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Objective:We compare the consistency, similarities and differences of operating procedures, data and conclusions of air-charged catheters(ACC) and water-filled catheters(WFC), as simultaneously using ACC and WFC in pressure-flow study(PFS).Methods:This study was a prospective, synchronously controlled study, including eligible patients who underwent PFS in the Department of Urology, Beijing Chaoyang Hospital from January 2021 to March 2021. Inclusion criteria: ① Patients need PFS for lower urinary tract symptoms like frequency of urination, urgent urination, urinary incontinence and dysuria; ② Age over 18 years old. Exclusion criteria: ① Unable to complete or cooperate during the urodynamic test; ② Patients with severe urethral stricture or acute stage urinary tract infection; ③ Pregnant women. The bladder pressure was measured continuously by using a 7FDR T-DOC ?AC three-chamber bladder pressure tube, which linked to ACC sensor and improved WFC pressure conduction module. At the same time, 7FA T-DOC ?AC single-lumen rectal pressure tube and 7F Labori-CAT411 double-lumen water sac abdominal pressure tube was used to measure the ACC and WFC rectum pressure, respectively. We recorded the Pdet, Pves and Pabd measured by ACC and WFC, at the point of initial sitting position, bladder filling at 100 ml, 150 ml, 200 ml, cough, Q max, maximum Pdet and the end of urination, and compared the mean values, differences, and consistencies of our data. Result:A total of 63 patients (26 female, 37 male) were included in this study, with an average age of 59.19 years (25-86 years old). During bladder filling phase, the mean values of Pves measured by ACC and WFC were 30.78/24.67cmH 2O (initial sitting position), 29.79/25.13cmH 2O (100 ml), 30.87/25.90cmH 2O (150 ml) and 30.95/26.17cmH 2O(200 ml), respectively, the mean value of Pabd were 30.03/24.17cmH 2O (initial sitting position), 28.81/21.78cmH 2O (100ml), 28.89/21.38cmH 2O (150ml), 28.44/21.60cmH 2O (200ml), respectively, and were significantly different at each sampling point ( P<0.01). During urination period, no significant differences were found in data( P>0.05), and the data measured with ACC and WFC system have good consistency. There were significant differences in Pves(mean 57.30/49.95 cmH 2O, respectively) and Pdet(mean 54.21/43.10 cmH 2O, respectively) between ACC and WFC in cough ( P<0.01), but there was a strong linear correlation between these data between two systems(R 2=0.792 in Pves and 0.756 in Pabd). Bland-Altman analysis showed that detrusor pressure at the maximum urine flow rate maintained good consistency between ACC and WFC, which 95% CI was -13.9 cmH 2O to 15.8 cmH 2O. Conclusions:In PFS, although the ACC measurement values (Pves and Pabd) during the filling phase are higher than those WFC readings, but the absolute measurement difference is small, so there is no practical meaning in clinical practice. There was no significant difference in detrusor pressure measured during voiding phase, which indicated that the urodynamic judgment and clinical conclusions of the two systems are highly consistent in judgment of the detrusor contractility and the bladder outlet obstruction.
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Objective To develop a clinical nomogram for predicting the probability of bladder outlet obstruction (BOO) in male LUTS/BPH using the most common and noninvasive parameters in clinical practice , with the hope of detecting BOO individually and precisely. Methods Retrospectively analyze the outpatients and inpatients of male LUTS/BPH from November 2003 to November 2015 in Guangzhou First People′s Hospital. Collect the Pressure-flow study parameters and other clinical parameters including Qmax , PV, TZV, TZI, PSA, and PVR. Find out the best independent predictors on the diagnosis of BOO and develop the nomogram for pre-dicting BOO. Results The data from 1 599 patients were analyzed. The areas under the ROC curve (AUCs)of PV, TZV, TZI, PSA, Qmax, and PVR were 0.803, 0.807, 0.698, 0.775, 0.742, and 0.641, respectively. Qmax, PV, and PSA were selected as the best clinical parameters to predict BOO. The Logistic regression equa-tion is Log(p)=0.332 4 - 0.201 8*Qmax + 0.026 6*PV + 1.135 1*PSA. Finally, a nomogram model was developed by R statistical software. This nomogram showed a concordance index of 0.854 according to the inter-nal validation of the model. Conclusions The clinical nomogram presented a high accuracy (85.4%) in de-tecting BOO, which would help predicting BOO in male LUTS/BPH noninvasively, individually, accurately, and providing valuable reference and guidance in clinical decision.
