Defining Voiding Dysfunction in Women: Bladder Outflow Obstruction Versus Detrusor Underactivity
2
조회
0
다운로드
6
인용
0
참고문헌
키워드
초록
Purpose: We aimed to develop urodynamic criteria to improve the accuracy of the diagnosis of bladder outlet obstruction (BOO) and detrusor underactivity (DU) in women with lower urinary tract symptoms (LUTS). Methods: Initially, in a group of 68 consecutive women with LUTS and increased postvoid residual (PVR) who had undergone urodynamic investigations, we examined the level of agreement between the operating physician’s diagnosis of BOO or DU and the diagnosis according to urodynamic nomograms/indices, including the Blaivas-Groutz (B-G) nomogram, urethral resistance factor (URA), bladder outlet obstruction index (BOOI), and bladder contractility index (BCI). Based on the initial results, we categorized 160 women into 4 groups using the B-G nomogram and URA (group 1, severe-moderate BOO; group 2, mild BOO and URA≥20; group 3, mild BOO and URA<20; group 4, nonobstructed) and compared the urodynamic parameters. Finally, we redefined women as obstructed (groups 1+2) and nonobstructed (groups 3+4) for subanalysis. Results: The agreement between the B-G nomogram and physician’s diagnosis was poor in the mild obstruction zone (κ=0.308, P=0.01). By adding URA (cutoff value=20), excellent agreement was reached (κ=0.856, P<0.001). Statistically significant differences were found among the 4 groups (analysis of variance) in maximum flow rate (Qmax) (P<0.0001), voided volume (VV) (P=0.042), PVR (P=0.032), BOOI (P<0.0001), and BCI (P<0.0001), with a positive linear trend for Qmax and VV and a negative linear trend for PVR and BOOI moving from groups 1 to 4. In the subanalysis, all parameters showed statistically significant differences between obstructed and nonobstructed women, except BCI (Qmax, P=0.0001; VV, P=0.0091; PVR, P=0.0005; BOOI, P=0.0001). Conclusions: The combination of the B-G nomogram with URA increased the accuracy of diagnosing BOO among women with LUTS. Based on this combination, most women in the mild obstruction zone of the B-G nomogram would be considered underactive rather than obstructed.
Abstract
Purpose: We aimed to develop urodynamic criteria to improve the accuracy of the diagnosis of bladder outlet obstruction (BOO) and detrusor underactivity (DU) in women with lower urinary tract symptoms (LUTS). Methods: Initially, in a group of 68 consecutive women with LUTS and increased postvoid residual (PVR) who had undergone urodynamic investigations, we examined the level of agreement between the operating physician’s diagnosis of BOO or DU and the diagnosis according to urodynamic nomograms/indices, including the Blaivas-Groutz (B-G) nomogram, urethral resistance factor (URA), bladder outlet obstruction index (BOOI), and bladder contractility index (BCI). Based on the initial results, we categorized 160 women into 4 groups using the B-G nomogram and URA (group 1, severe-moderate BOO; group 2, mild BOO and URA≥20; group 3, mild BOO and URA<20; group 4, nonobstructed) and compared the urodynamic parameters. Finally, we redefined women as obstructed (groups 1+2) and nonobstructed (groups 3+4) for subanalysis. Results: The agreement between the B-G nomogram and physician’s diagnosis was poor in the mild obstruction zone (κ=0.308, P=0.01). By adding URA (cutoff value=20), excellent agreement was reached (κ=0.856, P<0.001). Statistically significant differences were found among the 4 groups (analysis of variance) in maximum flow rate (Qmax) (P<0.0001), voided volume (VV) (P=0.042), PVR (P=0.032), BOOI (P<0.0001), and BCI (P<0.0001), with a positive linear trend for Qmax and VV and a negative linear trend for PVR and BOOI moving from groups 1 to 4. In the subanalysis, all parameters showed statistically significant differences between obstructed and nonobstructed women, except BCI (Qmax, P=0.0001; VV, P=0.0091; PVR, P=0.0005; BOOI, P=0.0001). Conclusions: The combination of the B-G nomogram with URA increased the accuracy of diagnosing BOO among women with LUTS. Based on this combination, most women in the mild obstruction zone of the B-G nomogram would be considered underactive rather than obstructed.
참고문헌 (20)
- Haylen BT, "An International Urogynecological Association(IUGA)", International Continence Society(ICS)joint report on the terminology for female pelvic floor dysfunction, 2010, pp.29, 4~20
- Osman NI, "Detrusor underactivity and the underactive bladder: a new clinical entity? A review of current terminology, definitions, epidemiology, aetiology, and diagnosis", Eur Urol, 65, pp.389~398 (2014)
- Nathan Hoag, "Underactive Bladder: Clinical Features, Urodynamic Parameters, and Treatment", International Neurourology Journal, 19(3), pp.185~189 (2015), 대한배뇨장애요실금학회
- Sekido N, "Bladder contractility and urethral resistance relation : what does a pressure flow study tell us", Int J Urol, 19, pp.216~228 (2012)
- Groutz A, "Non-neurogenic female voiding dysfunction", Curr Opin Urol, 12, pp.311~316 (2002)
- Akikwala TV, "Comparison of diagnostic criteria for female bladder outlet obstruction", J Urol, 176, pp.2093~2097 (2006)
- Vírseda CM, "May the Blaivas and Groutz nomogram substitute videourodynamic studies in the diagnosis of female lower urinary tract obstruction", Arch Esp Urol, 59, pp.601~606 (2006)
- Kranse R, "Relative bladder outlet obstruction", J Urol, 168, pp.565~570 (2002)
- Méndez-Rubio S, "Postmicturition residual; urodynamic", Actas Urol Esp, 34, pp.365~371 (2010)
- Kuo HC, "Videourodynamic characteristics and lower urinary tract symptoms of female bladder outlet obstruction", Urology, 66, pp.1005~1009 (2005)
- Chassagne S, "Proposed cutoff values to define bladder outlet obstruction in women", Urology, 51, pp.408~411 (1998)
- Gomes CM, "Voiding dysfunction and urodynamic abnormalities in elderly patients", Rev Hosp Clin Fac Med Sao Paulo, 59, pp.206~215 (2004)
- Lowenstein L, "Obstructive voiding symptoms are not predictive of elevated postvoid residual urine volumes", Int Urogynecol J Pelvic Floor Dysfunct, 19, pp.801~804 (2008)
- Nitti VW, "Diagnosing bladder outlet obstruction in women", J Urol, 161, pp.1535~1540 (1999)
- 이영숙, "Efficacy of an Alpha-Blocker for the Treatment of Nonneurogenic Voiding Dysfunction in Women: An 8-Week, Randomized, Double-Blind, Placebo-Controlled Trial", International Neurourology Journal, 22(1), pp.30~40 (2018), 대한배뇨장애요실금학회
- Aganović D, "The urodynamic nomogram in defining the degree of obstruction in patients with benign prostatic enlargement--defining clear obstruction", Med Arh, 57, pp.81~86 (2003)
- Cucchi A, "Development of idiopathic detrusor underactivity in women : from isolated decrease in contraction velocity to obvious impairment of voiding function", Urology, 71, pp.844~848 (2008)
- Salinas JC, "Factors for voiding dysfunction and cystocele", Arch Esp Urol, 58, pp.316~323 (2005)
- Vírseda CM, "Pressure-flow studies in the diagnosis of micturition disorders in the female", Arch Esp Urol, 51, pp.1021~1028 (1998)
- Valentini FA, "Urodynamics in women from menopause to oldest age : what motive? What diagnosis", Int Braz J Urol, 37, pp.100~107 (2011)