The similarities and differences between air-charged catheters and water-filled catheters in the application of pressure-flow study / 中华泌尿外科杂志

Objective:We compare the consistency, similarities and differences of operating procedures, data and conclusions of air-charged catheters(ACC) and water-filled catheters(WFC), as simultaneously using ACC and WFC in pressure-flow study(PFS).Methods:This study was a prospective, synchronously controlled study, including eligible patients who underwent PFS in the Department of Urology, Beijing Chaoyang Hospital from January 2021 to March 2021. Inclusion criteria: ① Patients need PFS for lower urinary tract symptoms like frequency of urination, urgent urination, urinary incontinence and dysuria; ② Age over 18 years old. Exclusion criteria: ① Unable to complete or cooperate during the urodynamic test; ② Patients with severe urethral stricture or acute stage urinary tract infection; ③ Pregnant women. The bladder pressure was measured continuously by using a 7FDR T-DOC ?AC three-chamber bladder pressure tube, which linked to ACC sensor and improved WFC pressure conduction module. At the same time, 7FA T-DOC ?AC single-lumen rectal pressure tube and 7F Labori-CAT411 double-lumen water sac abdominal pressure tube was used to measure the ACC and WFC rectum pressure, respectively. We recorded the Pdet, Pves and Pabd measured by ACC and WFC, at the point of initial sitting position, bladder filling at 100 ml, 150 ml, 200 ml, cough, Q max, maximum Pdet and the end of urination, and compared the mean values, differences, and consistencies of our data. Result:A total of 63 patients (26 female, 37 male) were included in this study, with an average age of 59.19 years (25-86 years old). During bladder filling phase, the mean values of Pves measured by ACC and WFC were 30.78/24.67cmH 2O (initial sitting position), 29.79/25.13cmH 2O (100 ml), 30.87/25.90cmH 2O (150 ml) and 30.95/26.17cmH 2O(200 ml), respectively, the mean value of Pabd were 30.03/24.17cmH 2O (initial sitting position), 28.81/21.78cmH 2O (100ml), 28.89/21.38cmH 2O (150ml), 28.44/21.60cmH 2O (200ml), respectively, and were significantly different at each sampling point ( P<0.01). During urination period, no significant differences were found in data( P>0.05), and the data measured with ACC and WFC system have good consistency. There were significant differences in Pves(mean 57.30/49.95 cmH 2O, respectively) and Pdet(mean 54.21/43.10 cmH 2O, respectively) between ACC and WFC in cough ( P<0.01), but there was a strong linear correlation between these data between two systems(R 2=0.792 in Pves and 0.756 in Pabd). Bland-Altman analysis showed that detrusor pressure at the maximum urine flow rate maintained good consistency between ACC and WFC, which 95% CI was -13.9 cmH 2O to 15.8 cmH 2O. Conclusions:In PFS, although the ACC measurement values (Pves and Pabd) during the filling phase are higher than those WFC readings, but the absolute measurement difference is small, so there is no practical meaning in clinical practice. There was no significant difference in detrusor pressure measured during voiding phase, which indicated that the urodynamic judgment and clinical conclusions of the two systems are highly consistent in judgment of the detrusor contractility and the bladder outlet obstruction.

Development of a clinical nomogram for predicting bladder outlet obstruction in male LUTS/BPH / 实用医学杂志

Objective To develop a clinical nomogram for predicting the probability of bladder outlet obstruction (BOO) in male LUTS/BPH using the most common and noninvasive parameters in clinical practice , with the hope of detecting BOO individually and precisely. Methods Retrospectively analyze the outpatients and inpatients of male LUTS/BPH from November 2003 to November 2015 in Guangzhou First People′s Hospital. Collect the Pressure-flow study parameters and other clinical parameters including Qmax , PV, TZV, TZI, PSA, and PVR. Find out the best independent predictors on the diagnosis of BOO and develop the nomogram for pre-dicting BOO. Results The data from 1 599 patients were analyzed. The areas under the ROC curve (AUCs)of PV, TZV, TZI, PSA, Qmax, and PVR were 0.803, 0.807, 0.698, 0.775, 0.742, and 0.641, respectively. Qmax, PV, and PSA were selected as the best clinical parameters to predict BOO. The Logistic regression equa-tion is Log(p)=0.332 4 - 0.201 8*Qmax + 0.026 6*PV + 1.135 1*PSA. Finally, a nomogram model was developed by R statistical software. This nomogram showed a concordance index of 0.854 according to the inter-nal validation of the model. Conclusions The clinical nomogram presented a high accuracy (85.4%) in de-tecting BOO, which would help predicting BOO in male LUTS/BPH noninvasively, individually, accurately, and providing valuable reference and guidance in clinical decision.

