The Tzu Chi nomograms for maximum urinary flow rate (Q_max) in children: comparison with Miskolc nomogram

Abstract

Objective• To report the first ranking method-based age-and gender-specific nomograms for maximum urinary flow rate (Qmax) in children. Patients and Methods• Healthy children aged 4-12 years were enrolled for two sets of uroflowmetry tests.• The first and the higher value of the two consecutive Qmax of each child with a voided volume (VV) of ≥50 mL were included for establishing single-and dual-Qmax nomograms.• Children with possible urinary tract infection or lower urinary tract dysfunctions were excluded. Results• In all, 1128 children (583 boys and 545 girls) with a mean (SD) age of 7.7 (2.2) years were eligible for analysis and construction of nomograms.• Multivariate analysis showed that the Qmax was significantly affected by age, VV and gender (all P < 0.01).• The values of the corresponding percentile of the Qmax were significantly higher in the dual-Qmax nomogram compared with the single-nomogram.• In boys aged 8-12 years, the 5th percentile line of the Miskolc nomogram was significantly lower than that of the present nomograms at all VVs.• Minimally acceptable Qmax values, around the 10th percentile of the dual-Qmax nomogram, were >11.5 mL/s in children aged ≤6 years and >15.0 mL/s in children aged ≥7 years. External validation is required for the present dual-Qmax nomograms. Conclusion• We recommend repeating uroflowmetry in cases with a Qmax lower than the minimally acceptable age-and genderspecific Qmax values.

Breaking the vicious circle: Onabotulinum toxin A in children with therapy-refractory dysfunctional voiding

“…The voided volumes and peak flow rates showed no statistically significant changes compared to prior treatment. The Tzu Chi nomograms were used to evaluate change in peak flow rates; however, this did not show significant changes either [16]. Results are summarised in Table 2.…”

A quantitative approach to the interpretation of uroflowmetry in children

“…Unfortunately, we know from experience that supposedly normal children can still harbor abnormal voiding patterns and not be symptomatic; therefore, including them in a nomogram of supposed normal voiders tends to skew the data making it difficult to model. When we look at this data set, we saw that there were a significant numbers of children with elevated post‐void residuals, abnormally high voided volumes, and fast or slow flows that would be qualified as normal in the creation of a nomogram, but no one, if they were evaluating these patients in their office would describe them as a normal voider. This is the reason that we have chosen the bell‐shaped curve voiders as the critical criterion to define normal.…”

“…We used data that were generated from a previous study . From September 2006 through February 2011, all the kindergartens and elementary schools in Xing‐Dian City were invited to join the study.…”

Can the idealized voider derived flow indexes be a measure of voiding efficiency and how accurate are they?

“…Data that were generated from a previous study was reanalyzed in this study. We included children from 4 to 12 years and all voids equal to or more than 50 cc.…”