Bladder outlet obstruction nomogram for women with lower urinary tract symptomatology

Abstract

The aim of our study was to construct a bladder outlet obstruction nomogram for women with lower urinary tract symptoms. A urodynamic database of 600 consecutive women was reviewed. Bladder outlet obstruction, utilizing strict diagnostic criteria, was diagnosed in 50 (8.3%) patients. A comparison of patient characteristics, uroflowmetry, and detrusor pressure-uroflow studies was carried out between the obstructed patients (mean age, 64.4 ± 17.6 years) and 50 age-matched unobstructed controls (mean age, 64.8 ± 10.7 years). Maximum flow rates were significantly higher in free uroflow studies (free Qmax) than in pressureflow studies (Qmax), in both obstructed (9.3 ± 3.7 versus 5.7 ± 3.6 mL/s, respectively. P ‫ס‬ 2.6 10 −6 ) and unobstructed (25.6 ± 11.2 versus 11.8 ± 5.9 mL/s, respectively. P ‫ס‬ 8.7 10 −12 ) patients. Comparison of detrusor pressure at maximum flow (pdet.Qmax) and maximum detrusor pressure during voiding (pdet.max) values did not reveal significant differences, in both obstructed (39.3 ± 18.4 versus 49.7 ± 25.5 cm H 2 O, respectively) and unobstructed (16.5 ± 8.4 versus 20.6 ± 9.2 cm H 2 O, respectively) patients. Further statistical analysis was carried out to construct bladder outlet obstruction nomogram. The nomogram classifies any pair of values of free Qmax and pdet.max into one of the following four zones: no obstruction, mild obstruction, moderate obstruction, and severe obstruction. Of the 50 obstructed women, 34 (68%) were classified by the nomogram as mildly, 12 (24%) as moderately, and 4 (8%) as severely obstructed. A positive correlation was found between subjective severity of the symptoms (assessed by the AUA Symptom Index score) and the four nomogram zones. In conclusion, the nomogram makes it possible to differentiate between obstructed and unobstructed women and between various degrees of obstruction. We believe the nomogram may also serve as an instrument to assess treatment outcomes.

Voiding Chain Cystourethography: Assessing A Historical Test's Role in Selection for Urethrolysis

“…When patient history or time frame does not offer this diagnostic advantage, more thorough evaluation is warranted than just proceeding to urethrolysis, especially if she has already had a history of that operation (14). The complex nature of female voiding dysfunction may require additional parameters besides pressure-flow criteria (1)(2)(3)(4)(5)(6)(7)15). We desired to see if the VCC, as a non-pressure-flow based test, would assist in positively predicting those patients that would have a successful urethrolysis.…”

“…While recognizing the value of the various pressure flow criteria developed for female bladder outlet obstruction (BOO), our clinic relies principally on the video urodynamic appearance of the bladder and urethra with voiding as described by Nitti et al (1) and the Blaivas Groutz (B-G) nomogram (2). In some patients with a high index of clinical suspicion, the pressure flow criteria for obstruction were not strictly met and/or it was difficult to identify the urethra during testing.…”

Aetiology of Urinary Outflow Obstruction at a tertiary Care Hospital in Bangladesh

“…Typically, obstructive symptoms include hesitancy, sensation of incomplete bladder emptying, diminished urinary stream, and post voiding urinary dribbling. Irritative complaints include urinary urgency, frequency of urination, occasional dysuria, and nocturia [3][4] .…”

The effect of a 6 Fr catheter in women: Are they obstructive?

“…Pressure-flow studies (PFS) provide important parameters during the UDS for the evaluation of bladder outlet obstruction (BOO). Several different UDS criteria for the diagnosis of BOO in women have been proposed, [1][2][3][4][5][6] but there are currently no accepted universal definition.…”