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• W2085698735 abstract "No AccessJournal of UrologyCLINICAL UROLOGY: Original Articles1 Aug 2002Relative Bladder Outlet Obstruction Ries Kranse and Ron van mastrigt Ries KranseRies Kranse More articles by this author and Ron van mastrigtRon van mastrigt More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)64681-2AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Currently bladder outlet obstruction in males is defined by the provisional International Continence Society nomogram which is partly based on expert opinion and partly on measurements before and after transurethral prostate resection. Recently there has been some interest in the development of a similar nomogram for females. Materials and Methods: We studied the possibility of defining bladder outlet obstruction based on a sign that it causes, namely post-void residual urine. Results: The probability of relative post-void residual urine exceeding 20% of bladder capacity was modeled in males and females using 1 parameter, that is URA/w20 or the ratio of the obstruction parameter urethral resistance factor (URA)-to-the bladder contractility parameter Watts factor at 20% (w20). URA/w20 represents relative bladder outlet resistance or bladder outlet resistance normalized to bladder contractility. Above a threshold of URA/w20 = 6.8 in females and 8.2 in males a relative post-void residual exceeding 20% was noted in 90% of measurements. These thresholds may be used to define relative obstruction. The provisional International Continence Society nomogram for obstruction in males was transformed into an identical nomogram for females by equating the probabilities of post-void residual urine in each gender. The latter differed from that in men, in that the lines demarcating the zones were horizontal or flow rate independent but the intercepts were approximately the same at 20 and 40 cm. water. Conclusions: Instead of defining obstruction as an absolute level of bladder outlet resistance we suggest that it is better to define it relatively, that is as a level of bladder outlet resistance that depends on bladder contractility. References 1 Griffiths, D.J.: Urodynamics. The mechanics and hydrodynamics of the lower urinary tract. In: Medical Physics Handbook. Ltd. 4. Bristol, United Kingdom: Adam Hilger, 1980 Google Scholar 2 : Obstructed voiding in the female. Br J Urol1988; 61: 36. Google Scholar 3 : Urinary bladder function and its control in healthy females. Am J Physiol1986; 251: R225. Google Scholar 4 : Assessment of detrusor contraction strength or contractility. Neurourol Urodyn1991; 10: 1. Crossref, Google Scholar 5 : Urethral resistance? Urodynamic concepts of physiological and pathophysiological bladder outlet function during voiding. Neurourol Urodyn1985; 4: 161. Google Scholar 6 : 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 Urodyn1989; 8: 17. Google Scholar 7 : Bladder outlet obstruction index, bladder contractility index and bladder voiding efficiency: three simple indices to define bladder voiding function. BJU Int1999; 84: 14. Google Scholar 8 : Standardization of terminology of lower urinary tract function: pressure-flow studies of voiding, urethral resistance, and urethral obstruction. International Continence Society Subcommittee on Standardization of Terminology of Pressure-Flow Studies. Neurourol Urodyn1997; 16: 1. Google Scholar 9 : Bladder outlet obstruction nomogram for women with lower urinary tract symptomatology. Neurourol Urodyn2000; 19: 553. Crossref, Medline, Google Scholar 10 : Estimation of the lag time between detrusor pressure- and flow rate-signals. Neurourol Urodyn1995; 14: 217. Google Scholar 11 : A handbook of statistical analyses using Stata. Boca Raton: Chapman & Hall1998. Google Scholar 12 : The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology1982; 143: 29. Google Scholar 13 : Pressure-flow studies in the diagnosis of bladder outlet obstruction: a study comparing suprapubic and transurethral techniques. Br J Urol1997; 79: 693. Google Scholar 14 : The assessment of prostatic obstruction from urodynamic measurements and from residual urine. Br J Urol1979; 51: 129. Crossref, Medline, Google Scholar 15 : The prognostic value of bladder contractility in transurethral resection of the prostate. J Urol1992; 148: 1856. Google Scholar From the Department of Urology-Urodynamics, Erasmus University Rotterdam, Rotterdam, The Netherlands© 2002 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byGravina G, Costa A, Galatioto G, Ronchi P, Tubaro A and Vicentini C (2007) Urodynamic Obstruction in Women With Stress Urinary Incontinence—Do Nonintubated Uroflowmetry and Symptoms Aid Diagnosis?Journal of Urology, VOL. 178, NO. 3, (959-964), Online publication date: 1-Sep-2007.DasGUPTA R and FOWLER C (2018) Urodynamic Study of Women in Urinary Retention Treated With Sacral NeuromodulationJournal of Urology, VOL. 171, NO. 3, (1161-1164), Online publication date: 1-Mar-2004.KRANSE R and van MASTRIGT R (2018) Bladder Outlet ResistanceJournal of Urology, VOL. 169, NO. 3, (1007-1010), Online publication date: 1-Mar-2003. Volume 168Issue 2August 2002Page: 565-570 Advertisement Copyright & Permissions© 2002 by American Urological Association, Inc.Keywordsurodynamicsbladder neck obstructionbladderMetricsAuthor Information Ries Kranse More articles by this author Ron van mastrigt More articles by this author Expand All Advertisement PDF downloadLoading ..." @default.
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