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PURPOSE: We evaluated whether a 6Fr transurethral catheter affects urinary flow in women undergoing pressure-flow studies. MATERIALS AND METHODS: We retrospectively reviewed urodynamics database of 201 consecutive women referred for the evaluation of lower urinary tract symptoms from January 1997 to June 2000. Before the urodynamic study, all patients voided privately using a standard toilet and free uroflowmetry parameters were recorded. Then, a standard pressure-flow study was performed using 6Fr transurethral catheter. We excluded the patients with inadequate voided volume(<150ml) and volume difference more than 30% between two studies. Urinary flow parameters between the two studies were analysed by paired t-test according to voided volume, main urodynamic diagnosis and uroflowmetry pattern. RESULTS: Of 201 women, 144 were excluded and 57 were subjects of our analysis. According to voided volume, pressure-flow study parameters were significantly different from the equivalent free uroflowmetry parameters: the maximum flow rate and average flow rate were significantly lower and flow time was significantly longer in pressure-flow studies(p<0.01). According to main urodynamic diagnosis categories, the subgroups of patients with normal urodynamic study, bladder outlet obstruction, detrusor instability and others showed significantly lower maximum flow rate and average flow rate in pressure-flow studies(p<0.01). According to uroflowmetry pattern, obstructive patterns such as undulating and intermittent pattern were more common in pressure-flow studies. CONCLUSIONS: The 6Fr transurethral catheter used in pressure-flow studies significantly affects urinary flow parameters. In order to make a accurate diagnosis, we must not merely rely on the results of pressure-flow studies, but we must take into account patient's individual clinical situation and also, if available, the results of free uroflowmetry in addition to pressure flow study parameters.
Subject(s)
Female , Humans , Catheters , Diagnosis , Lower Urinary Tract Symptoms , Retrospective Studies , Urinary Bladder Neck Obstruction , UrodynamicsABSTRACT
Objective To evaluate objectively the traditional methods on the assessment of bladder outlet obstruction(BOO) due to BPH. Methods Correlation between the urodynamic findings and the traditional diagnostic parameters such as age,IPSS,Vp,Qmax z and PVRr was studied.The clinical prostatic score(CPS),derived from multiple regression of clinical parameters depending on URA,was evaluated. Results The parameters such as age,IPSS,Vp,Qmax z and PVRr were evaluated with reference to pressure flow study.Every parameter alone was not enough for BOO diagnosis. The regression equation was CPS=49.8-3.3 Qmax z+0.5 IPSS+0.2 Vp+7.5 PVRr.Correlation coefficient between CPS and urodynamic findings was 0.629 and was significantly higher than that of any clinical parameter alone.With CPS≥35,the sensitivity was 83.7% and specificity 85.8% for the diagnosis of BOO.With CPS
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Objective To evaluate pressure-flow study in assessment of dysuresia symptom in elderly male patients. Methods A total of 125 elderly male patients with dysuresia and prostatic enlargement underwent urodynamic examination.Their age ranged from 56 to 83 years with a mean of 68 years.If the patients urinated smoothly with satisfying urinary flow curve,the pressure-flow study would be performed on them.According to the results,the patients were classified as 3 groups:BOO,equivocal BOO and non-BOO groups.Their detrusor contractive function was classified as strong,normal,weak or very weak. Results Of the 125 patients undergoing urodynamic test,87 obtained definite pressure-flow study findings.Of the 87 patients,39 were with BOO,18 with equivocal BOO and 30 without BOO.In the BOO,equivocal BOO and non-BOO groups,detrusor pressure at maximum flow was (99.2?34.3) cmH 2O (1cmH 2O=0.098 kPa),(46.9?9.9)cmH 2O and (30.8?10.0)cmH 2O,respectively;intravesical opening pressure was (99.4?39.6) cmH 2O, (43.7?9.9) cmH 2O and (29.9?9.7) cmH 2O, respectively; minimum voiding detrusor pressure was (61.3?27.5) cmH 2O, (33.9?14.1)cmH 2O and (22.1?12.5)cmH 2O,respectively;and maximum detrusor pressure was (113.0?42.1)cmH 2O,(55.8?14.9)cmH 2O and (38.4?11.3)cmH 2O,respectively.The detrusor function was normal or strong in 74.4% (29/39) of patients with BOO,27.8%(5/18) of patients with equivocal BOO and 26.7% (8/30) of patients without BOO.All these parameters of the BOO group were higher than those of the equivocal BOO group and non-BOO group (both P
