Predictive Factors for Female Bladder Outlet Obstruction Defined by Pressure-Flow Study

Seung Beom Ha; Seong Soo Kim; Seung Tae Lee; Kyung Eun Min; Seong Jin Jeong; Sung Kyu Hong; Seok-Soo Byun; Sang Eun Lee

doi:10.4111/kju.2009.50.9.848

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Ha, Kim, Lee, Min, Jeong, Hong, Byun, and Lee: Predictive Factors for Female Bladder Outlet Obstruction Defined by Pressure-Flow Study

Original Article

Lower Urinary Tract Dysfunction

Korean Journal of Urology

Korean Journal of Urology 2009; 50(9): 848-853.

Published online: 18 September 2009

DOI: https://doi.org/10.4111/kju.2009.50.9.848

Predictive Factors for Female Bladder Outlet Obstruction Defined by Pressure-Flow Study

Seung Beom Ha, Seong Soo Kim¹, Seung Tae Lee², Kyung Eun Min³, Seong Jin Jeong, Sung Kyu Hong, Seok-Soo Byun, Sang Eun Lee

Department of Urology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.

¹Department of Urology, Seoul Metropolitan Dongbu Hospital, Seoul, Korea.

²Department of Urology, National Police Hospital, Seoul, Korea.

³Department of Urology, East-West Neo Medical Center, Kyung Hee University College of Medicine, Seoul, Korea.

Correspondence to: Seong Jin Jeong. Department of Urology, Seoul National University Bundang Hospital, 300, Gumi-dong, Bundang-gu, Seongnam 463-707, Korea. TEL: 031-787-7349, FAX: 031-787-4057, urojsj@snubh.org

Received 21 May 2009 Accepted 20 August 2009

Abstract

Purpose

We investigated pre-urodynamic study parameters of bladder outlet obstruction (BOO) defined by pressure-flow study (PFS) in female patients without anatomical obstruction.

Materials and Methods

The cohort of this study consisted of 320 women who did not have anatomical BOO in whom urodynamic study was conducted for lower urinary tract symptoms (LUTS). BOO was defined when the PFS maximal flow rate (Qmax) was ≤12 ml/sec and Pdet Qmax was ≥25 cmH₂O. The main outcomes were the incidence of BOO and its predictive factors in our cohort.

Results

Of the total patients, 39 (12.2%) were diagnosed with BOO in the PFS. Free Qmax and maximal voided volume (MVV) were significant predictors of BOO (p<0.001, p=0.011, respectively) in the multivariate logistic regression. When free Qmax was set to ≤15 ml/sec, its sensitivity and specificity predicting BOO were 82% and 72%, respectively; when MVV was set to ≤350 ml, its values were 71% and 46%, respectively. However, the positive predictive values (PPVs) of free Qmax and MVV were low (34.4% and 28.2%, respectively), whereas the negative predictive values (NPVs) of these parameters were relatively high (96.5% and 91.2%, respectively).

Conclusions

Factors predicting BOO defined by PFS in female patients complaining LUTS without anatomical obstruction were free Qmax and MVV. The PPV of these factors was low, and the NPV was high. Therefore, if free Qmax is >15 ml/sec or MVV is >350 ml, PFS may be not essential. On the contrary, if free Qmax and MVV are below these levels, PFS may be indicated to evaluate the presence of BOO.

Keywords: Urinary bladder neck obstruction, Urodynamics, Female

Figures and Tables

Fig. 1

Receiver operator characteristic curves of free Qmax and maximal voided volume, and the sensitivity and specificity for detection of BOO according to their cutoff levels. Qmax: maximal flow rate, AUC: area under curve, CI: confidence interval, BOO: bladder outlet obstruction.

Table 1

Urodynamic study parameters in female patients with lower urinary tract symptoms according to the presence of PFS-proven BOO

Data presented are Mean±SD or number (%). PFS: pressure-flow study, BOO: bladder outlet obstruction, MUCP: maximal urethral closure pressure, IDO: idiopathic detrusor overactivity, Qmax: maximal flow rate, Pdet, open: detrusor pressure at the onset of measured flow, PdetQmax: detrusor pressure at maximal flow rate, PVR: post-void residual, ^a: Student's t-test, ^b: chi-square test

Table 2

Demographic and voiding characteristics of female patients according to the presence of PFS-proven BOO

Data presented are Mean±SD or number (%). PFS: pressure-flow study, BOO: bladder outlet obstruction, UFM: uroflowmetry, PVR: post-void residual, Qmax: maximal flow rate, ^a: Student's t-test, ^b: chi-square test

Table 3

Multivariate logistic regression to evaluate the preurodynamic study parameters predicting the presence of PFS-proven BOO

PFS: pressure-flow study, BOO: bladder outlet obstruction, Qmax: maximal flow rate, PVR: post-void residual

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