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The significance and factors related to bladder outlet obstruction in pelvic floor dysfunction in preoperative urodynamic studies: A retrospective cohort study.

Lee YJ, Kim SR, Kim SK, Bai SW - Obstet Gynecol Sci (2014)

Bottom Line: The mean PdetQmax was significantly higher with BOO (39.6 vs. 25.4 cmH2O, P = 0.004).In the univariate analysis, menopause, MCC and cystoscopic bladder trabeculation were associated with BOO.In the multivariate model, however, no significant association with BOO was found.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea.

ABSTRACT

Objective: To demonstrate the significance of bladder outlet obstruction (BOO) in preoperative urodynamic studies (UDS) in women who have been diagnosed with pelvic floor dysfunction including pelvic organ prolapsed (POP) and stress urinary incontinence (SUI).

Methods: The medical records of 150 patients with pelvic floor dysfunction who underwent preoperative UDS at Yonsei University Health System from 2006 to 2012 were reviewed. Under the criteria of BOO, as a maximal flow rate in free-flow study (Qmax) less than 12 mL/sec and a detrusor pressure at Qmax in pressure-flow study (PdetQmax) higher than 20 cmH2O in UDS, they were divided into two groups: a group of 50 patients with BOO and a group of 100 patients without BOO. Comparisons were made between the patients with and without BOO in preoperative UDS.

Results: In the POP-with-SUI group, 25 patients with BOO had lower mean Qmax (10.0 vs. 25.4 mL/sec, P < 0.001), higher PdetQmax (49.6 vs. 21.5 cmH2O, P < 0.001), lower maximum cystometric capacity (422.7 vs. 454.0 mL, P = 0.007), and higher postvoidal residual volume (44.3 vs. 21.1 mL, P = 0.021) than the patients without BOO. In the SUI-only group, the mean Qmax was significantly lower in the 25 patients with BOO (9.4 vs. 25.4 mL/sec, P < 0.001). The mean PdetQmax was significantly higher with BOO (39.6 vs. 25.4 cmH2O, P = 0.004). In the univariate analyses, menopause, maximum cystometric capacity, and cystoscopic bladder trabeculation were associated with BOO.

Conclusion: In the univariate analysis, menopause, MCC and cystoscopic bladder trabeculation were associated with BOO. In the multivariate model, however, no significant association with BOO was found.

No MeSH data available.


Related in: MedlinePlus

Urogenital distress inventory-6.
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Figure 1: Urogenital distress inventory-6.

Mentions: A suspicious BOO was determined as a maximal flow rate in free-flow study (Qmax) less than 12 mL/sec and a detrusor pressure at Qmax in pressure-flow study (PdetQmax) higher than 20 cmH2O in the UDS [11]. The patients with and without BOO were compared in a preoperative UDS, and their baseline demographics, including their age, body mass index (BMI), presence of menopause, history of pelvic surgery, and presence of difficult labor, were reviewed retrospectively. The parameters of the UDS, such as Qmax (mL/sec), PdetQmax (cmH2O), postvoidal residual volume (PVR, mL), maximal cystometric capacity (MCC, mL), valsalva leak point pressure (VLPP), maximum urethra closure pressure (MUCP), and prevalence of detrusor overactivity (DO), were evaluated. The preoperative and postoperative urinary symptoms, including frequency, urgency, stress incontinence, urgency incontinence, dysuria, and urinary retention, were also assessed, using urogenital distress inventory-6 (UDI-6) (Fig. 1) [12]. UDI-6 consists of six questionnaires evaluating the subjective improvement of the urinary symptoms. The UDI-6 form has a value between 0 and 3, according to how much the patient is bothered by each symptom, whereas in this study, 1 point was given for each questionnaire (the score equivalent to UDI-6 score 1 is 0 point, and that equivalent to UDI-6 score 2 or 3 is 1 point), and the scores of the individual patients as well as the total scores of the patients with and without BOO were presented.


