Uroflowmetric Parameters Research Articles

Position‐related changes in uroflowmetric parameters in healthy young men

Uroflowmetric measurements are a common procedure in urological examination of patients presenting with lower urinary tract symptoms and it can be influenced by various factors. In this study, we investigated position-related changes in uroflowmetric parameters and postvoiding residual urine (PVR) volume in healthy young men. Thirty normal healthy male volunteers, whose mean age was 28.6 +/- 0.7 years old were studied and evaluated with uroflowmetry in the standing, sitting, and squatting down voiding positions. Three measurements were obtained for each voiding position and for each man (total 270 urinary flows). PVR were measured by transabdominal ultrasound. The maximum flow rate (Q(max)), average flow rate (Q(ave)), corrected maximum flow rate (cQ(max)), voiding volume (VV), voiding time (VT), and PVR values were compared between the three different voiding positions. The mean Q(max) values for the standing, sitting, and squatting down voiding positions of the patient group were 26.8 +/- 1.3, 31.3 +/- 1.2, 31.0 +/- 1.0 ml/sec, respectively and the mean Q(ave) values were 16.8 +/- 0.6, 18.5 +/- 0.6, 18.6 +/- 0.6 ml/sec, respectively. There were significant differences between voiding positions regarding the Q(max) (P < 0.0001) and Q(ave) (P = 0.0002) values in the patient groups. However, the difference between VT, VV, and PVR in the standing, sitting, and squatting down voiding position of the patient group was not statistically significant. Our results suggest that the urinary flow rates are affected by the voiding position. Therefore, it is important to perform uroflowmetric measurements in the same position.

Uroflowmetry in Children - Is It Necessary to Repeat the Study in a Single Patient?

Uroflowmetry, as the only non-invasive urodynamic means of assessing the function of the lower urinary tract is widely used in children. A possible psychological influence on the results is the reason why uroflowmetry is often repeated in the same patient. The investigation was conducted to compare parameters of repeated uroflowmetry in a single child with the results of single uroflowmetry performed in a group of children. The goal of the study was to evaluate the efficacy of a single uroflow procedure in children. A single uroflowmetric study was performed in 44 children aged from 9 - 11 years (mean 10 yrs). Out of the group one child was chosen who had 32 successive uroflow attempts. The range and average values of the uroflowmetric parameters were compared in both groups. Pearson's correlation coefficient was used for calculation and for a comparison of the uroflowmetric parameters of both groups (significance level p < 0.05). Average values of the voided volume, maximal and average flow were lower in the 32 attempts of a single child than in the control group (44 attempts). The values of the Pearson's correlation coefficient were ranged from 0.2 to 0.4 for flow/voided volume ratio and from 0.4 to 0.8 for flow time/voided volume ratio in both groups. There were no differences between the values in both groups apart from flow time/voided volume correlation (significance level p < 0.05). Repetition of uroflowmetric study does not seem to improve the efficacy of the modality in assessing voiding function in children.

Voiding Position does not Affect Uroflowmetric Parameters and Post‐void Residual Urine Volume in Healthy Volunteers

