MP71-04 SIMPLE MODIFICATION OF BLADDER OUTLET OBSTRUCTION INDEX FOR BETTER PREDICTION OF ENDOSCOPICALLY PROVEN PROSTATIC OBSTRUCTION

Abstract

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Evaluation and Symptoms1 Apr 2015MP71-04 SIMPLE MODIFICATION OF BLADDER OUTLET OBSTRUCTION INDEX FOR BETTER PREDICTION OF ENDOSCOPICALLY PROVEN PROSTATIC OBSTRUCTION Jang Hee Han, Ho Song Yu, Joo Yong Lee, Joohan Kim, Jong Kyu Kwon, Ho Chul Choi, and Kang Su Cho Jang Hee HanJang Hee Han More articles by this author , Ho Song YuHo Song Yu More articles by this author , Joo Yong LeeJoo Yong Lee More articles by this author , Joohan KimJoohan Kim More articles by this author , Jong Kyu KwonJong Kyu Kwon More articles by this author , Ho Chul ChoiHo Chul Choi More articles by this author , and Kang Su ChoKang Su Cho More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2617AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Abrams-Griffiths number (AG number) is the most widely used index for predicting bladder outlet obstruction (BOO). However, we often encounter that the obstructed prostatic urethra determined by AG number is not consistent with endoscopically proven obstruction. We assessed whether the modification of AG number can improve the prediction of BOO. METHODS We retrospectively reviewed the pressure-flow study and cysto-urethroscopy in 176 LUTS/BPH patients who were unresponsive to medical therapy. After applying the exclusion criteria, a total of 130 patients were eligible for analysis. During the pressure flow study (PFS), some groups of patients try to urinate with abdominal straining which increases intravesical pressure, and consequently the AG number can be underestimated theoretically. For this reason, the modified AG number was defined as (PdetQmax+ΔPabd)-2Qmax. We compared the diagnostic accuracy of known methods with our modified AG number using receiver operating characteristic (ROC) curves. RESULTS With endoscopic evaluation, BOO was observed in 92 patients (70.7%). According to the original AG number, 40 (30.8%), 38 (29.2%) and 52 (40.0%) patients were unobstructed, equivocal, and obstructed, respectively. During voiding phase of PFS, mean ΔPabd was 11.81±13.04 cmH2O; ΔPabd less than 10 cmH2O was in 75 patients (57.7%), ΔPabd ranged 10 to 20 cmH2O in 23(17.7%), and ΔPabd over 20 cmH2O in 32 (24.6%). Of 92 patients with endoscopically proven obstruction, only 47 patients (51.1%) were determined as BOO according to original AG number, but 72 patients (78.3%) were classified as BOO based on modified AG number. Diagnostic accuracy of modified AG number (Positive predictive value=0.78, Negative predictive value=0.87, Sensitivity=0.94, Specificity=0.62, Accuracy=0.81) was higher compared to original AG number (Positive predictive value=0.51, Negative predictive value=0.87, Sensitivity=0.90, Specificity=0.42, Accuracy=0.62). In ROC testing, the area under curve was 0.906 in modified AG number and 0.849 in original AG number. The optimal cutoff value of each method was 37.5 and 23.50. CONCLUSIONS Our simple modification of AG number is better correlated with endoscopically proven obstruction than the original method, thus it should be considered when evaluating BOO in patients with LUTS/BPH. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e913 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jang Hee Han More articles by this author Ho Song Yu More articles by this author Joo Yong Lee More articles by this author Joohan Kim More articles by this author Jong Kyu Kwon More articles by this author Ho Chul Choi More articles by this author Kang Su Cho More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...