The role of pulmonary pressure/cardiac index to identify pulmonary hemodynamic responders to acute oxygen breathing pulmonary hypertension COPD patients / La utilidad de la relación presión arterial pulmonar - índice cardiaco para identificar respondedores hemodinámicos a la administración aguda de oxígeno en sujetos con enfermedad pulmonar obstructiva crónica e hipertensión pulmonar

Objectives: We sought to analyze exercise-derived mean pulmonary artery pressure (Mpap) - cardiac index (CI) - relationship to expand the concepts regarding its nature and to better identify pulmonary hemodynamic responders to acute oxygen breathing (AOB - 99.5%) in pulmonary hypertension (PH) - COPD patients. Methods: mPAP/CI and extrapolated pressure (Pext) to zero flow were obtained breathing room air (BRA) and under AOB - 99.5% in 40 stable COPD patients with rest and exercise PH. Hemodynamic characteristics were analyzed for the entire cohort and separate for cases those with resting < or > 30 mmHg mPAP (cohort - A and B, respectively). Results: mPAP/CI abnormal location, slope (Sp: 5.77; 95% CI: 5.02 - 6.52 mmHg/L min/m²) and Pext values (15.8 mmHg) were associated with hypoxemia/decreased mixed venous - PO2 and lung mechanics abnormalities. Hemodynamic conditions that did not change for Sp (5.47; 95% CI: 3.64 - 7.3 mmHg/L min/m², p = 0.4) and Pext (15.7 mmHg, p = 0.2) associated with a mPAP/CI significantly decrease in parallel during AOB - 99.5%. For cohort - A, an average-mPAP decline (12.3 mmHg, p <0.004) associated with a slope decrease (from 6.02; 95% CI: 4.04 - 8 to 4.3; 95% CI: 4.11 - 4.49 mmHg/L min/m², (p <0.008), mPAP/CI - 95% CI down-ward displacement and Pext decrease (from 8.58 ± 3 to 4.7 ± 1.4 mmHg, p <0.01) in relation to BRA were observed. For cohort-B, average-mPAP and mPAP/CI - 95% CI location did not change, Sp show a trend to decrease (p = 0.08) and Pext significantly increase (from 12 ± 2.9 to 20.6 ± 4.9 mmHg, p <0.03) in relation to BRA. Under AOB - 99.5%, significant differences for mPAP/ CI - 95% CI location, average-mPAP (A: 19.5 ± 6 vs. B: 41.2 ± 11.5 mmHg, p <0.001) and Pext (A: 4.7 ± 1.4 vs. B: 20.6 ± 4.9 mmHg, p <0.001), without Sp change between cohorts A and B were documented. Conclusions: When exercise derived mPAP/CI is analyzed, valuable information for linear-pulmonary vascular resistance - (LPVR) could be obtained for PH - COPD patients. mPAP/CI abnormalities not always reflect "pure arteriolar" increased LPVR for all PH-COPD patients. Hemodynamic benefit on the pulmonary circulation and right ventricular afterload could be expected with long-term oxygen therapy in resting <30 mmHg mPAP-PH-COPD patients.