To investigate the effect of voiding position using uroflowmetry and post-void residual (PVR) urine volume assessment in healthy men and women. The study population comprised 72 healthy volunteers. The mean (range) ages of the male (n = 36) and female (n = 36) subjects were 30 (18-40) years and 32 (21-44) years, respectively. The uroflowmetric studies were repeated in the standing, sitting and crouching positions for men and in the sitting and crouching positions for women. At least three measurements were obtained for all voiding positions for each volunteer. PVR volumes were measured using trans-abdominal ultrasound after each voiding. Maximum flow rate (Qmax), average flow rate (Qave), voided volume (VV) and PVR values obtained in each voiding position were compared with those obtained in the other positions. Comparisons were done using one-way ANOVA. The mean Qmax and Qave values obtained in the sitting, crouching and standing positions in men were 24.29 +/- 0.73 and 15.67 +/- 0.37, 23.28 +/- 0.64 and 15.56 +/- 0.33, and 23.58 +/- 0.63 and 15.81 +/- 0.34 ml/s, respectively. The mean VV and PVR values obtained in the sitting, crouching and standing positions in men were 297.5 +/- 12.71 and 13.52 +/- 1.02, 306.3 +/- 13.46 and 14.02 +/- 1.08, and 309.9 +/- 13.14 and 12.92 +/- 0.95 ml, respectively. In women, the mean Qmax and Qave values obtained in the sitting and crouching positions were 28.09 +/- 0.66 and 18.26 +/- 0.36, and 27.98 +/- 0.59 and 17.31 +/- 0.35 ml/s, respectively. The mean VV and PVR values obtained in the sitting and crouching positions in women were 331.8 +/- 13.28 and 11.82 +/- 0.99, and 326.9 +/- 12.87 and 12.79 +/- 1.07 ml, respectively. There were no significant differences in any of the parameters between voiding positions in either group. Urinary flow rates and PVR urine volume do not seem to be affected by voiding position in healthy men and women.

Effects of Forced Diuresis Achieved by Oral Hydration and Oral Diuretic Administration on Uroflowmetric Parameters and Clinical Waiting Time of Patients with Lower Urinary Tract Symptoms

Introduction: We studied the impact of diuresis forced by oral hydration or single-dose oral diuretic administration on uroflowmetric parameters and clinical waiting time of patients with lower urinary tract symptoms. Patients and Methods: A total of 58 patients with a mean age of 59 (range 41–77) years who presented with lower urinary tract symptoms were included in the study. The patients were grouped with respect to their International Prostate Symptom Scores as having mild, moderate, or severe symptoms. The prostatic volumes of the patients were calculated using transrectal ultrasound. Uroflowmetric measurements were performed on 3 consecutive days. On the 1st day, the test was performed without diuretic stimulation; on the 2nd day, oral hydration was applied, and on the 3rd day, the patients received 20 mg of furosemide orally. Voiding time, maximum flow rate, voided volume, and the time elapsed in minutes until voiding (waiting time) were recorded. Results: Diuretic stimulation did not significantly alter the uroflowmetric parameters in each symptom group, but the waiting time was significantly reduced. Forced diuresis caused acute urinary retention in 5 of 20 (25%) severely symptomatic patients. Conclusions: Forced diuresis with oral hydration or oral administration of diuretics improves patient comfort and test applicability by shortening clinical waiting time and reducing the number of attempts to reach the sufficient urine volume for reliable measurements and can be applied safely for mild and moderately symptomatic patients. On the other hand, the risk of 25% of acute urinary retentions should be reconsidered, and the decision about diuretic stimuli should be made carefully by the clinician in severely symptomatic patients.

Phase III Multicenter Placebo-Controlled Study of Tamsulosin in Benign Prostatic Hyperplasia

Objectives. To evaluate the efficacy and safety of two once-daily doses of tamsulosin, the first selective alpha 1A-antagonist studied in clinical trials. Methods. Patients with benign prostatic hyperplasia (BPH) were randomized to receive either tamsulosin (0.4 and 0.8 mg/day) or placebo (n = 756). Primary efficacy parameters were improvement in the total American Urological Association (AUA) symptom score and peak urinary flow (Qmax). Secondary efficacy parameters were improvement in measurements at individual double-blind visits corresponding to the primary efficacy parameters; percentage of patients with a 3-mL/s increase in Qmax; total AUA irritative, obstructive, and bother scores; individual AUA symptom scores; total, irritative, obstructive, and individual Boyarsky symptom scores; average urinary flow rate and other uroflowmetric parameters; and investigator’s global assessment. Results. Statistically significant improvements in all efficacy parameters were observed in tamsulosin-treated compared with placebo-treated patients. Additionally, the 0.4-mg/day dose demonstrated a rapid onset of action (4 to 8 hours) based on Qmax after the first dose of double-blind medication. A review of the safety parameters demonstrated excellent tolerance at 1 week after the initial 0.4-mg/day dose and continued tolerance during the additional 12 weeks of 0.4- and 0.8-mg/day dosing. The incidence of positive orthostatic test results in the tamsulosin groups was comparable to that observed in the placebo group. Adverse events were comparable in the 0.4-mg/day tamsulosin and placebo groups and were somewhat higher in the 0.8-mg/day tamsulosin group. Conclusions. Tamsulosin was effective, safe, and well tolerated in the target BPH population at both the 0.4- and 0.8-mg/day dose levels, without the blood pressure-lowering effects typical of nonselective alpha-adrenergic antagonists.

