Uroflowmetry Tests Research Articles

Agreement between two uroflowmetry tests in children with lower urinary tract symptoms

BackgroundUroflowmetry is a non-invasive examination considered as a first-line assessment for children with lower urinary tract symptoms (LUTS). Currently, the performance of two uroflowmetry tests is recommended by ICCS for all patients with LUTS. This study aims to evaluate the differences between two uroflowmetry tests in children with lower urinary tract symptoms and their impact on the patient's diagnostic workup and clinical outcome. MethodsForty patients with LUTS, aged 4-17 years, were evaluated prospectively with two consecutive uroflowmetry tests and ultrasonography. They were classified based on the ICCS criteria for curve pattern and divided into two groups based on the SPU classification of fractionated (staccato and intermittent) and smooth (bell, tower and plateau). They were also separated into three groups based on estimated bladder capacity (voided volume + post-void residual on ultrasound): high (> 115%), low (< 60%) or normal capacity. ResultsThe mean age was 8 (IQR 6.0-10.0) years and 25 (62.5%) patients were female. There was an increase in nonbell-shaped curves from the first (32.5%) to the second test (52.5%). The curve shape between the uroflowmetries based on ICCS classification showed a Kappa value of 0.349 (fair). Classifying curves as fractionated or smooth yielded a Kappa value of 0.714 (substantial) (table). The Bland-Altman test showed disagreement in the parameter of time to Qmax. There was a significant difference in categorizing bladder capacity as high, low, or normal: it was concordant in 63.6% for high, 68.4% for normal and 50% for low capacity (p = 0.001). DiscussionDespite the disagreement found classifying the curves based on the ICCS pattern, also demonstrated in other studies, there was a substantial agreement using the SPU criteria. It reinforces the greater reliability of the SPU system and it may be the key to reduce the subjectivity of uroflowmetry. Even though this classification being associated with a higher agreement in interpretation of the curves, repeating uroflowmetry does not present a clinically significant divergence that changes the patient's diagnostic workup. Our study is limited by the lack of EMG and larger sample. ConclusionConsidering the flow curve pattern, the agreement between two uroflowmetries was substantial according to the SPU and only reasonable by the ICCS classification. Regardless of some differences found between the flows, a second uroflowmetry test might not have clinical relevance that justifies its recommendation for all patients.

Automatic classification of the physical surface in sound uroflowmetry using machine learning methods

This work constitutes the first approach for automatically classifying the surface that the voiding flow impacts in non-invasive sound uroflowmetry tests using machine learning. Often, the voiding flow impacts the toilet walls (traditionally made of ceramic) instead of the water in the toilet. This may cause a reduction in the strength of the recorded audio signal, leading to a decrease in the amplitude of the extracted envelope. As a result, just from analysing the envelope, it is impossible to tell if that reduction in the envelope amplitude is due to a reduction in the voiding flow or an impact on the toilet wall. In this work, we study the classification of sound uroflowmetry data in male subjects depending on the surface that the urine impacts within the toilet: the three classes are water, ceramic and silence (where silence refers to an interruption of the voiding flow). We explore three frequency bands to study the feasibility of removing the human-speech band (below 8 kHz) to preserve user privacy. Regarding the classification task, three machine learning algorithms were evaluated: the support vector machine, random forest and k-nearest neighbours. These algorithms obtained accuracies of 96%, 99.46% and 99.05%, respectively. The algorithms were trained on a novel dataset consisting of audio signals recorded in four standard Spanish toilets. The dataset consists of 6481 1-s audio signals labelled as silence, voiding on ceramics and voiding on water. The obtained results represent a step forward in evaluating sound uroflowmetry tests without requiring patients to always aim the voiding flow at the water. We open the door for future studies that attempt to estimate the flow parameters and reconstruct the signal envelope based on the surface that the urine hits in the toilet.

Chengai Nomogram: A Comprehensive Study of Uroflow Parameters and Characteristics in Healthy Adult Males From South India.