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Objective A study of the quality control in retrospective analysis of computerized pressure flow data was carried out and compared with the manual results. The objective was to evaluate the impact of various artifacts on the outcome of pressure flow analysis. Methods A total of 582 pressure flow traces were included in the comparative analysis. For each trace, values of maximum urinary flow rate (Qmax) and detrusor pressure at Qmax (P det.Qmax ) were read from manually smoothed and corrected uroflow curve and detrusor pressure curve respectively. Obstruction coefficient (OCO) was used to detect urethral resistance. ICS nomograms were employed to classify and diagnose obstruction, and Schfer nomograms to grade the obstruction. The results obtained by manual readings were compared with those of computerized readings. The difference was tested by statistic analyses. Results After manual correction, Qmax had a consistently significant decrease ( P 0.05). OCO underwent a systematically significant increase, with a mean of 0.067 ( P
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PURPOSE: The pressure-flow study is only objective study that can determine the presence or absence of bladder outlet obstruction and impaired detrusor contractility. Although many results of pressure-flow study are reported in diseased state such as benign prostatic hyperplasia, but are rarely evaluated in adult male patients without voiding symptoms as control group. The purpose of this study was to evaluate the findings of pressure-flow study in asymptomatic male patients. MATERIALS AND METHODS: Twenty-three male patients without voiding symptom were recruited for this study. Mean age of these patients was 49.8 years(range 21-70). Mean AUA symptom score was 1.1(range 0-4) and mean prostatic volume was 27.3gm(range 20-35) on digital rectal examination. The study was done by using 7 Fr. urethral catheter on sitting or standing position. RESULTS: Mean values were followed; PdetQmax was 48.1cmH2O(range 25-94), Qmax was 15.7ml/sec(range 3-23), and postvoid residual urine was 14.5ml(range 0-80). According to the Abrams-Griffiths nomogram, 8 were unobstructed and 4 were obstructed, the remaining 11 falling in the equivocal zone. In each types, mean group specific urethral resistance factor (URA) was 12.8cmH2O in unobstructive type, 51.5 in obstructive type, and 22.1 in equivocal type. CONCLUSIONS: The results were maybe guessed as following; First, the values of defining obstrucion were set too low. Second, obstruction was less relevance in the development of symptoms than had been suggested previosly by some observers. Therefore, we thought that interpretations of pressure-flow finding were carefully considered to method of test, and/or uncomfortable voiding.
Subject(s)
Adult , Humans , Male , Digital Rectal Examination , Nomograms , Prostatic Hyperplasia , Urinary Bladder Neck Obstruction , Urinary CathetersABSTRACT
PURPOSE: We performed this study to elucidate whether patient`s satisfaction and improvement of clinical parameters after transurethral resection of prostate(TURP) correlate with the degree of preoperative obstruction. We investigated the role of urodynamic studies as a predictor of outcome after TURP. MATERIALS AND METHODS: Parameters including pre-operative symptom scores(IPSS), uroflow rate, prostate volume and urodynamic studies, were assessed in 27 patients undergoing TURP due to BPH. Bladder outlet obstruction was assessed by pressure-flow study(PFS). Post-operative evaluation was performed with IPSS and uroflowmetry 3 months after surgery. Post-operative patient`s satisfaction was determined by subjective responses to the questionnaires. The subjective responses, clinical and urodynamic parameters were compared and statistically analyzed. RESULTS: Eighteen patients(67%) had preoperative bladder outlet obstruction(BOO; defined as L-PURR> or =3), while 14(52%) demonstrated associated detrusor instability(DI). Significant improvements in IPSS, quality of life, peak flow rate and residual urine were noted in all patients post-operatively(p or =3) and 91%(L-PURR<3). CONCLUSIONS: No differences in the improvements of clinical parameters except voiding symptom scores were noted between obstructive and non-obstructive BPH. However, patient`s satisfaction after surgery was higher for patients in whom preoperative pressure-flow study confirmed obstruction. Also, obstructive parameters such as L-PURR or URA may be useful in predicting postoperative results.
