Methods of bladder outlet obstruction identification based on pressure flow study
Article published in Urologia Polska 2006/59/3.
Bartosz Dybowski, Piotr Radziszewski, Andrzej Borkowski
- Katedra i Klinika Urologii Akademii Medycznej w Warszawie
benign prostatic hyperplasia, bladder outlet obstruction, pressure flow study, nomograms
- Introduction and the aim of the study. Diagnosis of bladder outlet obstruction (BOO) usually made on the basis of symptoms and free uroflowmetry may be misleading and responsible for treatment failure. In order to assess precisely bladder outlet conditions it is necessary to perform pressure-flow study. The aim of this study is to present methods of urodynamic BOO assessment.
- Material and method. Theoretical background, application, limitations and instructions on using particular methods are described, as well as results of comparative studies. Bibliog-raphy of Interntional Continence Society standardization report on pressure-flow studies and some new publications found in Medline (Pubmed) are reviewed.
- Results. The most commonly used methods of diagnosing BOO in men are Schäfer, ICS provisional and URA nomograms. Comparative studies found that these methods give similar results. Clinical value of other methods is poorly documented. In women none of described methods is widespread.
- Conclusions. It is still an unsolved question which of the methods of pressure-flow study analysis remains the best because there are few well designed, large clinical studies available on this issue.
- Schafer W: The contribution of the bladder outlet to the relation between pressure and flow rate during micturition, in Hinman F Jr (ed): Benign prostatic hypertrophy. New York Berlin Heidelberg, Springer, 1983, str. 470-496.
- Schafer W, Waterbar F, Langen PH, Deutz FJ: A simplified graphic procedure for detailed analysis of detrusor and outlet function during voiding. Neurourol Urodyn 1989, 8, 405-407.
- Schafer W, Rubben H, Noppeney R, Deutz FJ: Obstructed and unobstructed \'prostatic obstruction\': a plea for objectivation of bladder outflow obstruction by urodynamics. World J Urol 1989, 6, 198-203.
- Schafer W: Analysis of bladder-outlet function with the linearized passive urethral resistance relation, linPURR, and a disease-specific approach for grading obstruction: from complex to simple. World J Urol 1995, 13, 47-58.
- Schafer W, Sterling AM: Simple analysis of voiding function by coefficients: obstruction coefficient, OCO, and detrusor strength coefficient, DECO. Proceedings (video presentations-informally discussed posters-read by title) of the 25th annual meeting of the International Continence Society 1995, 338-339.
- Abrams PH, Griffiths DJ: The assessment of prostatic obstruction from urodynamic measurements and from residual urine. Br J Urol 1979, 51, 129-134.
- Griffiths D, Hofner K, van Mastrigt R et al: The standardisation of terminology of lower urinary tract function: Pressure-flow studies of voiding, urethral resistance and urethral obstruction. Neurourol Urodyn 1997, 16, 521-532.
- Griffiths D, van Mastrigt R, Bosch R: Quantification of urethral resistance and bladder function during voiding, with special reference to the effects of prostate size reduction on urethral obstruction due to benign prostatic hyperplasia. Neurourol Urodyn 1989, 8, 17-27.
- Rollema HJ, van Mastrigt R: Improved indication and follow up in transurethral resection of the prostate using the computer program CLIM: a prospective study. J Urol 1992, 148, 111-115.
- Eckhardt MD, van Venrooij GE, Boon TA: Urethral resistance factor (URA) versus Schafer\'s obstruction grade and Abrams-Griffiths (AG) number in the diagnosis of obstructive benign prostatic hyperplasia. Neurourol Urodyn 2001, 20, 175-185.
- Spangberg A: Estimation of urethral resistance by curve fitting in the pressure-flow plot. Theory and experience in normal men and men with benign prostatic hypertrophy. World J Urol 1995, 13, 65-69.
- Griffiths DJ: Hydrodynamics of male micturition. II. Measurements of stream parameters and urethral elasticity. Med Biol Eng 1971, 9, 589-596.
- Griffiths DJ: Hydrodynamics of male micturition. I. Theory of steady flow through elastic-walled tubes. Med Biol Eng 1971, 9, 581-588.
- van Mastrigt R, Kranse M: Analysis of pressure-flow data in terms of computer-derived urethral resistance parameters. World J Urol 1995, 13, 40-46.
- Hofner K, Kramer AE, Tan HK et al: CHESS classification of bladder-outflow obstruction. A consequence in the discussion of current concepts. World J Urol 1995, 13, 59-64.
- Eri LM, Wessel N, Tysland O, Berge V: Comparative study of pressure-flow parameters. Neurourol Urodyn 2002, 21, 186-193.
- Blaivas JG, Groutz A: Bladder outlet obstruction nomogram for women with lower urinary tract symptomatology. Neurourol Urodyn 2000, 19, 553-564.
- Nitti VW, Tu LM, Gitlin J: Diagnosing bladder outlet obstruction in women. J Urol, 161, 1535-1540.
- Defreitas GA, Zimmern PE, Lemack GE, Shariat SF: Refining diagnosis of anatomic female bladder outlet obstruction: comparison of pressure-flow study parameters in clinically obstructed women with those of normal controls. Urology 2004, 64, 675-679.
- Groutz A, Blaivas JG, Chaikin DC: Bladder outlet obstruction in women: definition and characteristics. Neurourol Urodyn 2000, 19, 213-220.
- Chassagne S, Bernier PA, Haab F et al: Proposed cutoff values to define bladder outlet obstruction in women. Urology 1998, 51, 408-411.
- Kuo HC: Urodynamic parameters for the diagnosis of bladder outlet obstruction in women. Urol Int 2004, 72, 46-51.
- Di Grazia E, Troyo Sanroman R, Aceves JG: Proposed urodynamic pressure-flow nomogram to diagnose female bladder outlet obstruction. Arch Ital Urol Androl 2004, 76, 59-65.
- Massey JA, Abrams PH: Obstructed voiding in the female. Br J Urol 1988, 61, 36-39.
- Cormier L, Ferchaud J, Galas J-M et al: Diagnosis of female bladder outlet obstruction and relevance of the parameter area under the curve of detrusor pressure during voiding: preliminary results. J Urol 2002, 167, 2083-2087.
Klinika Urologii AM
ul. Lindleya 4
tel. (022) 502 15 16