Introduction Uroflowmetry is a widely accepted non-invasive diagnostic modality used in the evaluation of lower urinary tract dysfunction. While various nomograms have been established for different populations and races, there has been a lack of studies that focus on the South Indian populations. Consequently, the objective of the study was to investigate the urinary flow parameters in a healthy adult male South Indian population using uroflowmetry and identify the variations in flow rates. Additionally, the study sought to assess the influence of age and voided volume (VV) on flow rates and create a representative nomogram. Methods A total of 500 uroflowmetry tests were prospectively performed on healthy adult males. The gravimetric method was utilized for uroflowmetry. Flow charts and parameters were analyzed for correlation and linear regression models, and statistical calculations were employed to generate uroflow nomograms. Results The mean age of the participants was 37.77±9.91 years. The mean values for maximum flow rate (Qmax), average flow rate (Qavg), and VV were 23.42±6.64 mL/s, 11.71±3.77 mL/s, and 229.90±59 mL, respectively. A significant correlation was observed between flow rates (Qmax and Qavg) and VV, which indicated that increased VV leads to higher flow rates. Additionally, a significant negative correlation between the flow rates and age was noted. Conclusion The findings provide insight into the uroflow parameters of the South Indian adult male population and contribute to the development of nomograms, establishing normal reference ranges for flow rates across varying VVs. As a tribute to the hospital and the study participants, the nomogram was named the "Chengai Nomogram."

Is there a difference in fecal microbiota of children with and without voiding dysfunction?

Voiding dysfunction (VD), which encompasses many urinary symptoms that are not caused by neurological or anatomical anomalies, is a frequently encountered functional urinary bladder disorder in children. It was reported that there was an association between lower urinary tract symptoms and fecal microbiota in adult patients. Therefore, we aimed to investigate the differences in fecal microbiota between children with or without VD. Two patient groups, including 30 patients, were compared. Group 1 included patients with VD, while Group 2 consisted of healthy children. All study participants were asked to fill lower urinary tract and voiding dysfunction symptom score forms with the assistance of their parents. Subsequently, uroflowmetry tests and postvoiding residual urine measurements were performed. Fresh stool samples were collected from all children and analyzed by polymerase chain reaction. General bacterial load and presence of Roseburia intestinalis, Clostridium difficile, Fusobacterium nucleatum, and Bacteroides clarus were tested. The two groups were significantly different regarding general bacterial load; the presence of Fusobacterium nucleatum. Clostridium difficile and Bacteroides clarus was not detected in the fresh stool samples of the patients in Group 2; the counts of Roseburia intestinalis were less in Group 1 than in Group 2, although there was no statistically significant difference. There was a negative correlation between symptom scores, general bacterial load, and the presence of Fusobacterium nucleatum. However, there was no correlation between the presence of Roseburia intestinalis and symptom scores. There is a potential relationship between VD and a deviation in the fecal microbiota in the pediatric population.

A Prospective Comparative Study of Mobile Acoustic Uroflowmetry and Conventional Uroflowmetry.

PurposeThe aim of this study was to assess the performance of a mobile acoustic Uroflowmetry (UFM) application compared with standard UFM in the pediatric population.MethodsA mobile acoustic UFM application represents a noninvasive method to estimate the urine flow rate by recording voiding sounds with a smartphone. Male pediatric patients who were undergoing UFM testing were prospectively recruited, and the voiding sounds were recorded and analyzed. The intraclass correlation coefficient (ICC) was used to compare the maximum flow rate (Qmax), average flow rate (Qavg), voiding time (VT), and voiding volume (VV) as estimated by acoustic UFM with those calculated by standard UFM. Differences in Qmax, Qavg, VT, and VV between the 2 UFM tests were determined using 95% Bland-Altman limits of agreement.ResultsA total of 16 male patients were evaluated. Their median age was 9 years. With standard UFM, the median Qmax, Qavg, VT, and VV were 18.7 mL/sec, 11.1 mL/sec, 15.2 seconds, and 157.8 mL, respectively. Strong correlations were observed between the 2 methods for Qmax (ICC=0.755, P=0.005), VT (ICC=0.974, P<0.001), and VV (ICC=0.930, P<0.001), but not for Qavg (ICC=0.442, P=0.135). The Bland-Altman plot showed good agreement between the 2 UFM tests. Flow patterns recorded by acoustic UFM and conventional UFM showed good visual correlations.ConclusionsAcoustic UFM was comparable to standard UFM for male pediatric patients. Further validation of its performance in different toilet settings is necessary for broader use.

