Time-Series Analysis of Detrusor Pressure as an Adjunctive Parameter for Diagnosing Bladder Outlet Obstruction in Men

To evaluate whether time-series analysis of detrusor pressure during the pressure-flow phase provides diagnostic information that complements conventional urodynamic parameters in the assessment of bladder outlet obstruction (BOO) in men with lower urinary tract dysfunction.

An observational, analytical, cross-sectional study was conducted including men ≥18 years undergoing urodynamic evaluation for voiding dysfunction. Pressure-flow studies were performed according to International Continence Society standards. Detrusor pressure data recorded during voiding were exported at one-second resolution and analyzed as timeseries restricted to the active flow phase. From these segments, descriptive statistical metrics were derived, including mean detrusor pressure during voiding (mPeDet). BOO was classified using conventional indices and final clinical judgment by an experienced urologist, which served as the reference standard. Diagnostic performance was assessed using receiver operating characteristic (ROC) analysis and Cohen kappa.

Forty-one patients were included (median age, 59 years). mPeDet showed a strong correlation with the bladder outlet obstruction index (r=0.89, P<0.001). ROC analysis demonstrated excellent diagnostic performance for mPeDet in identifying BOO, with an area under the curve of 0.95. A cutoff value of 37 cm H₂O yielded a sensitivity of 88% and specificity of 87%. Agreement between mPeDet-based classification and final clinical diagnosis was moderate (κ=0.69).

Time-series-based evaluation of detrusor pressure during voiding provides additional clinically relevant information compared to conventional point-based urodynamic parameters. mPeDet may serve as a simple and reproducible complementary marker for the assessment of BOO, particularly in cases with diagnostic uncertainty.