Uroflowmetric parameters measured by spontaneous uroflowmetry and instrumented uroflowmetry in the same patient

In order to evaluate the obstructive effects of microtip transducer catheters on flowmetry parameters, 156 patients had a spontaneous uroflowmetry (SU) followed by an instrumented uroflowmetry (IU), with intravesical pressure recording for comparison of maximum flow rate (Qmax), corrected maximum flow rate for volume voided (Qmax.corr.), time to maximum flow rate (TQmax), and flow curve patterns. With SU and IU, Qmax values were 26±11 ml/s compared with 21±11 ml/s (P<0.001), Qmax.corr. as 29±10 m/s compared with 21±11 ml/s (P<0.0001) and TQmax values were 11±9 s compared with 30±52 s (P<0.0001). Vesical opening pressure (VOP) was higher in patients with a low TQmax (< 15 s) (23 cmH2O±20) than with a higher TQmax (17 cmH2O±16) (P<0.04). Curve patterns with both methods show good correlations in 71% of patients, no correlations in 14% and doubtful correlations in 15%. The occlusive effect of the catheter during micturition induces a decrease in Qmax and Qmax.corr. and an increase in TQmax values, due to a lowered VOP in many patients, but little difference in curve pattern interpretation.

Studies on the urophonography (3)--Clinical investigation on prostatic cancer

Recently we have developed an entirely new method of sonic detection of lower urinary tract disorders during micturition. This procedure was designated as "urophonography" and its recording as "urophonogram". Sixteen patients with prostatic cancer before and three months after anti-androgenic therapy and ten healthy male volunteers underwent urophonography. The urophonograms were classified into four types. Type 1 was characterized by its diamond shape, while Type 2 was characterized by its random sound spikes. Type 3 was a mixture of Types 1 and 2. Type 4 had few sound spikes. Analysis of these urophonograms also revealed that the frequencies of these urethral sounds belonged to the range from 0.4 to 1.5 KHz. The amplitude (power) of the sounds was in the range of 40-60 dB. Healthy volunteers belonged to Type 4. Prostatic cancer patients belonged to Types 1, 2 and 3 at 18.8, 68.8, nad 12.4%, respectively. After the treatment the percentages of Types 1, 2, 3, and 4 changed to 18.8, 50.0, 0, and 31.2%, respectively. Comparison of uroflowmetric parameters with urophonograms showed that Type 2 patients showed a lesser degree of micturition disturbances, evidenced by these parameters. It was considered that urophonograms were useful as urodynamic investigation.

尿音図に関する研究(2)