The significance and factors related to bladder outlet obstruction in pelvic floor dysfunction in preoperative urodynamic studies: A retrospective cohort study.

Lee YJ, Kim SR, Kim SK, Bai SW - Obstet Gynecol Sci (2014)

Urogenital distress inventory-6.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3924746&req=5

Figure 1: Urogenital distress inventory-6.
Mentions: A suspicious BOO was determined as a maximal flow rate in free-flow study (Qmax) less than 12 mL/sec and a detrusor pressure at Qmax in pressure-flow study (PdetQmax) higher than 20 cmH2O in the UDS [11]. The patients with and without BOO were compared in a preoperative UDS, and their baseline demographics, including their age, body mass index (BMI), presence of menopause, history of pelvic surgery, and presence of difficult labor, were reviewed retrospectively. The parameters of the UDS, such as Qmax (mL/sec), PdetQmax (cmH2O), postvoidal residual volume (PVR, mL), maximal cystometric capacity (MCC, mL), valsalva leak point pressure (VLPP), maximum urethra closure pressure (MUCP), and prevalence of detrusor overactivity (DO), were evaluated. The preoperative and postoperative urinary symptoms, including frequency, urgency, stress incontinence, urgency incontinence, dysuria, and urinary retention, were also assessed, using urogenital distress inventory-6 (UDI-6) (Fig. 1) [12]. UDI-6 consists of six questionnaires evaluating the subjective improvement of the urinary symptoms. The UDI-6 form has a value between 0 and 3, according to how much the patient is bothered by each symptom, whereas in this study, 1 point was given for each questionnaire (the score equivalent to UDI-6 score 1 is 0 point, and that equivalent to UDI-6 score 2 or 3 is 1 point), and the scores of the individual patients as well as the total scores of the patients with and without BOO were presented.

Bottom Line: The mean PdetQmax was significantly higher with BOO (39.6 vs. 25.4 cmH2O, P = 0.004).In the univariate analysis, menopause, MCC and cystoscopic bladder trabeculation were associated with BOO.In the multivariate model, however, no significant association with BOO was found.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea.

ABSTRACT

Objective: To demonstrate the significance of bladder outlet obstruction (BOO) in preoperative urodynamic studies (UDS) in women who have been diagnosed with pelvic floor dysfunction including pelvic organ prolapsed (POP) and stress urinary incontinence (SUI).

Methods: The medical records of 150 patients with pelvic floor dysfunction who underwent preoperative UDS at Yonsei University Health System from 2006 to 2012 were reviewed. Under the criteria of BOO, as a maximal flow rate in free-flow study (Qmax) less than 12 mL/sec and a detrusor pressure at Qmax in pressure-flow study (PdetQmax) higher than 20 cmH2O in UDS, they were divided into two groups: a group of 50 patients with BOO and a group of 100 patients without BOO. Comparisons were made between the patients with and without BOO in preoperative UDS.

Results: In the POP-with-SUI group, 25 patients with BOO had lower mean Qmax (10.0 vs. 25.4 mL/sec, P < 0.001), higher PdetQmax (49.6 vs. 21.5 cmH2O, P < 0.001), lower maximum cystometric capacity (422.7 vs. 454.0 mL, P = 0.007), and higher postvoidal residual volume (44.3 vs. 21.1 mL, P = 0.021) than the patients without BOO. In the SUI-only group, the mean Qmax was significantly lower in the 25 patients with BOO (9.4 vs. 25.4 mL/sec, P < 0.001). The mean PdetQmax was significantly higher with BOO (39.6 vs. 25.4 cmH2O, P = 0.004). In the univariate analyses, menopause, maximum cystometric capacity, and cystoscopic bladder trabeculation were associated with BOO.

Conclusion: In the univariate analysis, menopause, MCC and cystoscopic bladder trabeculation were associated with BOO. In the multivariate model, however, no significant association with BOO was found.

No MeSH data available.


Related in: MedlinePlus