[Interobserver agreement in the diagnosis of bladder outlet obstruction in women]. / Variabilidad interobservador en el diagnóstico de obstrucción del tracto de salida vesical en mujeres.

Background: The diagnosis of bladder outlet obstruction (BOO) in women is a challenge for functional urology. In Mexico there are few data that report the prevalence of OTSV in women, being up to 24% in a group of patients. Objective: The aim of this study is to compare six different definitions of bladder outlet obstruction and evaluate the interobserver agreement in an educational setting. Material and Methods: Urodynamic studies (UDS) of women with and without diagnosis of BOO were retrospectively assesed. Farrar, Chassagne, Lemack, Defreitas, Blavais and Groutz, Solomon-Greenwell definitions were evaluated. All UDS were independently reviewed by 5 observers. The easiest, the hardest and the fastest were chosen. Interobserver agreement to classify the patients as obstructed was assessed by kappa reliability statistical analysis. We classified the type of mistakes the participants made; error of interpretation and miscalculation. Results: A total of 28 urodynamic studies were reviewed. All observers had a substantial agreement (0.64-0.78) to classify BOO using all but Lemack and Solomon-Greenwell definitions. A total 120 errors from 840 responses were found; 45.8% errors of interpretation of UDS and 54.1% miscalculation of the equation. Finally, all the participants chose the Solomon-Greenwell was the most difficult definition. Conclusion: Chassagne, Defreitas and Farrar definitions proved substantial interobserver agreement. Solomon-Greenwell and Lemack´s definitions had the highest number of pitfalls and the lowest level of agreement.

Introducción: el diagnóstico de obstrucción de tracto de salida vesical (OTSV) en mujeres supone un reto para la urología funcional. En México existen pocos datos que reporten la prevalencia de OTSV en mujeres, siendo de hasta el 24% en un grupo de pacientes. Objetivo: comparar seis definiciones diferentes de obstrucción de tracto de salida vesical (OTSV) en mujeres y evaluar la concordancia entre observadores en un entorno educativo. Material y métodos: evaluación retrospectiva de estudios urodinámicos de mujeres con y sin diagnóstico de OTSV. Se evaluaron las definiciones de Farrar, Chassagne, Lemack, Defreitas, Blavais y Groutz y Solomon-Greenwell. A todos los participantes se les brindó un taller teórico-práctico para analizar los estudios urodinámicos en su fase de flujo-presión y diagnosticar la OTSV. Los estudios urodinámicos fueron revisados de forma independiente por cinco observadores. La concordancia interobservador para clasificar a los pacientes como obstruidos se evaluó mediante análisis estadístico de confiabilidad kappa. Se clasificó el tipo de errores que cometieron los participantes, error de interpretación de estudios urodinámicos y error de cálculo en los criterios. Resultados: se revisaron en total 28 estudios urodinámicos. Todos los observadores tuvieron una concordancia buena de (0.64-0.78) para clasificar OTSV usando todas las definiciones excepto las de Lemack y Solomon-Greenwell. Se encontraron un total de 120 errores de 840 respuestas, 45.8% errores de interpretación y 54.1% error de cálculo de la ecuación. Los participantes eligieron la definición de Solomon-Greenwell, la más difícil. Conclusión: las definiciones de Chassagne, Defreitas y Farrar demostraron una concordancia sustancial entre observadores. Las definiciones de Solomon-Greenwell y Lemack tuvieron el mayor grado de dificultad y el menor nivel de acuerdo.

Diagnosis and treatment of urethral stricture in men with neurogenic lower urinary tract dysfunction: A systematic review.

AIM: To summarize available data focused on diagnosis and management of urethral stricture in men with neurogenic lower urinary tract dysfunction by a systematic review of the literature. MATERIALS AND METHODS: A systematic review of the literature was carried out through an extensive electronic database search performed in PubMed/MEDLINE and Scopus databases for full texts, and International Continence Society, American Urology Association, and European Association of Urology abstracts for citations related to urethral structure. This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. RESULTS: A total of 316 articles were identified, 48 of which were selected for this review. Different strategies are currently being used for the management of urethral strictures, such as clean intermittent catheterization (CIC) which reduces stricture by up to 68%; direct vision internal urethrotomy which shows lower rates of renarrowing; urethroplasty which shows a success rate up to 70%; urinary diversion is the treatment of choice when reconstruction is not possible. CONCLUSIONS: Further studies are needed in this population because of the heterogeneity of the outcomes and the lack of a standardized definition and classification of this population.