Different urodynamic patterns in female bladder outlet obstruction: Can urodynamics alone reach the diagnosis?

Abstract

ObjectiveTo define the different urodynamic patterns in female bladder outlet obstruction (BOO) and to assess whether urodynamics alone can be relied on for the diagnosis.Patients and methodsThis prospective study included 60 clinically obstructed women and 27 with stress urinary incontinence as a control group. All patients had pressure-flow studies and were divided into four groups. Group A (control group, 27 patients) and group B (22) had a maximum urinary flow rate (Qmax) of >15 mL/s and a detrusor pressure at Qmax (PdetQmax) of <30 or >30 cm H2O, respectively. Group C (20 patients) and group D (18) had a Qmax of <15 mL/s and a PdetQmax of >30 or <30 cm H2O, respectively.ResultsThe mean Qmax for groups A, B, C, and D were 21.8, 21.9, 10.8 and 9.9 mL/s, respectively, while the mean PdetQmax was 20.8, 40.4, 48.7, and 18.7 cm H2O, respectively. The residual urine volume was <100 mL in groups A and B but >100 mL in groups C and D. When compared with group A, groups B–D had a significant difference in vesical pressure, groups B and C had a significant difference in PdetQmax, while Qmax, the maximum voided volume and residual urine volume were significantly different in groups C and D. Group A was obviously unobstructed, group B might have early obstruction, group C had compensated obstruction, while group D can be considered to have late de-compensated obstruction.ConclusionsBOO in females has three different urodynamic patterns, i.e. early, compensated and late obstruction. However, urodynamics should be combined with the clinical presentation and residual urine volume for an accurate diagnosis.

Is urodynamic study is a necessity for evaluation of lower urinary tract symptoms in postmenopausal female patients? Result of a prospective observational study

“…[ 19 ] There is an agreement that neither pressure-flow data only nor clinical symptoms alone are sufficient for diagnosing BOO in females. In the study by Elmissiry et al .,[ 4 ] two thresholds in accordance with the study of Chassagne et al . [ 11 ] were used and they showed that the best threshold for Qmax and PdetQmax derived from receiver operating characteristic curves to define obstruction in women was 15 mL/s and 30 cmH 2 O, respectively, with a sensitivity of 80% and a specificity of 70%.…”

“…The first group of patients with voiding symptoms, that is, the clinically obstructed patient can be divided urodynamically into three grades of BOO as mentioned in a study by Elmissiry et al . [ 4 ]…”

“…The threshold for Qmax reported in women with BOO is <11–15 mL/s while that for PdetQmax is >20–50 cmH 2 O. [ 4 15 16 17 18 ] Some investigators believe that low flow in the presence of a normal or low detrusor pressure might be an indication of relative obstruction. [ 19 ] There is an agreement that neither pressure-flow data only nor clinical symptoms alone are sufficient for diagnosing BOO in females.…”

In Search of Best Pressure Flow Criteria to Define Bladder Outlet Obstruction in Indian Females

“…Incidence has been varied, ranging from 2.7-23%, due to non-uniform definitions. [5] In our study, it measured 31.25% (25/80). Symptoms alone are insufficient in predicting BOO.…”

Parametric design, fabrication and validation of one-way polymeric valves for artificial sphincters

“…For application in the urinary system, hermetic closure should be assured: sudden coughs and involuntary abdominal muscle contractions can generate pressures up to 12 kPa. However, this physiological parameter depends on the patient's anatomical features, therefore a tunable opening pressure (OP) is desirable [20][21][22]. As highlighted below, this can be achieved by making small changes to the valve profile geometry or by slightly changing material stiffness.…”