Comparison of uroflowmetry tests performed with a sensation of normal desire to void versus urgency and correlation of test results with IPSS.

The objective of this study was to evaluate the uroflowmetry test results performed for normal and urgent desire to void and their correlation with International Prostate Symptom Score (IPSS) values in adult male patients having lower urinary tract symptoms (LUTS) complaints. In this prospective study, a total of 83 patients were included. With a normal desire to void, maximum flowrate (Qmax)-normal, average flowrate (Qaverage)-normal, and void volume (VV)-normal values were obtained. Residual urine volume was examined by suprapubic ultrasound within 5 minutes following uroflowmetry, and calculated. The maximum bladder volume (MBV)-normal value was calculated by adding the residual-normal volume and VV-normal values. The same procedures were repeated the next day with the sensation of urgency, Qmax-urgency, Qaverage-urgency, VV-urgency, residue-urgency, MBV-urgency values were obtained. Statistically significant difference was determined for all parameters, and higher values were obtained in the urgency group for all parameters (p<0.05). A correlation analysis was performed for the Qmax-normal and Qmax-urgency values and the IPSS. Both parameters were not statistically significantly correlated with IPSS, but the correlation coefficient of Qmax-urgency was found to be higher than Qmax-normal (p=0.85, Correlation Coefficient=-0.022 for Qmax-normal and IPSS; and p=0.069, Correlation Coefficient=-0.214 for Qmax-urgency and IPSS, respectively). Our study is the first study examining the effect of bladder sensitivity on uroflowmetry parameters in male patients having LUTS. More reliable results might be obtained in adult male patients with LUTS complaints when the uroflowmetry test is performed with a feeling of urgency to void. Our results need to be supported by more objective criteria, rather than subjective criteria such as IPSS.

Standardization for reliable uroflowmetry testing in adults.

To assess if a standard hydration protocol will achieve voided volumes over 150 mL and more reliable uroflowmetry results. This is a single-blinded crossover study of 40 patients with benign prostatic obstruction and 34 healthy volunteers. Subjects were enrolled prospectively between January and March 2019. All subjects performed two randomly ordered uroflowmetry tests. One test was performed when subjects sensed their bladder was full and had the urge to void and another one after emptying the bladder and ingesting 1.5 L of water within 1 hour (prehydration). Uroflowmetry parameters were compared between the benign prostatic obstruction group and the healthy volunteers. Uroflowmetry results were categorized as reliable, residual, and suboptimal with respect to voided volumes. This study has been registered in the UMIN Clinical Trials Registry (UMIN000035446). The benign prostatic obstruction group and the healthy volunteer group presented no difference in respect of uroflowmetry test reliability (P = .459). Uroflowmetry results were reliable in 58 (78.4%) subjects in the prehydrated group and was reliable in 30 (40.5%) subjects in the non-prehydrated group. The difference was statistically significant (P < .05). In the benign prostatic obstruction group and healthy volunteer group, the rate of reliable uroflowmetry tests was significantly higher with prehydration (P < .05). The comparative analysis of uroflowmetry parameters between tests performed with and without prehydration revealed higher values in the prehydrated group (voided volume, maximum flow rate, average flow rate, and postvoiding residual volume; P < .05). Prehydration of patients with 1.5 L of water within 1 hour before uroflowmetry improves uroflowmetry outcomes. By this hydration protocol, the chance to obtain a voided volume over 150 mL is increased significantly.

High Rates of Inadequate Urine Volume Cause Failure of Clinic Based Uroflowmetry in Men with Lower Urinary Tract Symptoms

IntroductionClinic based uroflowmetry is commonly used in the diagnosis and management of lower urinary tract symptoms. AUA (American Urological Association) guidelines recommend 2 separate uroflowmetry tests with a voided volume greater than 150 ml for accurate interpretation. We characterized the interpretability of a series of uroflowmetry tests done at our institution and hypothesized that a significant number were noninterpretable because of inadequate urine volume. MethodsUroflowmetry results were collected from male patients at the UH (University of Utah Hospital) and VAMC (George Wahlen Veterans Affairs Medical Center) urology clinics between August 31, 2014 and September 30, 2014. Average time to perform uroflowmetry was determined. Tests with a volume of 150 ml or less were classified as noninterpretable. Data were characterized using descriptive statistics. ResultsDuring the study period 169 tests were collected, including 104 at UH and 65 at VAMC, of which 107 (63%) were noninterpretable. An estimated total of 1,452 tests were performed at UH and VAMC within a 12-month period. Average time to perform uroflowmetry by health care workers was 2 minutes 18 seconds. The estimated time loss per year for medical personnel due to noninterpretable uroflow studies was 35 hours. ConclusionsMore than 50% of clinic based uroflowmetry tests at our institution had a voided volume of 150 ml or less and were deemed noninterpretable per AUA guidelines. Current clinic based uroflowmetry testing strategies are inefficient and wasteful. Reliable, accurate alternatives to clinic based uroflowmetry for the diagnosis and management of lower urinary tract symptoms should be explored.

