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The ICS-'BPH' Study: uroflowmetry, lower urinary tract symptoms and bladder outlet obstruction
J M Reynard1, Q Yang, J L Donovan
1Department of Urology, The Royal London Hospital.
British Journal of Urology
|December 5, 1998
Summary
Uroflowmetry can help diagnose bladder outlet obstruction (BOO) in men with lower urinary tract symptoms (LUTS), offering better insights than symptoms alone. Low-volume voids also provide valuable diagnostic information for BOO.
Area of Science:
- Urology
- Andrology
- Diagnostic Medicine
Background:
- Lower urinary tract symptoms (LUTS) are common in men, often related to bladder outlet obstruction (BOO).
- Accurate diagnosis of BOO is crucial for effective treatment and improved patient outcomes.
- Uroflowmetry is a non-invasive test, but its diagnostic performance for BOO requires further definition.
Purpose of the Study:
- To determine the relationship between uroflow variables and LUTS in men.
- To establish performance statistics (sensitivity, specificity, PPV, NPV) for maximum urinary flow rate (Qmax) in diagnosing BOO.
- To evaluate the diagnostic utility of low-volume voids in assessing BOO.
Main Methods:
- A study involving 1271 men (aged 45-88) across 12 international centers over 2 years.
- Data collected included symptom questionnaires, voiding diaries, uroflowmetry, and pressure-flow studies.
- Analysis focused on uroflow variables, Qmax, BOO correlation, and diagnostic performance of low-volume voids.
Main Results:
- The correlation between LUTS and uroflow variables was generally poor.
- Maximum urinary flow rate (Qmax) was significantly lower in men with BOO (9.7 mL/s) compared to those without (12.6 mL/s).
- A Qmax threshold of 10 mL/s showed 70% specificity and 47% sensitivity for BOO; a 15 mL/s threshold had 82% sensitivity and 38% specificity.
- Voiding volumes less than 150 mL were associated with a 72% chance of BOO, while larger voids had a 56% chance.
- Combining a 10 mL/s Qmax threshold with higher voiding volumes improved the positive predictive value for BOO to 69%.
Conclusions:
- Uroflowmetry, while not a replacement for pressure-flow studies, offers significant diagnostic improvement over symptom assessment alone for LUTS in men.
- Defined performance statistics for Qmax thresholds can aid in more accurate BOO diagnosis, potentially reducing the need for invasive pressure-flow studies.
- Low-volume uroflowmetry provides valuable diagnostic information and should not be disregarded in clinical practice.