Objetivos: En esta investigación clínica-hemodinámica, analizamos la relación que se establece entre la presión arterial pulmonar media (PAPm) con la del índice cardiaco (IC), obtenida durante el ejercicio, con miras a expandir los conceptos relacionados con su propia naturaleza. Con ello, tratar de identificar mejor a los sujetos portadores de EPOC que se han caracterizado por ser respondedores durante la administración aguda de oxígeno (AAO2 - 99.5%). Métodos: Se obtuvieron la PAPm/IC y la presión extrapolada a cero flujo (Pext = bo)en 40 sujetos con EPOC y portadores de hipertensión pulmonar (HP) clínicamente estables, respirando aire ambiental (RAA) y bajo la influencia de la AAO2 - 99.5% en las condiciones de reposo y durante el ejercicio. Las características hemodinámicas se analizaron para toda la cohorte y para aquellos sujetos con PAPm en resposo < o > de 30 mmHg (Cohorte A y B, respectivamente). Resultados: La ubicación anormal de la PAPm/IC, de la pendiente (Sp: 5.77; 95% IC: 5.02 - 6.52 mmHg/L min/m²) y la de los valores para Pext (15.8 mmHg) se asociaron con: hipoxemia/ disminución de la presión venosa mezclada del O2, así como con anormalidades de la mecánica pulmonar. Condiciones hemodinámicas que no se modificaron para la Sp (5.47; 95% IC: 3.64 - 7.3 mmHg/L min/m², p = 0.4) y la Pext (15.7 mmHg, p = 0.2); sin embargo, sí se vieron asociadas a una disminución significativa en paralelo de la PAPm/IC durante la AAO2 99.5%. Observaciones hemodinámicas que para la cohorte A, se caracterizaron por una reducción de la PAPm promedio (12.3 mmHg, p <0.004), por una disminución de la Sp de 6.02; 95% CI: 4.04 - 8 a 4.3; 95% CI: 4.11 - 4.49 mmHg/L min/m², (p <0.008) y por el descenso de Pext de 8.58 ± 3 a 4.7 ± 1.4 mmHg, p <0.01, al compararse con las documentadas RAA. En cambio, para la cohorte B, la PAPm promedio y la PAPm/IC no se modificaron, Sp mostró sólo tendencia a disminuir (p = 0.08) y Pext aumento de 12 ± 2.9 a 20.6 ± 4.9 mmHg, (p <0.03) en relación a las registradas RAA. Bajo la AAO2 - 99.5%, se observaron diferencias significativas para la PAPm/ IC - 95% IC en su localización, para la PAPm promedio (A: 19.5 ± 6 vs. B: 41.2 ± 11.5 mmHg, p <0.001) y Pext (A: 4.7 ± 1.4 vs. B: 20.6 ± 4.9 mmHg, p <0.001) y sin cambios en la Sp, entre la cohorte A y la B. Conclusiones: Cuando se analiza la PAPm/IC, se obtiene información que es valiosa para interpretar la resistencia vascular pulmonar linear en sujetos con EPOC e H P. Sin embargo, las anormalidades de la PAPm/IC, no necesariamente reflejan aumento exclusivo de la resistencia arteriolar pulmonar para sujetos con EPOC e H P. De acuerdo con las observaciones agudas de este estudio, posiblemente solo sea de esperarse beneficio con la oxigenoterapia a largo plazo sobre la circulación pulmonar y la post-carga del ventrículo derecho, para aquellos portadores de EPOC e HP cuando la PAPm en el reposo sea <30 mmHg.

Interpretación de la relación presión-flujo en la hipertensión arterial pulmonar idiopática / Pressure-flow relationships interpretation in idiopathic pulmonary arterial hypertension

Objetivo: Conocer más de la relación presión arterial pulmonar media/índice cardiaco y sus perfiles en enfermos con hipertensión arterial pulmonar idiopática. Métodos: La presión arterial pulmonar media/índice cardiaco y la presión extrapolada al eje de cero flujo se obtuvo en 40 enfermos respirando aire ambiente, oxígeno 99.5% e hidralazina. Se obtuvieron dos grupos de acuerdo a criterios de "respuesta vasodilatadora aguda", respondedores (n = 20) y no respondedores (n = 20). Se analizó este criterio versus el propuesto por la Task Force de la Sociedad Europea de Cardiología en la población respondedora. Resultados: La presión arterial pulmonar media/Índice cardiaco se ubicó de forma anormal en el diagrama de presión-flujo de la cohorte total, (p < 0.01). Sin alteraciones en el intercambio gaseoso o mecánica pulmonar. Para los enfermos respondedores versus no respondedores, la pendiente fue anormal 2.2 (95%IC:1.1-3.3) vs. 5.89 (95%IC:4.69-7.11) mm Hg/L min/m² e incremento de la presión extrapolada al eje de cero flujo (38.2 ± 7.5 a 66.3 ± 7.5 mm Hg, p < 0.01). Sin diferencias con oxígeno al 99.5%. Con vasodilatador, la presión arterial pulmonar media disminuyó (52.1 ± 9.5 a 40 ± 5.5 mm Hg, p < 0.01) vs. no se modificó (96.2 ± 8.5 vs. 90 ± 7.5 mmHg, p = 0.3), pendiente 1.15 (95%IC:0.68-1.62) vs. 1.28 (95%IC:0.78-1.78) mmHg/Lmin/m², la presión extrapolada al eje de cero flujo no cambió vs. incrementó (69.4 ± 7.8 a 85.1 ± 8.5 mm Hg, p < 0.01), en relación al control. En no respondedores con vasodilatador, la presión arterial pulmonar media/índice cardiaco (90 ± 7.5 mmHg, pendiente:1.28; 95%IC: 0.78 - 1.78 mm Hg/L min/m²) fue diferente al comparar respondedores con menor o mayor de 40 mm Hg de presión arterial pulmonar media. Presiones 34 ± 3 vs. 45 ± 4 mm Hg y pendientes 1.14 (95%IC: 0.67 -1.61 vs. 2.22 (95%IC: 1.35 - 3.09 mm Hg/L min/m²), respectivamente p < 0.01. Conclusiones: Las anormalidades de la relación presión arterial pulmonar media/Índice cardiaco reflejan el incremento de las resistencias vasculares pulmonares reales a nivel arteriolar pulmonar en enfermos con hipertensión arterial pulmonar idiopática. Ambos criterios de respuesta vasodilatadora aguda son de utilidad para identificar respondedores y no, en esta población de enfermos.