Lowest Acceptable Bladder Capacity for Interpretation of Uroflowmetry Tests in Children.

To determine the age-specific lowest acceptable value of bladder capacity (LABC) for interpretation of uroflowmetry tests in children. From September 2008 through July 2012, healthy children aged 4-9 years were enrolled. All children were asked to have two sets of uroflowmetry and post-void residual (PVR) tests. We selected the tests with lower bladder capacity (voided volume+ PVR) of each child to analyze the LABC. Only bell shaped curves were regarded as normal. PVR >20 mL and Qmax <15 mL/s in children aged 4-6 years, and PVR >10 mL, Qmax <15.0 mL/s in children aged 7-9 years were defined as abnormal, respectively. Receiver operative characteristic curves were used to determine the age-specific cut-off value of LABC. The upper boundary of optimal bladder capacity (OBC) for interpretation of uroflowmetry was defined at 115% expected bladder capacity, and LABC as lower boundary. Linear regression was used to establish the relationship between age and LABC. Totally, 930 children were eligible for analysis of LABC. Through ROC curve analysis and regression analysis, the best fitted age specific LABC defined though differentiating low Qmax is 52.08 mL + age in years × 4.78 mL. For simplicity, the proposed LABC is age in years × 5 + 50. Good reproducibility of normal flow pattern, Qmax and PVR in each child were observed in the uroflowmetry tests within OBC. Through the large scale study for uroflowmetry tests in children, we proposed the age-specific lowest acceptable bladder capacity for interpretation of uroflowmetry tests as age in years × 5 + 50 mL.

WITHDRAWN: The lowest acceptable bladder capacity for interpretation of uroflowmetry tests in children

Summary Introduction Under- or overdistended bladder is associated with impaired bladder emptying. Therefore, uroflowmerty of low bladder capacity is regarded as irrelevant for interpretation. However, is no general consensus with regard to the lowest acceptable value of bladder capacity (LABC) for interpretation of uroflowmetry in children. Objective The objective was to determine the age-specific lowest acceptable value of bladder capacity in children. Study design From September 2008 to July 2012, healthy children aged 4–9 years were enrolled for analysis. An uroflowmeter was placed in the toilets at each kindergarten or elementary school. All post-void residual urine (PVRs) was assessed within 5 minutes after voiding by suprapubic ultrasound, and estimated by the equation of height × width × depth × 0.52 mL. All children were asked to have two sets of uroflowmetry and PVR tests. Two pediatric urologists reviewed the uroflow patterns and classified the uroflow patterns as bell-shaped, intermittent, tower, plateau, and staccato-shaped. We selected tests of lower bladder capacity (voided volume + PVR) from each child to analyze the optimal cut-off value for defining the LABC. Only bell-shaped curves were regarded as normal. PVR > 20 mL and Q max 10 mL, Q max Q max and high PVR, receiver operative characteristic curves (ROC) were used to determine the age-specific cut-off value of LABC. The upper boundary of optimal bladder capacity for interpretation of uroflowmetry was defined at 115% expected bladder capacity (EBC, age in years × 30 + 30 mL), and LABC as the lower boundary. Linear regression was used to establish the relationship between age and LABC. Results In total, 930 children were eligible for analysis of LABC. Through ROC curve analysis and regression analysis, the best-fitted age-specific LABC defined by differentiating low Q max (A) and high PVR (B) is 52.08 mL + age in years × 4.78 and 85.79 mL + age in years × 7.64 mL, respectively. For simplicity, the proposed LABC- Q max (A) and LABC-PVR (B) is age in years × 5 + 50 (LABC- Q max ) and age in year × 7.5 + 85 mL (LABC-PVR), respectively. Better reproducibility of normal flow pattern, Q max and PVR in each child were observed in the uroflowmetry tests both performed below the 115% EBC and above the LABC- Q max . Therefore, we chose LABC- Q max as the preferred lowest acceptable bladder capacity for interpretation of uroflowmetry tests. Discussion The current study used a physiological approach to determine the lowest acceptable values of bladder capacity that urinary bladder can have adequate performance for normal flow pattern, good peak flow rate, and low PVR. Within the optimal bladder capacity (upper boundary as 115% expected bladder capacity and lower boundary as LABC- Q max ), the reproducibility of uroflowmetry tests is good which improved the reliability of uroflowmetry tests. Conclusions Through the large scale study for uroflowmetry tests in children, we proposed the age specific lowest acceptable bladder capacity for interpretation of uroflowmetry tests as age in years × 5 +50 mL.

