ICS‐SUFU standard: Theory, terms, and recommendations for pressure‐flow studies performance, analysis, and reporting. Part 2: Analysis of PFS, reporting, and diagnosis

Abstract

AimsThe Working Group (WG), initiated by the International Continence Society (ICS) Standardisation Steering Committee and supported by the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction, has revised the ICS Standard for pressure‐flow studies of 1997.MethodsBased on the ICS standard for developing evidence‐based standards, the WG developed this new ICS standard in the period from May 2020 to December 2022. A draft was posted on the ICS website in December 2022 to facilitate public discussion and the comments received have been incorporated into this final release.ResultsThe WG has recommended analysis principles for the diagnosis of voiding dysfunction for adult men and women without relevant neurological abnormalities. New standard terms and parameters for objective and continuous grading of urethral resistance (UR), bladder outflow obstruction (BOO) and detrusor voiding contraction (DVC) are introduced in this part 2 of the standard. The WG has summarized the theory and recommendations for the practice of pressure‐flow study (PFS) for patients in part 1. A pressure‐flow plot is recommended for the diagnosis of every patient, in addition to time‐based graphs. Voided percentage and post void residual volume should always be included in PFS analysis and diagnosis. Only parameters that represent the ratio or subtraction of pressure and synchronous flow are recommended to quantify UR and only parameters that combine pressure and flow in a product or sum are recommended to quantify DVC. The ICS BOO index and the ICS detrusor contraction index are introduced in this part 2 as the standard. The WG has suggested clinical PFS dysfunction classes for male and female patients. A pressure‐flow scatter graph including every patient's pdet at maximum flow (pdetQmax) with maximum flow rate (Qmax) point should be included in all scientific reports considering voiding dysfunction.ConclusionPFS is the gold standard used to objectively assess voiding function. Quantifying the dysfunction and grading of abnormalities are standardized for adult males and females.

Novel clinical diagnostic criteria based on noninvasive examination findings to predict the presence of urodynamic detrusor underactivity in men

“… 6 In addition, a very small amount of urinary flow observed after the start of the examination or at the end of the main voiding were excluded from the analysis if voiding was not observed for more than 10 s before or after slight voiding. Each UDS procedure was performed with the recommended methods proposed by the ICS 18,19 . UDS data were analyzed after anonymization by staff members who were not involved in performing the UDS.…”

“…In this study, urodynamic DU, BOO, DU + BOO, and normal (non‐DU + non‐BOO) were defined as detrusor contraction index (DCI) < 100 and BOO index (BOOI) < 40, DCI ≥ 100 and BOOI ≥ 40, DCI < 100 and BOOI ≥ 40, and DCI ≥ 100 and BOOI < 40, respectively. BOOI and DCI were calculated using the following formula: Pdet Qmax (detrusor pressure at Qmax) − 2Qmax and Pdet Qmax + 5Qmax, respectively 19 . Patients were categorized into the DU, BOO, DU + BOO, and normal groups based on the PFS findings, and we compared the subjective and urodynamic parameters among the four groups.…”

“…Each UDS procedure was performed with the recommended methods proposed by the ICS. 18,19 UDS data were analyzed after anonymization by staff members who were not involved in performing the UDS.…”

“…BOOI and DCI were calculated using the following formula: Pdet Qmax (detrusor pressure at Qmax) − 2Qmax and Pdet Qmax + 5Qmax, respectively. 19 Patients were categorized into the DU, BOO, DU + BOO, and normal groups based on the PFS findings, and we compared the subjective and urodynamic parameters among the four groups. The frequency of meeting our proposed diagnostic criteria for diagnosing male DU was examined in each group, and the sensitivity (the probability that men with urodynamic DU meet the clinical DU diagnostic criteria), specificity (the probability that men without urodynamic DU do not meet the clinical DU diagnostic criteria), positive predictive value (PPV; the probability that men who meet the clinical DU diagnostic criteria truly have urodynamic DU), and negative predictive value (NPV; the probability that men who do not meet the clinical DU diagnostic criteria truly do not have urodynamic DU) were evaluated.…”

Re: Solomon-Greenwell as the most accurate nomogram for female bladder outlet obstruction

“…First it is necessary to clarify that the ICS document of 2002 defines "dysfunctional voiding" as an "intermittent and/or fluctuating flow rate due to involuntary intermittent contractions of the peri-urethral striated muscle during voiding, (2) in neurologically normal individual", and that this term is no longer recommended in the lastest ICS-SUFU standard of pressure-flow study analysis. (3) That is why we think that the authors of the commented article meant to refer to women diagnosed with "voiding dysfunction" (as a generic term) and not to women diagnosed with "dysfunctional voiding". "Voiding dysfunction", "a diagnosis by symptoms and urodynamic investigations, is defined as abnormally slow and/or incomplete micturition" by the ICS, "based on a repeated measurement to confirm abnormality".…”