Objectives: We analyze exercise-derived mean pulmonary artery pressure/cardiac index relationship to expand the concepts regarding its nature and to better identify "responders" in idiopathic pulmonary arterial hypertension patients. Methods: Mean pulmonary artery pressure/cardiac index relationship and extrapolated pressure to zero flow were obtained in 40 patients' breathing room air, oxygen 99.5% and hydralazine. The hemodynamic characteristics were analyzed for the cohort and separate for responders (n = 20) and non responders (n = 20) according to the acute response to vasodilator. We tested this previous criteria versus the Task Force on diagnosis and treatment prescribed by the European Society of Cardiology. Results: The mean pulmonary arterial pressure/cardiac index was located abnormally in the pressure-flow diagram of the total cohort (p < 0.01). No alterations in gas exchange or lung mechanics. For patients responders versus non-responders, the slope was abnormal 2.2 (95% CI:1.1-3.3) vs. 5.89 (95% CI: 4.69 - 7.11), mm Hg/L min/m² and increased extrapolated pressure to zero flow (38.2 ± 7.5 to 66.3 ± 7.5 mm Hg, p <0.01). Without difference with oxygen 99.5%. With vasodilator effect, mean pulmonary arterial pressure decreased (52.1 ± 9.5 to 40 ± 5.5 mm Hg, p <0.01) versus it did not change (96.2 ± 8.5 versus 90 ± 7.5 mm Hg, p=0.3), slope 1.15 (95% CI: 0.68 - 1.62) vs. 1.28 (95% CI: 0.78-1.78) mmHg/L min/m², the extrapolated pressure to zero flow did not change (69.4 ± 7.8 to 85.1 ± 8.5 mm Hg), p <0.01, compared to control. In non-responders with vasodilator, mean pulmonary arterial pressure/cardiac index (90 ± 7.5 mmHg, slope: 1.28, 95% CI :0.78 - 1.78 mm Hg/L min/m²) was different between responders < or > 40 mmHg mean pulmonary arterial pressure. Pressures were 34 ± 3 vs. 45 ± 4 mm Hg and slopes 1.14 (95% CI: 0.67 - 1.61) vs. 2.22(95% CI: 1.35 - 3.09) mm Hg/L min/m², p <0.01, respectively.. Conclusions: Abnormalities of the mean pulmonary arterial pressure/cardiac index relationship exercise-derived seems to reflect "mainly arteriolar" increased lineal pulmonary vascular resistance in idiopathic pulmonary arterial hypertension patients. Both acute vasodilator response criteria are useful to identify responders and not responders in this patient population.

Propofol Attenuates Prostacyclin-induced Pulmonary Vasorelaxation in U46619 Preconstricted Dog / 대한마취과학회지

BACKGROUND: The goal of our study was to investigate the effects of propofol anesthesia on the pulmonary vascular response to prostacyclin during U46619 precontraction in dogs. METHODS: Eight mongrel dogs were anesthetized and instrumented to measure the left pulmonary vascular pressure-flow relation, by loosely positioning a hydraulic occluder around the right main pulmonary artery and placing an electromagnetic flow probe around the left main pulmonary artery. During slowly occlusion of the right main pulmonary artery, the pressure-flow plots were measured in the left main pulmonary artery in the control and propofol-anesthetized (5.0 mg/kg plus 0.5 mg/kg/min intravenously) states at baseline, after preconstriction with the U46619, and during the cumulative intravenous administration of prostacyclin. RESULTS: Propofol had no effect on the baseline pressure-flow relation versus the control state. A lower (P <0.05) dose of U46619 was necessary to achieve the same degree of preconstriction during propofol anesthesia. The pulmonary vasodilator response to prostacyclin was markedly attenuated (P <0.05) during propofol anesthesia compared to the control state. CONCLUSIONS: These results imply that propofol directly inhibits the pulmonary vasodilatory effects of prostacyclin. However the signal transduction pathway of cyclooxygenase-induced pulmonary vasodilation requires further investigation to determine mechanisms involved.