The Tzu Chi nomograms for maximum urinary flow rate (Qmax) in children: comparison with Miskolc nomogram

To report the first ranking method-based age- and gender-specific nomograms for maximum urinary flow rate (Qmax ) in children. Healthy children aged 4-12 years were enrolled for two sets of uroflowmetry tests. The first and the higher value of the two consecutive Qmax of each child with a voided volume (VV) of ≥50 mL were included for establishing single- and dual-Qmax nomograms. Children with possible urinary tract infection or lower urinary tract dysfunctions were excluded. In all, 1128 children (583 boys and 545 girls) with a mean (sd) age of 7.7 (2.2) years were eligible for analysis and construction of nomograms. Multivariate analysis showed that the Qmax was significantly affected by age, VV and gender (all P < 0.01). The values of the corresponding percentile of the Qmax were significantly higher in the dual-Qmax nomogram compared with the single-nomogram. In boys aged 8-12 years, the 5th percentile line of the Miskolc nomogram was significantly lower than that of the present nomograms at all VVs. Minimally acceptable Qmax values, around the 10th percentile of the dual-Qmax nomogram, were >11.5 mL/s in children aged ≤6 years and >15.0 mL/s in children aged ≥7 years. External validation is required for the present dual-Qmax nomograms. We recommend repeating uroflowmetry in cases with a Qmax lower than the minimally acceptable age- and gender-specific Qmax values.

Inter-Observer, Intra-Observer and Intra-Individual Reliability of Uroflowmetry Tests in Aged Men: A Generalizability Theory Approach.

To evaluate the inter-observer, intra-observer and intra-individual reliability of uroflowmetry and post-void residual urine (PVR) tests in adult men. Healthy volunteers aged over 40 years were enrolled. Every participant underwent two sets of uroflowmetry and PVR tests with a 2-week interval between the tests. The uroflowmetry tests were interpreted by four urologists independently. Uroflowmetry curves were classified as bell-shaped, bell-shaped with tail, obstructive, restrictive, staccato, interrupted and tower-shaped and scored from 1 (highly abnormal) to 5 (absolutely normal). The agreements between the observers, interpretations and tests within individuals were analyzed using kappa statistics and intraclass correlation coefficients. Generalizability theory with decision analysis was used to determine how many observers, tests, and interpretations were needed to obtain an acceptable reliability (> 0.80). Of 108 volunteers, we randomly selected the uroflowmetry results from 25 participants for the evaluation of reliability. The mean age of the studied adults was 55.3 years. The intra-individual and intra-observer reliability on uroflowmetry tests ranged from good to very good. However, the inter-observer reliability on normalcy and specific type of flow pattern were relatively lower. In generalizability theory, three observers were needed to obtain an acceptable reliability on normalcy of uroflow pattern if the patient underwent uroflowmetry tests twice with one observation. The intra-individual and intra-observer reliability on uroflowmetry tests were good while the inter-observer reliability was relatively lower. To improve inter-observer reliability, the definition of uroflowmetry should be clarified by the International Continence Society.