Subject(s)
Humans , Prostate , Quality of Life , Surveys and Questionnaires , Transurethral Resection of Prostate , Urinary Bladder , Urinary Bladder Neck Obstruction , UrodynamicsABSTRACT
PURPOSE: It has been well known that 70-80% of men with prostatism actually manifest bladder outlet obstruction(BOO) and the rest have detrusor underactivity(DU) or other abnormalities. Accordingly, the treatment of BPH by the results of symptom score, or uroflow may be partly incorrect. It is also well known that the pressure-flow study is the gold-standard to define the presence and degree of BOO. Therefore, we investigated pressure-flow study to identify non-obstructed, underactive detrusor function among the patients presented with prostatism. MATERIALS AND METHODS: This study included 96 patients older than 50 years (mean 69.6+/-5.8) with prostatism. All patients were assessed by history taking, symptom score, digital rectal examination, uroflowmetry and pressure-flow study. Patients were divided into irritative and obstructive symptom groups according to their chief complaints. Urodynamic parameters between those two groups were analyzed and compared. RESULTS: Of the total 96 patients, detrusor instability was noted in 45(47%) at the filling cystometry. Of the 53 patients presented with irritative symptoms, 33 showed detrusor instability(62%); Of the 43 patients mainly presented with obstructive symptoms, only 12(28%) showed detrusor instability. Statistically significant correlation was found between irritative symptoms and detrusor instability as well as obstructed symptoms and BOO. In the total patients, BOO was found in 49(51%) and detrusor underactivity(DU) was found in 36(37%) with equivocal cases in 11(12%). Of the 43 patients mainly presented with obstructive symptoms, BOO and DU was found in 23(53%) and 13(30%) respectively. Of the 53 patients presented with irritative symptoms, BOO and DU was found in 26(49%) and 23(43%) respectively. There were no significant differences between irritative and obstructive symptom group as well as BOO and DU group in the clinical parameters as determined by symptom score, prostate size, and uroflowmetry. CONCLUSIONS: In this study, significant proportion(37%) of the whole patient population was classified as detrusor underactivity as diagnosed by urodynamics to which treatment for BPH may not be as effective as for those manifested with BOO. It is suggested that pressure-flow study is to be considered to patients with prostatism who didn`t show any symptomatic improvement despite the treatment for BPH.
Subject(s)
Humans , Male , Digital Rectal Examination , Incidence , Prostate , Prostatic Hyperplasia , Prostatism , Urinary Bladder , UrodynamicsABSTRACT
PURPOSE: The effect of a urethral catheter on pressure-flow study has important implications for the practice and interpretation of pressure flow studies. We wonder which catheter would be adequate for pressure flow study. We report 3 different size of catheters(4Fr, 10Fr, 12Fr) effects on urinary flow rate, voiding pressures and pressure flow plot. MATERIALS AND METHOD: Pressure flow studies were carried out on 141 patients(male;88, female;53), whose diseases were BPH in 22, prostatodynia in 37,urethral syndrome in 36, Hinman syndrome in 2, neurogenic bladder in 28, unstable bladder in 10, urethral stricture in 2 and bladder stone in 2. RESULTS: There was no significant difference between pre- and postcatheterization maximum flow rate in 4Fr group. But there were significant difference between pre- and post-catheterization maximum flow rate in 10Fr and 12Fr group. The detrusor pressure was significantly higher in 10Fr and 12Fr group than in 4Fr group. The larger size of catheter groups had more obstructive patterns in pressure flow plot. CONCLUSIONS: These results showed 4Fr catheter had less effect on pressure flow study than 10Fr, 12Fr catheter.
Subject(s)
Catheters , Urethral Stricture , Urinary Bladder , Urinary Bladder Calculi , Urinary Bladder, Neurogenic , Urinary CathetersABSTRACT
Patients with symptomatic BPH have different patterns of obstruction: compressive (difficulty in opening the urethra) and constrictive (decreasing elasticity of urethra) obstruction. 26 patients with symptomatic BPH were classified into two different groups according to the types of obstruction as shown by pressure/flow study and clinical outcomes were compared between these groups. There were no differences in the mean age and weight of the prostate at presentation between two groups. Of the 26 patients, 16 had compressive, and 10 had constrictive obstruction. Amount of postvoiding residual urine (PVR), maximal detrusor contraction pressure (Pdet. max.), detrusor maximal flow pressure (Pdet. Qmax.), and minimal urethral opening pressure (Pmuo) were significantly higher in compressive obstruction group than in constrictive obstruction group as shown by analysis of the urodynamic parameters before treatment. Patients were treated with VLAP followed by TURP for obstructing prostate tissues to facilitate early voiding after catheter removal. Postoperative results were evaluated using the parameters such as peak flow rate (Qmax.), amount of PVR and AUA symptom score. Significant increases in Qmax, decreases of symptom score and amount of PVR were evident for both groups of obstruction after treatment. Improvements of the clinical parameters were substantially better in constrictive,than compressive obstruction groups, but without statistically significant differences.