The diagnostic value of pressure-flow study in elderly male patients with dysuresia / 中华泌尿外科杂志

Objective To evaluate pressure-flow study in assessment of dysuresia symptom in elderly male patients. Methods A total of 125 elderly male patients with dysuresia and prostatic enlargement underwent urodynamic examination.Their age ranged from 56 to 83 years with a mean of 68 years.If the patients urinated smoothly with satisfying urinary flow curve,the pressure-flow study would be performed on them.According to the results,the patients were classified as 3 groups:BOO,equivocal BOO and non-BOO groups.Their detrusor contractive function was classified as strong,normal,weak or very weak. Results Of the 125 patients undergoing urodynamic test,87 obtained definite pressure-flow study findings.Of the 87 patients,39 were with BOO,18 with equivocal BOO and 30 without BOO.In the BOO,equivocal BOO and non-BOO groups,detrusor pressure at maximum flow was (99.2?34.3) cmH 2O (1cmH 2O=0.098 kPa),(46.9?9.9)cmH 2O and (30.8?10.0)cmH 2O,respectively;intravesical opening pressure was (99.4?39.6) cmH 2O, (43.7?9.9) cmH 2O and (29.9?9.7) cmH 2O, respectively; minimum voiding detrusor pressure was (61.3?27.5) cmH 2O, (33.9?14.1)cmH 2O and (22.1?12.5)cmH 2O,respectively;and maximum detrusor pressure was (113.0?42.1)cmH 2O,(55.8?14.9)cmH 2O and (38.4?11.3)cmH 2O,respectively.The detrusor function was normal or strong in 74.4% (29/39) of patients with BOO,27.8%(5/18) of patients with equivocal BOO and 26.7% (8/30) of patients without BOO.All these parameters of the BOO group were higher than those of the equivocal BOO group and non-BOO group (both P

An evaluation of clinical prostatic score on the assessment of bladder outlet obstruction / 中华泌尿外科杂志

Objective To evaluate objectively the traditional methods on the assessment of bladder outlet obstruction(BOO) due to BPH. Methods Correlation between the urodynamic findings and the traditional diagnostic parameters such as age,IPSS,Vp,Qmax z and PVRr was studied.The clinical prostatic score(CPS),derived from multiple regression of clinical parameters depending on URA,was evaluated. Results The parameters such as age,IPSS,Vp,Qmax z and PVRr were evaluated with reference to pressure flow study.Every parameter alone was not enough for BOO diagnosis. The regression equation was CPS=49.8-3.3 Qmax z+0.5 IPSS+0.2 Vp+7.5 PVRr.Correlation coefficient between CPS and urodynamic findings was 0.629 and was significantly higher than that of any clinical parameter alone.With CPS≥35,the sensitivity was 83.7% and specificity 85.8% for the diagnosis of BOO.With CPS

The Effect of a 6Fr Transurethral Catheter on the Urinary Flow in Female Pressure-Flow Studies

PURPOSE: We evaluated whether a 6Fr transurethral catheter affects urinary flow in women undergoing pressure-flow studies. MATERIALS AND METHODS: We retrospectively reviewed urodynamics database of 201 consecutive women referred for the evaluation of lower urinary tract symptoms from January 1997 to June 2000. Before the urodynamic study, all patients voided privately using a standard toilet and free uroflowmetry parameters were recorded. Then, a standard pressure-flow study was performed using 6Fr transurethral catheter. We excluded the patients with inadequate voided volume(<150ml) and volume difference more than 30% between two studies. Urinary flow parameters between the two studies were analysed by paired t-test according to voided volume, main urodynamic diagnosis and uroflowmetry pattern. RESULTS: Of 201 women, 144 were excluded and 57 were subjects of our analysis. According to voided volume, pressure-flow study parameters were significantly different from the equivalent free uroflowmetry parameters: the maximum flow rate and average flow rate were significantly lower and flow time was significantly longer in pressure-flow studies(p<0.01). According to main urodynamic diagnosis categories, the subgroups of patients with normal urodynamic study, bladder outlet obstruction, detrusor instability and others showed significantly lower maximum flow rate and average flow rate in pressure-flow studies(p<0.01). According to uroflowmetry pattern, obstructive patterns such as undulating and intermittent pattern were more common in pressure-flow studies. CONCLUSIONS: The 6Fr transurethral catheter used in pressure-flow studies significantly affects urinary flow parameters. In order to make a accurate diagnosis, we must not merely rely on the results of pressure-flow studies, but we must take into account patient's individual clinical situation and also, if available, the results of free uroflowmetry in addition to pressure flow study parameters.