2275 INTRA-INDIVIDUAL, INTER-OBSERVER AND INTER-OBSERVER RELIABILITY OF UROFLOWFLOWMETRY TESTS IN AGED MEN: A GENERALIZABILITY THEORY APPROACH

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Urodynamics Testing1 Apr 20132275 INTRA-INDIVIDUAL, INTER-OBSERVER AND INTER-OBSERVER RELIABILITY OF UROFLOWFLOWMETRY TESTS IN AGED MEN: A GENERALIZABILITY THEORY APPROACH Ying-Buh Liu, Shang-Jen Chang, and Stephen Shei-Dei Yang Ying-Buh LiuYing-Buh Liu Taipei, Taiwan More articles by this author , Shang-Jen ChangShang-Jen Chang Taipei, Taiwan More articles by this author , and Stephen Shei-Dei YangStephen Shei-Dei Yang Taipei, Taiwan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2204AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To evaluate the intra-individual, inter-observer and inter-observer reliability of uroflowmetry tests in aged men with generalizability theory. METHODS The study was approved by the ethic committee in our hospital. Healthy volunteers with age over 40 years without neurological diseases or other systemic diseases including diabetes or immue dysfunction were enrolled for evaluation of uroflowmetry tests. An uroflowmeter was set up in a quiet, private room where volunteers could void in familiar environment. The volunteers went to the toilet when he had normal desire to void. Every participant received two sets of uroflowmetry and PVR tests (measured with trans-abdominal sonography). The uroflowmetry tests were interpreted by four urologists independently for two times with 2 weeks apart. Uroflowmetery curves are classified as bell-shaped, obstructive, restrictive, staccato, interrupted and tower-shaped and scored from 1 (absolutely abnormal) to 5 (normal). The agreement between observers, interpretations and tests within individuals were analyzed using the intraclass correlation coefficients. Generalizibility theory with decision analysis was applied to analyze the intra-individual, inter-observer, and intra-observer reliability. RESULTS Of 108 volunteers, we randomly selected the results of uroflowmetry from 25 partipants for evaluation of reliability. Mean age of the studied children was 55.3 years. The intra-individual and intra-observer reliability on uroflometry tests were both good (ICC = 0.82 and 0.78, respectively). However, the inter-observer reliability was fair (ICC = 0.53) In decision study of generalizability theory (table), the reliability was 0.55 if we have only one observer, one observation and one tests. If we increase the number of observers, observations or times of tests, the reliability would increase. CONCLUSIONS The intra-individual and intra-observer reliability on uroflometry tests were good while the inter-observer reliability were relatively poor. To improve the inter-observer reliability, the definition of uroflowmetry should be more clarified by International Continence Society in addition to education of observers. No. of observers No. of observations Times of Tests Reliability 1 1 1 0.55 1 1 2 0.60 1 1 3 0.62 1 2 1 0.61 1 2 2 0.67 1 2 3 0.69 2 1 1 0.68 2 1 2 0.74 2 1 3 0.76 2 2 1 0.73 2 2 2 0.78 2 2 3 0.80 © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e933 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ying-Buh Liu Taipei, Taiwan More articles by this author Shang-Jen Chang Taipei, Taiwan More articles by this author Stephen Shei-Dei Yang Taipei, Taiwan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Uroflowmetry Nomograms for Healthy Children 5 to 15 Years Old

We determined flow rates and generated flow rate-voided volume nomograms based on healthy children 5 to 15 years old voiding spontaneously in their natural environment. A total of 824 healthy school children of both genders were enrolled. A single uroflow record from each child was evaluated. A total of 103 children with a voided volume of less than 50 ml and/or a staccato/interrupted uroflow pattern were excluded, and 721 records were analyzed. Data were evaluated using several mathematical formulas and goodness of fit was determined. Linear regression analysis was used to generate nomograms. Flow rates and voided volumes increased with increasing age, with the effect being more pronounced in girls. No significant difference was noted in uroflow rates from 5 to 10 years, but significant differences (p <0.001) started appearing at 11 to 15 years. Also no significant difference was noted in uroflow rates among children 11 to 15 years. Therefore, 2 age groups were designated, with group 1 consisting of patients 5 to 10 years old and group 2 consisting of patients 11 to 15 years old. There were 222 boys and 122 girls in group 1 and 240 boys and 137 girls in group 2. In group 1 the maximum and average ± SD flow rates were 15.26 ± 4.54 ml per second and 7.68 ± 3.26 ml per second, respectively, for boys and 17.98 ± 6.06 ml per second and 9.19 ± 4.23 ml per second, respectively, for girls. In group 2 these rates were 22.50 ± 7.24 ml per second and 10.78 ± 4.03 ml per second, respectively, for boys and 27.16 ± 9.37 ml per second and 13.48 ± 5.21 ml per second, respectively, for girls. This large study, which expands the scant existing literature on uroflow parameters in healthy children, will hopefully promote wider application of uroflowmetry testing in the pediatric population.

