Postvoid Residual Volume Correlates With Bladder Outlet Obstruction and Not With Detrusor Contraction Strength Parameters in Women: A Matched Case-Control Study
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Purpose: To compare voiding parameters in women with and without increased postvoid residual (PVR) volume, to correlate these parameters with PVR volume and PVR percentage, and to describe their ability to predict an increased PVR volume. Methods: Retrospective cross-sectional study of urodynamics data prospectively acquired from consecutive symptomatic women over a 5-year period. Patients with spinal cord disorders and with abdominal straining during voiding (abdominal pressure ≥10 cm H2O over baseline at maximum flow rate [Qmax]) were excluded. Increased PVR volume was defined as ≥50 mL. Patients with and without increased PVR volume were matched by age, presence of urodynamic stress urinary incontinence and premicturition bladder volume. Female bladder outlet obstruction (BOO) index (female-BOOI), urethral resistance (UR), projected isovolumetric pressure 1 (PIP1), and relative BOO indexes (female-BOOI/PIP1 and UR/PIP1 ratios) were calculated. Linear regression analysis was applied to correlate the voiding indexes with PVR volume and PVR percentage. The area under the curve (AUC) of the receiver operating characteristic (ROC) analysis was calculated to describe diagnostic accuracy of these indexes for increased PVR volume. Results: One-hundred ten women with mean age 65.9±13.7 (range, 20–87) years were included. All voiding parameters were significantly different between women with and without increased PVR volume, except for PIP1. Female-BOOI showed the best correlation with increased PVR volume (R2=0.2509, P<0.001) and PVR percentage (R2=0.3677, P<0.001). PIP1 showed no correlation. Relative BOOI indexes did not improve these correlations. ROC curve analyzes confirmed that female-BOOI and UR had good ability to predict increased PVR volume (AUC=0.841 and AUC=0.856, respectively). Conclusions: PVR volume and PVR percentage correlated with BOO but not to detrusor contraction strength parameters in symptomatic women that void without abdominal straining. The results of this study contribute to the understanding of the pathophysiology of increased PVR volume in women.
Abstract
Purpose: To compare voiding parameters in women with and without increased postvoid residual (PVR) volume, to correlate these parameters with PVR volume and PVR percentage, and to describe their ability to predict an increased PVR volume. Methods: Retrospective cross-sectional study of urodynamics data prospectively acquired from consecutive symptomatic women over a 5-year period. Patients with spinal cord disorders and with abdominal straining during voiding (abdominal pressure ≥10 cm H2O over baseline at maximum flow rate [Qmax]) were excluded. Increased PVR volume was defined as ≥50 mL. Patients with and without increased PVR volume were matched by age, presence of urodynamic stress urinary incontinence and premicturition bladder volume. Female bladder outlet obstruction (BOO) index (female-BOOI), urethral resistance (UR), projected isovolumetric pressure 1 (PIP1), and relative BOO indexes (female-BOOI/PIP1 and UR/PIP1 ratios) were calculated. Linear regression analysis was applied to correlate the voiding indexes with PVR volume and PVR percentage. The area under the curve (AUC) of the receiver operating characteristic (ROC) analysis was calculated to describe diagnostic accuracy of these indexes for increased PVR volume. Results: One-hundred ten women with mean age 65.9±13.7 (range, 20–87) years were included. All voiding parameters were significantly different between women with and without increased PVR volume, except for PIP1. Female-BOOI showed the best correlation with increased PVR volume (R2=0.2509, P<0.001) and PVR percentage (R2=0.3677, P<0.001). PIP1 showed no correlation. Relative BOOI indexes did not improve these correlations. ROC curve analyzes confirmed that female-BOOI and UR had good ability to predict increased PVR volume (AUC=0.841 and AUC=0.856, respectively). Conclusions: PVR volume and PVR percentage correlated with BOO but not to detrusor contraction strength parameters in symptomatic women that void without abdominal straining. The results of this study contribute to the understanding of the pathophysiology of increased PVR volume in women.