Recently we have developed an entirely new method of sonic detection of lower urinary tract disorders during micturition. The detection of these sounds was performed by a data catching and recording system, consisting of a detector, amplifier, and recorder. This procedure was designated as "urophonography" and its recording as "urophonogram". Twenty-five patients with BPH before and three months after suprapubic prostatectomy and 10 healthy male volunteers underwent urophonography. The urophonograms were classified into four types. Type 1 was characterized by its diamond shape, while Type 2 was characterized by its random sound spikes. Type 3 was a mixture of Types 1 and 2. Type 4 had only few sound spikes. Analysis of these urophonograms also revealed that the frequencies of these urethral sounds belonged to the range from 0.4 to 1.5 KHz. The amplitude (power) of the sounds was in the range of 40-60 dB. Healthy volunteers belonged to Type 4. BPH patients belonged to Types 1, 2 and 3 at equal frequency. Comparison of uroflowmetric parameters with urophonograms revealed that Type 3 patients with BPH showed a lesser degree of micturition disturbances, which was consistent with the weight of prostatic tumors surgically resected. Urophonography was undertaken before and after the treatment on these patients. It was clearly shown that the pattern of urophonograms shifted to normal (Type 4). It was considered that urophonograms were useful for urodynamic investigation.

Uroflowmetric observations in pregnancy

AbstractUroflowmetric studies were performed on 752 antepartum patients at various stages of pregnancy and 153 patients 6 weeks postpartum. The mean voided volume in the antepartum group (203.4 ml) was significantly lower (P &lt; .001) than that of the postpartum group (261.1 ml). In the antepartum group, the data suggests a significant decrease in voided volume in the third trimester. The uroflowmetric parameters (FT, Q‐max, T‐Q‐max) studied were observed to be directly related to voided volumes. This is an observation known in the nonpregnant female. Presenting stations of zero and above do not appear to influence the uroflowmetric parameters. Subjective increases in frequency of urination during pregnancy are correlated with objective decreases in the volumes voided, and the converse is also found to be true. The contributory roles of the mechanical and endocrinological factors on micturition in pregnancy are discussed. It appears that the predominant factor may be mechanical.

Urodynamic evaluation of the bilharzial urinary bladder

AbstractUrodynamic evaluations of 63 male bilharzial patients and 25 normal males were included in the present work. According to the uroflowmetric parameters, patients were classified into two groups: those with normal voiding (38 patients) and those with impaired voiding (25 patients). Fluid cystometry followed by a micturition study were conducted in all patients with impaired voiding, 14 patients with normal micturition, and for two of the control group. The urodynamic data were computed and analyzed. Nineteen patients with bilharzial calcification of the urinary bladder underwent the same urodynamic evaluation. No urodynamic differences were found between the control group, the patients with normal voiding, and the patients with bilharzial bladder calcification. Patients with impaired voiding showed a significantly lower peak flow and longer micturition time; the voiding pressures and the abdominal contribution (%) were also significantly higher. Three factors were associated with impairment of micturition in our patients: (1) bladder outlet obstruction, (2) hypoactive detrusor, and () high‐grade vesicoureteral reflux.

Fluid weight uroflowmetry in women

This study evaluates fluid weight uroflowmetry as a screening technique for urogynecologic conditions. Sixty women with no known pathologic condition volunteered for the evaluation of normal uroflowmetric parameters and curve patterns. Forty were menstruating cyclically, and 20 were postmenopausal. The parameters studied included: (1) total voided volume, (2) flow time, (3) peak flow rate, and (4) time to peak flow rate. In addition, uroflowmetric tracings were classified according to their patterns of configuration into: (1) normal, (2) multiple peak, and (3) interrupted. The parameters studied showed no difference in the two normal groups. A wide range of values was observed. Neither age, parity, weight, height, nor menstrual cycle phase affected the data. Values obtained from patients with idiopathic instability of the detrusor muscle, sensory urgency, and stress urinary incontinence did not show differences or trends. Seventeen percent of the tracings of the normal population group showed either multiple peak or interrupted patterns. Patients with sensory urgency (p < 0.001) had a higher incidence of multiple peak and interrupted flow rate patterns.

Further Observations on the Cystometric and Uroflowmetric Effects of Bethanechol Chloride on the Human Bladder

We evaluated the cystometric and uroflowmetric effects of bethanechol chloride on non-neurogenic, non-decompensated human bladders. Statistically significant changes were measured using cystometric and uroflowmetric parameters. We discuss the indications and methods for therapy with bethanechol chloride.