Practical urodynamics in children, part 2: Normal uroflowmetry curve is not a guarantee of normal voiding function

Since uroflowmetry and postvoiding residual (PVR) urine tests are noninvasive and relatively inexpensive, they are regarded as first-line screening tools for evaluating pediatric voiding function.1 The International Children’s Continence Society states that bellshaped uroflowmetry curves usually imply normal voiding function in children.2 Herein, we present a girl with voiding dysfunction who had a normal bell-shaped uroflowmetry curve because of abdominal straining.

Large voided volume suggestive of abnormal uroflow pattern and elevated post‐void residual urine

To report the cut-off value for large voided volume (LVV) suggestive of abnormal uroflow pattern or elevated post-void residual urine (PVR) in healthy kindergarteners. From 2003 through 2008, we enrolled 417 healthy kindergarten children for evaluation of uroflowmetry tests and PVR. The uroflowmetry curves were interpreted if voided volumes (VV) were >50 ml, and categorized as bell-shaped, staccato, plateau, and interrupted. Only bell-shaped curves were categorized as normal. After 2006, PVR was assessed within 5 min after each voiding with a VV >50 ml. A PVR >20 ml is regarded as elevated. Receiver operative characteristic (ROC) curves were constructed to evaluate the cut-off value of VV/expected bladder capacity (EBC) with regard to nonbell-shaped uroflowmetry curves, and/or elevated PVR. Of 385 children (mean age: 4.85 ± 0.96 years), 699 uroflowmetry, and 556 PVR data were eligible for analysis. There were 502 (71.8%) bell-shaped, 76 (10.9%) plateau, 102 (14.6%) staccato, and 19 (2.7%) interrupted curves. Mean and median PVR were 12.4 ± 21.2 and 5.5 ml, respectively. Of 556 PVRs, 96 (17.3%) were >20 ml. Based on the ROC curve for the nonbell-shaped curves and/or elevated PVR, VV >100% EBC was best defined as LVV. There were statistically more elevated PVR, and more nonbell-shaped curves in the voidings with than without LVV. There is a trend that peak flow rate decreased when VV was >150% EBC. VV of more than 100% EBC can be defined as LVV which was associated with higher rates of abnormal uroflow pattern and/or elevated PVR.

The Effects of the Age Initiating Toilet Training on Urinary Continence and Voiding Function in Children

Purpose To report the effects of the age initiating toilet training on urinary continence and voiding function in children. Material and Methods In three years, we enrolled 318 healthy kindergarteners. One of the parents completed the questionnaire including the age initiating and the duration of toilet training, the current status of daytime and nighttime continence, the age of attaining daytime and nighttime continence, Dysfunctional Voiding Symptom Score (10 parameters, score 0–3), and Bristol Stool Scale. All children underwent uroflowmetry and post-void residual urine (PVR) tests. Results Finally, 235 respondents (106 boys/129 girls, mean age = 4.8 ± 0.9 years) were eligible for analysis. The mean age initiating toilet training was 24.4±8.4 months. Based on the age initiating toilet training, children were classified as Early (≦18months, n=67) or Late Group (>18 months, n=168). Early Group had higher rates of daytime and nighttime continence before 30 months of age than Late Group (89.6% vs. 42.9%, p 20ml) between two Groups. Conclusions Early toilet training was associated with early attainment of both daytime and nighttime continence. The children with early toilet training had normal voiding function and a trend of lower DVSS.

Do uroflowmetric findings change by treatment of urinary tract infection in girls with dysfunctional voiding?