참고문헌 (26)
- Belal M, "Noninvasive methods of diagnosing bladder outlet obstruction in men. Part 1 : Nonurodynamic approach", J Urol, 176, pp.22~28 (2006)
- Kranse R, "Weak correlation between bladder outlet obstruction and probability to void to completion", Urology, 62, pp.667~671 (2003)
- Sinha S, "Female voiding dysfunction : a review of clinical presentation, urodynamic diagnosis and management", Continence, 6, pp.100578~ (2023)
- Devreese AM, "Do posture and straining influence urinary-flow parameters in normal women?", Neurourol Urodyn, 19, pp.3~8 (2000)
- Schaefer W, "The urodynamics of voiding function in females : grading of bladder outflow conditions on a continuous scale", J Urol Suppl, 185, pp.e682~ (2011)
- Tan TL, "Stop test or pressure-flow study? Measuring detrusor contractility in older females", Neurourol Urodyn, 23, pp.184~189 (2004)
- Defreitas GA, "Refining diagnosis of anatomic female bladder outlet obstruction : comparison of pressure-flow study parameters in clinically obstructed women with those of normal controls", Urology, 64, pp.675~679 (2004)
- Bhatia NN, "Changes in urethral resistance after surgery for stress incontinence", Urology, 34, pp.200~204 (1989)
- Lemack GE, "Voiding dynamics in women : a comparison of pressure-flow studies between asymptomatic and incontinent women", Urology, 59, pp.42~46 (2002)
- Valdevenito JP, "Voiding dynamics in women with urinary incontinence but without voiding symptoms", Neurourol Urodyn, 39, pp.2223~2229 (2020)
- Karram MM, "Factors affecting detrusor contraction strength during voiding in women", Obstet Gynecol, 90, pp.723~726 (1997)
- Park J, "Voiding dysfunction in older women with overactive bladder symptoms : a comparison of urodynamic parameters between women with normal and elevated post-void residual urine", Neurourol Urodyn, 35, pp.95~99 (2016)
- Abrams P, "The standardisation of terminology in lower urinary tract function : report from the standardisation sub-committee of the International Continence Society", Urology, 61, pp.37~49 (2003)
- Schäfer W, "Good urodynamic practices : uroflowmetry, filling cystometry, and pressure-flow studies", Neurourol Urodyn, 21, pp.261~274 (2002)
- Haylen BT, "An International Urogynecological Association(IUGA)", International Continence Society(ICS)joint report on the terminology for female pelvic floor dysfunction, 2010, pp.21, 5~26
- Asimakopoulos AD, "Measurement of post-void residual urine", Neurourol Urodyn, 35, pp.55~57 (2016)
- Schäfer W, "Basic principles and clinical application of advanced analysis of bladder voiding function", Urol Clin North Am, 17, pp.553~566 (1990)
- Solomon E, "Developing and validating a new nomogram for diagnosing bladder outlet obstruction in women", Neurourol Urodyn, 37, pp.368~378 (2018)
- Schäfer W, "Urethral resistance? Urodynamic concepts of physiological and pathological bladder outlet function during voiding", Neurourol Urodyn, 4, pp.161~201 (1985)
- Rosier PFWM, "ICS-SUFU standard : theory, terms, and recommendations for pressure-flow studies performance, analysis, and reporting. Part 2 : Analysis of PFS, reporting, and diagnosis", Continence, 7, pp.100709~ (2023)
- Nitti VW, "Diagnosing bladder outlet obstruction in women", J Urol, 161, pp.1535~1540 (1999)
- Massey JA, "Obstructed voiding in the female", Br J Urol, 61, pp.36~39 (1988)
- Valentini FA, "Comparison of indices allowing an evaluation of detrusor contractility in women", Prog Urol, 30, pp.396~401 (2020)
- Griffiths D, "Detrusor contractility--order out of chaos", Scand J Urol Nephrol Suppl, (215), pp.93~100 (2004)
- Pauwels E, "Healthy, middleaged, history-free, continent women--do they strain to void?", J Urol, 175, pp.1403~1407 (2006)
- Bosch R, "Do functional changes occur in the bladder due to bladder outlet obstruction?-ICI-RS 2018", Neurourol Urodyn, 38(Suppl 5), pp.S56~S65 (2019)