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Ultrasonography of the Adult Male Urinary Tract for Urinary Functional Testing
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Quantifying bladder outflow obstruction in men: A comparison of four approximation methods exploiting large data

Wouter van Dort1, Peter F W M Rosier1, Bernard J Geurts2

  • 1Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands.

Neurourology and Urodynamics
|August 24, 2023
PubMed
Summary
This summary is machine-generated.

The three-parameter method (3PM) most accurately estimates minimum urethral opening pressure (pmuo) for bladder outflow obstruction (BOO). Linearized passive urethral resistance relation (linPURR) is the most physiologically accurate method for assessing BOO.

Keywords:
bladder outflow obstructionpressure flow studyurethral resistanceurodynamics

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Area of Science:

  • Urology
  • Urodynamics
  • Lower Urinary Tract Symptoms

Background:

  • Pressure flow study (PFS) is the gold standard for assessing urethral resistance (UR) and bladder outflow obstruction (BOO).
  • Minimum urethral opening pressure (pmuo) is a key parameter for BOO in men with benign prostatic hyperplasia.
  • Direct measurement of pmuo is challenging due to terminal dribbling, necessitating alternative estimation methods.

Purpose of the Study:

  • To compare four established methods for approximating pmuo from PFS data.
  • To evaluate the relationship between pmuo and maximum urine flow rate (Qmax) with corresponding pressure (pdetQmax).
  • To determine the most accurate method for grading UR and assessing BOO in clinical practice.

Main Methods:

  • Analysis of 1717 high-quality PFS from men with lower urinary tract symptoms.
  • Calculation of pmuo using three one-parameter methods and a three-parameter method (3PM).
  • Comparison of estimated pmuo values with precisely assessed pmuo, with accuracy defined as <10 cmH2O difference.

Main Results:

  • The 3PM model demonstrated superior accuracy, with 75.9% of approximations within 10 cmH2O of the actual pmuo.
  • Urethral resistance A (URA) and linearized passive urethral resistance relation (linPURR) showed comparable reliability.
  • Bladder outflow obstruction index (BOOI) was the least accurate method, tending to overestimate pmuo in higher UR grades.

Conclusions:

  • The 3PM method is the most accurate for estimating pmuo and quantifying BOO, while BOOI is the least accurate.
  • Given its general unavailability and unknown performance in lower-quality PFS, linPURR is considered the most physiologically accurate method currently.
  • Further research is needed to determine the clinical relevance of observed differences between the estimation methods.