A retrospective analysis on the quality control of computerized pressure-flow data / 中华泌尿外科杂志

Objective A study of the quality control in retrospective analysis of computerized pressure flow data was carried out and compared with the manual results. The objective was to evaluate the impact of various artifacts on the outcome of pressure flow analysis. Methods A total of 582 pressure flow traces were included in the comparative analysis. For each trace, values of maximum urinary flow rate (Qmax) and detrusor pressure at Qmax (P det.Qmax ) were read from manually smoothed and corrected uroflow curve and detrusor pressure curve respectively. Obstruction coefficient (OCO) was used to detect urethral resistance. ICS nomograms were employed to classify and diagnose obstruction, and Schfer nomograms to grade the obstruction. The results obtained by manual readings were compared with those of computerized readings. The difference was tested by statistic analyses. Results After manual correction, Qmax had a consistently significant decrease ( P 0.05). OCO underwent a systematically significant increase, with a mean of 0.067 ( P

Prognostic Value of Pressure-flow Study and Clinical Parameters in the Outcome Measurement after Transurethral Prostatectomy in Patients with BPH / 대한비뇨기과학회지

PURPOSE: We performed this study to elucidate whether patient`s satisfaction and improvement of clinical parameters after transurethral resection of prostate(TURP) correlate with the degree of preoperative obstruction. We investigated the role of urodynamic studies as a predictor of outcome after TURP. MATERIALS AND METHODS: Parameters including pre-operative symptom scores(IPSS), uroflow rate, prostate volume and urodynamic studies, were assessed in 27 patients undergoing TURP due to BPH. Bladder outlet obstruction was assessed by pressure-flow study(PFS). Post-operative evaluation was performed with IPSS and uroflowmetry 3 months after surgery. Post-operative patient`s satisfaction was determined by subjective responses to the questionnaires. The subjective responses, clinical and urodynamic parameters were compared and statistically analyzed. RESULTS: Eighteen patients(67%) had preoperative bladder outlet obstruction(BOO; defined as L-PURR> or =3), while 14(52%) demonstrated associated detrusor instability(DI). Significant improvements in IPSS, quality of life, peak flow rate and residual urine were noted in all patients post-operatively(p or =3) and 91%(L-PURR<3). CONCLUSIONS: No differences in the improvements of clinical parameters except voiding symptom scores were noted between obstructive and non-obstructive BPH. However, patient`s satisfaction after surgery was higher for patients in whom preoperative pressure-flow study confirmed obstruction. Also, obstructive parameters such as L-PURR or URA may be useful in predicting postoperative results.

Incidence of Detrusor Underactivity in Men with Prostatism Older than 50 years / 대한비뇨기과학회지

PURPOSE: It has been well known that 70-80% of men with prostatism actually manifest bladder outlet obstruction(BOO) and the rest have detrusor underactivity(DU) or other abnormalities. Accordingly, the treatment of BPH by the results of symptom score, or uroflow may be partly incorrect. It is also well known that the pressure-flow study is the gold-standard to define the presence and degree of BOO. Therefore, we investigated pressure-flow study to identify non-obstructed, underactive detrusor function among the patients presented with prostatism. MATERIALS AND METHODS: This study included 96 patients older than 50 years (mean 69.6+/-5.8) with prostatism. All patients were assessed by history taking, symptom score, digital rectal examination, uroflowmetry and pressure-flow study. Patients were divided into irritative and obstructive symptom groups according to their chief complaints. Urodynamic parameters between those two groups were analyzed and compared. RESULTS: Of the total 96 patients, detrusor instability was noted in 45(47%) at the filling cystometry. Of the 53 patients presented with irritative symptoms, 33 showed detrusor instability(62%); Of the 43 patients mainly presented with obstructive symptoms, only 12(28%) showed detrusor instability. Statistically significant correlation was found between irritative symptoms and detrusor instability as well as obstructed symptoms and BOO. In the total patients, BOO was found in 49(51%) and detrusor underactivity(DU) was found in 36(37%) with equivocal cases in 11(12%). Of the 43 patients mainly presented with obstructive symptoms, BOO and DU was found in 23(53%) and 13(30%) respectively. Of the 53 patients presented with irritative symptoms, BOO and DU was found in 26(49%) and 23(43%) respectively. There were no significant differences between irritative and obstructive symptom group as well as BOO and DU group in the clinical parameters as determined by symptom score, prostate size, and uroflowmetry. CONCLUSIONS: In this study, significant proportion(37%) of the whole patient population was classified as detrusor underactivity as diagnosed by urodynamics to which treatment for BPH may not be as effective as for those manifested with BOO. It is suggested that pressure-flow study is to be considered to patients with prostatism who didn`t show any symptomatic improvement despite the treatment for BPH.

