MP76-02 THE DEVELOPMENT AND VALIDATION A NEW NOMOGRAM FOR DIAGNOSING BLADDER OUTLET OBSTRUCTION IN WOMEN

Abstract

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Non-neurogenic Voiding Dysfunction1 Apr 2014MP76-02 THE DEVELOPMENT AND VALIDATION A NEW NOMOGRAM FOR DIAGNOSING BLADDER OUTLET OBSTRUCTION IN WOMEN Eskinder Solomon, Habiba Yasmin, Julie Jenks, Mahreen Pakzad, Rizwan Hamid, Jeremy Ockrim, Julian Shah, and Tamsin Greenwell Eskinder SolomonEskinder Solomon More articles by this author , Habiba YasminHabiba Yasmin More articles by this author , Julie JenksJulie Jenks More articles by this author , Mahreen PakzadMahreen Pakzad More articles by this author , Rizwan HamidRizwan Hamid More articles by this author , Jeremy OckrimJeremy Ockrim More articles by this author , Julian ShahJulian Shah More articles by this author , and Tamsin GreenwellTamsin Greenwell More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2395AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Bladder outlet obstruction (BOO) in men has been extensively researched and the ICS BOO nomogram is widely used. In women however, the criteria for obstruction is less defined and there are two main reasons why a well-accepted nomogram remains elusive. Blaivis and Groutz (Neuro&Urodyn 2000;19:553–64) have previously proposed a female BOO nomogram that plots maximum detrusor pressure (not necessarily at Qmax) against freeflow Qmax. The validity of using non-concurrent pressure-flow values to define resistance is debatable and a subsequent publication has reported an unlikely high prevalence of BOO when using the Blaivis-Groutz nomogram (Massolt et al, Neuro&Urody 24(3) 237-242). The aim of this study is to develop and validate a criteria for classifying BOO in women derived from concurrent Pdet.Qmax and Qmax based on radiographic evidence of increased urethral resistance. METHODS Retrospective video-urodynamics and clinical data of 186 women were analysed. The women were divided into six groups. The first four groups are categorised according to the primary cause of BOO; functional obstruction; anatomical obstruction; anti-incontinence surgery obstruction and cystocele. The fifth group consists of patients without voiding symptoms or stress urinary incontinence (SUI) and the sixth where SUI is demonstrated. The detrusor pressure at peak flow (Pdet.Qmax) were plotted against peak flow (Qmax) for voids with a volume > 100 ml. Cluster analysis was performed to derive an axis (BOO criterion) that best divides the definitively obstructed and unobstructed. The sensitivity and specificity of the BOO criterion was then validated by applying it to a further 350 women who have undergone video-urodynamics in our unit. RESULTS The axis of Pdet.Qmax = 2Qmax best divides the women with and without evidence of radiographic BOO in the original cohort. In the validation cohort, the criterion Pdet.Qmax > 2Qmax identifies BOO in women with sensitivity of 0.94, specificity of 0.93 and accuracy of 0.94. The figure below shows: Pdet.Qmax and Qmax for the validation cohort CONCLUSIONS The criterion Pdet.Qmax > 2Qmax defines BOO in women with excellent accuracy and should be utilised for urodynamic diagnosis of BOO in women. © 2014FiguresReferencesRelatedDetailsCited byWein A (2016) Re: Evaluation of Obstructed Voiding in the Female: How Close Are We to a Definition?Journal of Urology, VOL. 195, NO. 4 Part 1, (1041-1041), Online publication date: 1-Apr-2016. Volume 191Issue 4SApril 2014Page: e882 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Eskinder Solomon More articles by this author Habiba Yasmin More articles by this author Julie Jenks More articles by this author Mahreen Pakzad More articles by this author Rizwan Hamid More articles by this author Jeremy Ockrim More articles by this author Julian Shah More articles by this author Tamsin Greenwell More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...