Comparison of Diagnostic Criteria for Female Bladder Outlet Obstruction

Abstract

Each urodynamic definition of female bladder outlet obstruction has merit. Videourodynamic criteria and 1998 cut point criteria have the highest concordance. The Blaivas-Groutz nomogram overestimates obstruction compared to the other criteria. Therefore, it should not be used as the sole or standard definition of obstruction in women.

Bladder outlet obstruction in painful bladder syndrome/interstitial cystitis

“…Several recent publications have developed pressure-flow nomograms using data from patients with anatomical obstruction, however there continues to be no universally accepted definition of BOO in women. 22 Our cut-off of Q max 12 ml/sec and P det Q max !25 cm H 2 O was based on the work of Defreitas and Zimmern who studied UDPF in 169 women with clinically proven anatomical obstruction compared to 20 female volunteer without urologic symptoms or previous urologic surgery. 6 We deemed this to be the most accurate criteria since they employed true asymptomatic controls to create their cut points.…”

“…4 Their second definition of obstruction was Q max of 11 cm 3 /sec or less and P det Q max >21 cm H 2 O in combination with a clinical history and symptoms suggesting obstruction, but these were again using women with stress incontinence as the controls. 23 Other authors have proposed various cut-points, 5,[8][9][10]24 but in a comparison of five different diagnostic criteria to one another, 22 the cut-point chosen for our analysis was felt to actually underestimate obstruction compared to fluoroscopic urodynamics, and other criteria 4 to greatly overestimated it. Unfortunately, larger multi-center trials to validate these values for an accepted definition of BOO in women are still pending.…”

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

“…VCC definition of obstruction itself had the highest agreement with the video urodynamics definition of obstruction (1,4). This may be due to the similarity between the tests as a urethral imaging based study.…”

“…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.…”