Results of Pressure-Flow Studies in Adult Male Patients without Voiding Symptom / 대한비뇨기과학회지

PURPOSE: The pressure-flow study is only objective study that can determine the presence or absence of bladder outlet obstruction and impaired detrusor contractility. Although many results of pressure-flow study are reported in diseased state such as benign prostatic hyperplasia, but are rarely evaluated in adult male patients without voiding symptoms as control group. The purpose of this study was to evaluate the findings of pressure-flow study in asymptomatic male patients. MATERIALS AND METHODS: Twenty-three male patients without voiding symptom were recruited for this study. Mean age of these patients was 49.8 years(range 21-70). Mean AUA symptom score was 1.1(range 0-4) and mean prostatic volume was 27.3gm(range 20-35) on digital rectal examination. The study was done by using 7 Fr. urethral catheter on sitting or standing position. RESULTS: Mean values were followed; PdetQmax was 48.1cmH2O(range 25-94), Qmax was 15.7ml/sec(range 3-23), and postvoid residual urine was 14.5ml(range 0-80). According to the Abrams-Griffiths nomogram, 8 were unobstructed and 4 were obstructed, the remaining 11 falling in the equivocal zone. In each types, mean group specific urethral resistance factor (URA) was 12.8cmH2O in unobstructive type, 51.5 in obstructive type, and 22.1 in equivocal type. CONCLUSIONS: The results were maybe guessed as following; First, the values of defining obstrucion were set too low. Second, obstruction was less relevance in the development of symptoms than had been suggested previosly by some observers. Therefore, we thought that interpretations of pressure-flow finding were carefully considered to method of test, and/or uncomfortable voiding.

The Effect of Urethral Catheter on Pressure-Flow Study / 대한비뇨기과학회지

PURPOSE: The effect of a urethral catheter on pressure-flow study has important implications for the practice and interpretation of pressure flow studies. We wonder which catheter would be adequate for pressure flow study. We report 3 different size of catheters(4Fr, 10Fr, 12Fr) effects on urinary flow rate, voiding pressures and pressure flow plot. MATERIALS AND METHOD: Pressure flow studies were carried out on 141 patients(male;88, female;53), whose diseases were BPH in 22, prostatodynia in 37,urethral syndrome in 36, Hinman syndrome in 2, neurogenic bladder in 28, unstable bladder in 10, urethral stricture in 2 and bladder stone in 2. RESULTS: There was no significant difference between pre- and postcatheterization maximum flow rate in 4Fr group. But there were significant difference between pre- and post-catheterization maximum flow rate in 10Fr and 12Fr group. The detrusor pressure was significantly higher in 10Fr and 12Fr group than in 4Fr group. The larger size of catheter groups had more obstructive patterns in pressure flow plot. CONCLUSIONS: These results showed 4Fr catheter had less effect on pressure flow study than 10Fr, 12Fr catheter.

Analysis of Treatment Outcome (Visual Laser Assisted Prostatectomy) According to the Types of Bladder Outlet Obstructive Pattern in BPH / 대한비뇨기과학회지

Patients with symptomatic BPH have different patterns of obstruction: compressive (difficulty in opening the urethra) and constrictive (decreasing elasticity of urethra) obstruction. 26 patients with symptomatic BPH were classified into two different groups according to the types of obstruction as shown by pressure/flow study and clinical outcomes were compared between these groups. There were no differences in the mean age and weight of the prostate at presentation between two groups. Of the 26 patients, 16 had compressive, and 10 had constrictive obstruction. Amount of postvoiding residual urine (PVR), maximal detrusor contraction pressure (Pdet. max.), detrusor maximal flow pressure (Pdet. Qmax.), and minimal urethral opening pressure (Pmuo) were significantly higher in compressive obstruction group than in constrictive obstruction group as shown by analysis of the urodynamic parameters before treatment. Patients were treated with VLAP followed by TURP for obstructing prostate tissues to facilitate early voiding after catheter removal. Postoperative results were evaluated using the parameters such as peak flow rate (Qmax.), amount of PVR and AUA symptom score. Significant increases in Qmax, decreases of symptom score and amount of PVR were evident for both groups of obstruction after treatment. Improvements of the clinical parameters were substantially better in constrictive,than compressive obstruction groups, but without statistically significant differences.