Subject(s)
Humans , Catheters , Elasticity , Prostate , Transurethral Resection of Prostate , Treatment Outcome , Urinary Bladder , UrodynamicsABSTRACT
The diagnostic methods of evaluating infravesical obstruction, especially in BPH, are based on symptoms, history, digital rectal examination, intravenous pyelography, ultrasonography, uroflowmetry and residual urine, etc. But these methods cannot accurately and objectively evaluate infravesical obstruction. We measured voiding cystometry with uroflowmetry and urethral pressure profile in 24 BPH patients by Dantec UD5500. We classified the degree of obstruction into obstructive, equivocal and nonobstructive types by Griffiths' obstructive nomogram and Type 0 - VI by Schaefer's nomogram after computer assisted pressure-flow analysis. Among 24 patients, obstructive type was in 12, equivocal type in 6, and nonobstructive type in 6 by Griffiths' obstructive nomogram. Based on Schaefer's nomogram, type 0 was in 4 patients, type I in 6, type III in 4, type IV in 2, type V in 4 and type VI in 4. In our analyzed urodynamic parameters, Qmax, Pdet, Pmuo, Atheo and URA had statistical significance(p<0.05). We consider Griffiths' obstructive nomogram and Schaefer's nomogram based on pressure flow plot are objective methods of accurately evaluating infravesical obstruction.
Subject(s)
Humans , Digital Rectal Examination , Nomograms , Ultrasonography , Urodynamics , UrographyABSTRACT
BPH is found in 50% of males over the age of 50 and there is increase in incidence with age. But some patients with BPH do not induce bladder outlet obstruction and some patients with prostatism are not caused by bladder outlet obstruction. So, urodynamic study including pressure/flow study was performed in 45 males with prostatism to evaluate the degree of obstruction, and we measured maximal intravesical pressure, maximal detrusor pressure, prostatic urethral length, residual urine, minimal urethral resistance and pressure/flow plots. The 45 males were divided into 3 groups by maximal flow rate(MFR)(A: MFR>=15, B: 10<=MER<=15, C: MFR<10) and there was significant difference between each group only in minimal urethral resistance(P<0.05). The result of pressure/flow plots of A group showed that 93% (13/14) was nonobstructive pattern and the rest one was obstructive pattern which was caused by detrusor hyperreflexia. In B group. we could know the degree of obstruction in 58%(7/12) only with minimal urethral resistance and we could decide the degree of obstruction with pressure/flow plots in rest 5 cases whose minimal urethral resistances were between 0.43 and 0.65 unit. The result of pressure/flow plots of C group showed that 89%(17/19) was obstructive pattern and the rest 2 cases were nonobstructive patterns which were caused by detrusor hyporeflexia. In conclusion, with pressure/flow plots and minimal urethral resistance, we can decide the degree of obstruction in patients with prostatism especially whose MFR are between 10 and 15 ml/sec.
Subject(s)
Humans , Male , Incidence , Prostatism , Reflex, Abnormal , Urinary Bladder Neck Obstruction , UrodynamicsABSTRACT
The compliance of upper urinary tract plays a main role in preservation of renal function against pressure overload. It consists of renal pelvic compliance and ureteral compliance. We measured ureteral compliance in rat with new experimental model applying pressure-flow study. Two catheters were placed in left renal pelvis. one for flow infusion, another for pressure monitoring. Pressure-flow study was done with ligation of uretero-vesical junction(UVJ) and subsequent pressure-flow study with ligation of uretero-pelvic junction(UPJ) in the same rat. Ureteral compliance was calculated from upper urinary tract compliance with UVJ ligation minus pelvic compliance with UPJ ligation. The data from seven rats were analyzed. Mean ureteral compliance (+/-standard deviation) was 0.0011+/-0.00034 ml/cmH2O and mean contribution of ureter for upper urinary tract compliance was 19%. Our new experimental model for measurement of ureteral compliance was simple and easy to perform. Results in this study will be used as baseline data for further investigation of uretera1 compliance in chronic partial ureteral obstruction.