KMID : 1240020210250030244
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International Neurourology Journal 2021 Volume.25 No. 3 p.244 ~ p.251
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Defining Voiding Dysfunction in Women: Bladder Outflow Obstruction Versus Detrusor Underactivity
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Mytilekas Konstantinos-Vaios
Oeconomou Athanasios Sokolakis Ioannis Kalaitzi Marina Mouzakitis George Nakopoulou Evangelia Apostolidis Apostolos
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Abstract
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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¡Ã20; 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 (¥ê=0.308, P=0.01). By adding URA (cutoff value=20), excellent agreement was reached (¥ê=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.
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KEYWORD
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Urinary bladder, Underactive, Urinary bladder neck obstruction, Lower urinary tract symptoms
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