Clinical Significance of Pressure-Flow Plot in Infravesical Obstruction / 대한비뇨기과학회지

The diagnostic methods of evaluating infravesical obstruction, especially in BPH, are based on symptoms, history, digital rectal examination, intravenous pyelography, ultrasonography, uroflowmetry and residual urine, etc. But these methods cannot accurately and objectively evaluate infravesical obstruction. We measured voiding cystometry with uroflowmetry and urethral pressure profile in 24 BPH patients by Dantec UD5500. We classified the degree of obstruction into obstructive, equivocal and nonobstructive types by Griffiths' obstructive nomogram and Type 0 - VI by Schaefer's nomogram after computer assisted pressure-flow analysis. Among 24 patients, obstructive type was in 12, equivocal type in 6, and nonobstructive type in 6 by Griffiths' obstructive nomogram. Based on Schaefer's nomogram, type 0 was in 4 patients, type I in 6, type III in 4, type IV in 2, type V in 4 and type VI in 4. In our analyzed urodynamic parameters, Qmax, Pdet, Pmuo, Atheo and URA had statistical significance(p<0.05). We consider Griffiths' obstructive nomogram and Schaefer's nomogram based on pressure flow plot are objective methods of accurately evaluating infravesical obstruction.

Pressure/Flow Study in BPH / 대한비뇨기과학회지

BPH is found in 50% of males over the age of 50 and there is increase in incidence with age. But some patients with BPH do not induce bladder outlet obstruction and some patients with prostatism are not caused by bladder outlet obstruction. So, urodynamic study including pressure/flow study was performed in 45 males with prostatism to evaluate the degree of obstruction, and we measured maximal intravesical pressure, maximal detrusor pressure, prostatic urethral length, residual urine, minimal urethral resistance and pressure/flow plots. The 45 males were divided into 3 groups by maximal flow rate(MFR)(A: MFR>=15, B: 10<=MER<=15, C: MFR<10) and there was significant difference between each group only in minimal urethral resistance(P<0.05). The result of pressure/flow plots of A group showed that 93% (13/14) was nonobstructive pattern and the rest one was obstructive pattern which was caused by detrusor hyperreflexia. In B group. we could know the degree of obstruction in 58%(7/12) only with minimal urethral resistance and we could decide the degree of obstruction with pressure/flow plots in rest 5 cases whose minimal urethral resistances were between 0.43 and 0.65 unit. The result of pressure/flow plots of C group showed that 89%(17/19) was obstructive pattern and the rest 2 cases were nonobstructive patterns which were caused by detrusor hyporeflexia. In conclusion, with pressure/flow plots and minimal urethral resistance, we can decide the degree of obstruction in patients with prostatism especially whose MFR are between 10 and 15 ml/sec.

Experimental Study for Measurement of Ureteral Compliance in Rat / 대한비뇨기과학회지

The compliance of upper urinary tract plays a main role in preservation of renal function against pressure overload. It consists of renal pelvic compliance and ureteral compliance. We measured ureteral compliance in rat with new experimental model applying pressure-flow study. Two catheters were placed in left renal pelvis. one for flow infusion, another for pressure monitoring. Pressure-flow study was done with ligation of uretero-vesical junction(UVJ) and subsequent pressure-flow study with ligation of uretero-pelvic junction(UPJ) in the same rat. Ureteral compliance was calculated from upper urinary tract compliance with UVJ ligation minus pelvic compliance with UPJ ligation. The data from seven rats were analyzed. Mean ureteral compliance (+/-standard deviation) was 0.0011+/-0.00034 ml/cmH2O and mean contribution of ureter for upper urinary tract compliance was 19%. Our new experimental model for measurement of ureteral compliance was simple and easy to perform. Results in this study will be used as baseline data for further investigation of uretera1 compliance in chronic partial ureteral obstruction.