Assessing the Quality of Perineal Auscultation for A Noninvasive Diagnosis of Urinary Bladder Outlet Obstruction
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2017, Vol 1, Issue 2
Abstract
Objectives: The current standard method for diagnosing bladder outlet obstruction in patients with Lower Urinary Tract Symptoms (LUTS) is a pressure-flow study. Electronic perineal auscultation, i.e. recording sound with a contact microphone behind the scrotum during voiding, might be an easy-to-use non-invasive alternative. Of major importance for the clinical applicability of perineal auscultation is the quality of the sound recording. Methods: In a clinical population of 74 male LUTS patients we studied two measures for assessing the quality of electronic perineal auscultation: a Normalized Correlation Coefficient (NCC) and Signal-To-Noise Ratio (SNR). We compared these measures with the visual assessment of the electronic auscultatory signal by three experienced observers. The agreement between the experienced observers was expressed using the Weighted Kappa statistic. Both quality measures were compared to the combined visual assessments using the Kruskal Wallis test and the usefulness was evaluated using ROC-analysis. Results: The Weighted Kappa values between the three observers were 0.73, 0.66 and 0.76 (p<.05).For recordings classified as ‘good’ by the observers, the NCC was significantly higher than for the ‘medium’ and ‘poor’ quality recordings (p<.05). The areas under the ROC curve were 0.84 and 0.66 (both significant, p<.05) for NCC and SNR, respectively. Conclusion: We developed quality criteria to assess the quality of electronic perineal auscultation in patients with LUTS. These quality measures can be used to select auscultatory measurement signals that are suitable for further analysis and for improving the perineal auscultation setup. Keywords: Bladder outlet obstruction; Noninvasive; Normalized cross correlation; Perineal auscultation; Quality measure Abbreviations: LUTS: Lower Urinary Tract Symptoms; NCC: Normalized Correlation Coefficient; SNR: Signal To Noise Ratio; BPE: Benign Prostatic Enlargement; BOO: Bladder Outlet Obstruction; LUTS: Lower Urinary Tract Symptoms; PFS: Pressure-Flow Study; VUDE: Video Uro Dynamic Examination; NCC: Normalized Correlation Coefficient; SNR: Signal-To-Noise Ratio; ROC: Receiver Operator Characteristic; NOW: Netherlands Organization for Scientific Research Introduction In men the prostate generally increases in size with age, most often as a result of Benign Prostatic Enlargement (BPE). The latter may lead to Bladder Outlet Obstruction (BOO). Men with BOO generally have Lower Urinary Tract Symptoms (LUTS), including a weak urinary stream, frequent voiding (also nocturnal) and residual urine in the bladder after voiding. The current standard method for diagnosing BOO is a pressure-flow study (PFS) which is part of a (video) urodynamic examination (VUDE). The pressure flow study consists of a urinary flow measurement while simultaneously recording the detrusor pressure using a catheter inserted in the bladder and a second catheter in the rectum. This method is timeconsuming, costly, uncomfortable to the patient and potentially harmful (it may lead to serious side-effects).This poses a threshold for preoperative testing. To lower this threshold, easy-to-use noninvasive urodynamic testing methods have been developed such as the Doppler flow metry method [1], the condom-catheter method [2], the penile cuff method [3], bladder wall thickness measurement [4] and most recently perineal auscultation [5-6]. All of these methods have some drawbacks. The latter technique records the sound generated by the urinary flow through the urethra with a perineal contact microphone. In a model of the urethra it was shown that the sound, recorded downstream of an obstruction is related to the degree of obstruction [5]. The variability and repeatability of perineal auscultation has been studied in a male volunteer population [6]. In the latter study the authors found that the results were significantly different between volunteers. The quality of the sound recording is of major importance for the clinical applicability of perineal auscultation. Disturbances of the recording by e.g. movement of the microphone or noise from the surroundings can affect the results and thereby the diagnosis. To establish whether a measurement may result in a correct diagnosis objective quality measures are required. We studied two measures for assessing the quality of perineal auscultation in a clinical patient population, and compared these quality measures to the visual quality assessment of measured traces by three independent experienced observers.
Authors and Affiliations
Geert Geleijnse, Jan Groen, Ron van Mastrigt, Tim Idzenga
Keywords
Related Articles
- EP ID EP569387
- DOI 10.26717/BJSTR.2017.01.000239
- Views 188
- Downloads 0
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