Can Uroflowmetry Patterns in Women be Reliably Interpreted?

Abstract

Our aim was to investigate the proposition that uroflowmetry patterns can be reliably interpreted and correspond with specific urodynamic diagnoses. Uroflowmetry traces from 129 women with diagnoses of either genuine stress incontinence or detrusor instability were interpreted by four physicians with a minimum of 6 months experience in urogynecology. To test intraobserver variability, the traces were classified a second time 8 weeks later. Inter- and intraobserver variability was calculated by kappa analysis. There was marked intra- and interobserver variability in classification of traces, but no evidence of a correlation between urodynamic diagnosis and uroflowmetry pattern. Neither peak flow, total voided volume nor rate of acceleration of flow correlated with diagnosis. Although flow rates are important in predicting possible problems following surgery for stress incontinence, there is no evidence that flow patterns can be used as a screening test for specific urodynamic diagnoses.

A comparative analysis of pediatric uroflowmetry curves

“…In the majority of patients, the combination of voiding history, uroflowmetry and residual urine assessment makes it possible to differentiate between dysfunctional voiding, underactive bladder, overactive bladder and urethral obstruction 3. Surprisingly, up till very recently, comparative analysis of uroflowmetry has only been performed for adult urologic disease and only subjective expert opinion is used in pediatric LUTS 4–7. Two recent studies have been published in children, one in healthy children and one in patients with LUTS 8, 9.…”

Urine flow rate curve shapes and their descriptors

“…Additionally Ghobish defines it by 30‐60% Q r and 10‐25% T r , and van der Vis‐Melsen et al name it “low flat” with definition of flat flow with low average and maximum index of urine transport (IUT, the ratio of flow rate and square root of bladder volume). Other researchers have mostly the same definition as ICS, but use different terms: slow start, flattened, low flow, long‐tail, approximately normal, and prostatic…”

“…Abrams calls it supranormal and gives the more specific definition of a sharply increase flow to a very high Q max in the first 1‐3 s, and followed by a sudden reduction . Chou et al and Jorgensen et al call this shape “tall and peaked” and “high flow,” respectively, but the definition is similar to ICCS. Using Q max > 95% on the Iranian nomogram, Mostafavi et al also call this pattern “tower.”…”

Pediatric Bladder Disorders

“…It found a k among urologists of 0.36-0.54 and between the two interpretations by the same urologist of 0.54. In all cases, these results are insufficient to give a medical decision [59]. A debated topic is the need (or not) for two or three successive uroflowmetric measurements to affirm diagnosis, but the reproducibility in the same patient is poorly documented.…”