IN SEARCH OF BEST PRESSURE FLOW CRITERIA TO DEFINE BLADDER OUTLET OBSTRUCTION IN INDIAN FEMALES
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2017, Vol 6, Issue 65
Abstract
BACKGROUND Bladder outlet obstruction in females is increasingly being understood. However, caveats remain in defining clinical and urodynamic parameters to suggest BOO precisely. We compared urodynamic parameters of women with obstructive voiding to control, to better characterise BOO. MATERIALS AND METHODS Prospective observational study included 80 females with LUTS and 20 others, admitted for nephrolithiasis without LUTS, as control. Patients were divided into three groups based on symptomology. Group A had obstructive symptoms; Group B had irritative symptoms; while C was control. Clinical evaluation, Qmax, PVR, cystourethroscopy and urodynamic study were performed. ANOVA, Chi-square and ROC curve were used. Fixed combinations [set1 (Qmax<12, PdetQmax>20), set2 (Qmax<15, PdetQmax>30)] were tested to define BOO. RESULT Mean age in group A (n=27), B (n=53) and C (n=20) was 43 ± 17, 40 ± 14 and 37 ± 12 years respectively. Group A had lower Qmax [MDA-B=-5.94, p=.0005 & MDA-C=-15.5, p=.0005] and higher PVR [MDA-B=120, p=.005 & MDA-C=187, p=.0005,]. PdetQmax did not differ significantly (p=.061). BOO was found in 16/27 and 9/53 cases in group A and B respectively [Pearson value=25.38, p=.0005]. AUC for BOOI, Qmax, PdetQmax, PVR and MVV was 0.956, 0.939, 0.866, 0.810 and 0.809, respectively. Predicted cut-off values of above parameters were 4.7, 13.15, 28.5, 68.5 and 290.5. Set1 had lower sensitivity than set2 (80% v/s 84%), but higher specificity (94.5% v/s 87.3%). CONCLUSION We suggest Qmax<13.1 mL/s, PdetQmax> = 28.5 cm H2O, BOOI of> = 4.7 and PVR of > = 68.5 mL, as cut-off limit to define BOO. Relation with symptomology is modest. Fixed combination may give variable result; correlation with all parameters helps indeed.
Authors and Affiliations
Prasenjit Majee, Ranjit Kumar Das, Arpan Chowdhury, Ranjan Kumar Dey, Vishnu Agarwal
Keywords
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- EP ID EP231670
- DOI 10.14260/Jemds/2017/1014
- Views 91
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