [OR] = 9.460; 95% confidence interval [CI] = 2.955‐30.289), increased maximum flow rate (Qmax; OR = 1.184; 95% CI = 1.014‐1.382), increased detrusor pressure at maximum flow (Pdet@Qmax; OR = 1.032; 95% CI = 1.012‐1.052), DU with BCI < 100 (OR = 0.138; 95% CI = 0.030‐0.635), and obstruction with bladder outlet obstruction index > 40 (OR = 5.595; 95% CI = 1.685‐18.575). Conclusion Outlet de‐obstruction improves spontaneous voiding in men with DU and may benefit men who do not meet the urodynamic threshold for obstruction.

Symptoms and noninvasive test parameters that clinically differentiate detrusor underactivity from bladder outlet obstruction without a pressure‐flow‐based diagnosis in men with lower urinary tract symptoms

Takahashi

Takei

Namitome

et al. 2020

Aim: To examine the symptoms and noninvasive test parameters that clinically differentiate detrusor underactivity (DU) from bladder outlet obstruction (BOO) without using a pressure-flow study (PFS) in male patients with lower urinary tract symptoms. Methods: We examined 909 men who underwent PFS and also had the following data: International Prostate Symptom Score (IPSS), free uroflowmetry, postvoid residual (PVR), and prostate volume (PV). Using these data, significant symptoms and noninvasive test parameters that clinically differentiate DU from BOO were examined. Results: Significant parameters between DU patients and BOO patients were older age, smaller PV, and lower urgency symptom score (IPSS Q4). Optimal cutoff values were determined using receiver operating characteristic curves (≥74 years old, PV ≤ 34.8, and IPSS Q4 ≤ 1) and patients were categorized on the basis of the number of significant factors. The probability of DU or BOO in patients with three significant factors were 77% and 34%, respectively. Conclusion: Three factors (older age, smaller PV, and fewer urgency symptom) were the predictive factors to differentiate DU from BOO, which might be useful for estimating the probability of DU in clinical practice without a PFS.