The goal of the study was to evaluate the efficiency of repeated uroflowmetry study in girls who present with dysfunctional voiding with normal radiologic evaluation. Materials and methods: Twenty five children (25 girls with a mean age of 8.9 years) with recurrent urinary tract infection (UTI) and dysfunctional voiding who have normal radiologic evaluation were prospectively evaluated by uroflowmetry tests. Uroflowmetry study was repeated after the UTI treatment in asymptomatic period. Results: Mean urine volume was 254.31 ± 199.49 cc and the mean micturition time was 25.22 ± 15.43 s at the first uroflowmetry. Prolonged micturition time was noted in 8 (32%) patients. At the second uroflowmetry, mean urine volume was 370.77 ± 217.89 cc, and the mean micturition time was 29.63 ± 26.42 s. Prolonged micturition time was noted in 7 (28%) patients. Flow pattern curve was bell-shaped in 9 patients and abnormal in 16 patients (64%). In the second investigation a normal flow pattern curve was noted in 10 patients and an abnormal pattern in 15 patients. Conclusion: There was no difference between pre- and post-treatment uroflowmetry pattern in patients with dysfunctional voiding. Uroflowmetry investigation is not a very proper way for follow-up.

Age, gender, and voided volume dependency of peak urinary flow rate and uroflowmetry nomogram in the Indian population

Objectives:The objective of this study was measurement of urine flow parameters by a non invasive urodynamic test. Variation of flow rates based on voided volume, age, and gender are described. Different nomograms are available for different populations and racial differences of urethral physiology are described. Currently, there has been no study from the Indian population on uroflow parameters. So the purpose of this study was to establish normal reference ranges of maximum and average flow rates, to see the influence of age, gender, and voided volume on flow rates, and to chart these values in the form of a nomogram.Methods:We evaluated 1,011 uroflowmetry tests in different age groups in a healthy population (healthy relatives of our patients) 16-50 year old males, >50 year old males, 5-15 year old children, and >15 year pre-menopausal and post-menopausal females. The uroflowmetry was done using the gravitimetric method. Flow chart parameters were analyzed and statistical calculations were used for drawing uroflow nomograms.Results:Qmax values in adult males were significantly higher than in the elderly and Qmax values in young females were significantly higher than in young males. Qmax values in males increased with age until 15 years old; followed by a slow decline until reaching 50 years old followed by a rapid decline after 50 years old even after correcting voided volume. Qmax values in females increased with age until they reached age 15 followed by decline in flow rate until a pre-menopausal age followed by no significant decline in post-menopausal females. Qmax values increased with voided volume until 700 cc followed by a plateau and decline.Conclusions:Qmax values more significantly correlated with age and voided volume than Qavg. Nomograms were drawn in centile form to provide normal reference ranges. Qmax values in our population were lower than described in literature. Patients with voided volume up to 50 ml could be evaluated with a nomogram.

Effect of Tamsulosin on Systemic Blood Pressure and Nonneurogenic Dysfunctional Voiding in Children

A number of therapies for dysfunctional voiding in children have been proposed after conservative measures have failed. Prior studies have shown significant improvement in lower urinary tract symptoms with alpha1-adrenergic antagonists. Nonselective alpha1-adrenergic antagonists can result in systemic vasodilatation and hypotension. We examined the effects of tamsulosin, a uroselective alpha1A-adrenergic antagonist, on blood pressure, as well as its safety and efficacy in the treatment of dysfunctional voiding in a pediatric population. A total of 23 children without anatomical or neurogenic abnormalities presented with lower urinary tract symptoms refractory to conservative measures. All children had increased post-void residual urine or abnormal uroflowmetry in the absence of pelvic floor activity suggestive of bladder neck dysfunction. All patients were administered tamsulosin daily. Voiding diaries, blood pressure, uroflowmetry studies and patterns along with assessment of post-void residual urine were obtained before and after beginning tamsulosin in all children. Median duration of tamsulosin therapy was 7 months, and patient followup was 20 months. The number of voiding and incontinent episodes significantly decreased during treatment compared to baseline (p <0.05). Mean blood pressures before and during tamsulosin treatment were 98/55 mm Hg and 110/61 mm Hg, respectively. Significant increases in average and maximum urinary flow rates along with reduction in post-void residual urine were observed during tamsulosin therapy compared to baseline values (p <0.01). A 50% reduction in the number of abnormal uroflow patterns was observed with tamsulosin therapy. Tamsulosin demonstrated no clinically significant effect on blood pressure, while proving to be a safe and effective treatment option for lower urinary tract symptoms in a select pediatric population.