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A comparison of ambulatory and conventional urodynamic studies in men with borderline outlet obstruction
Author(s) -
Derek J. Rosario,
Scott MacDiarmid,
Stephen Radley,
Christopher Chapple
Publication year - 1999
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1046/j.1464-410x.1999.00927.x
Subject(s) - bladder outlet obstruction , medicine , urology , nomogram , confidence interval , lower urinary tract symptoms , ambulatory , population , urination , urinary flow , urinary system , prostate , environmental health , cancer
Objective To compare detrusor function and outlet behaviour on ambulatory urodynamic monitoring (AUM) with conventional cystometrography in symptomatic men with borderline evidence of bladder outlet obstruction (BOO), as determined by conventional cystometrography, and to assess the usefulness of AUM in reclassifying this population of patients into obstructed and unobstructed groups. Patients and methods Sixty‐nine consecutive men (mean age 59.6 years) with lower urinary tract symptoms (mean International Prostate Symptom Score 19.1) and borderline BOO on a medium‐fill conventional urodynamic study (CUS) were examined prospectively with AUM. Detrusor contractility, obstruction grade, maximal voiding detrusor pressure (pdet max ), detrusor pressure at peak flow (pdet Q max ) and peak flow rate (Q max ) determined by both methods were compared. The incidence of detrusor instability (DI) detected by both modalities was also evaluated. Results There was considerable disagreement between the investigations during the voiding phase. Detrusor contractility was higher on AUM than on CUS ( P =0.003) and obstruction grade was significantly lower on AUM ( P =0.018). There was no difference in pdet max nor pdet Q max . The mean (95% confidence interval) Q max was higher on AUM, at 12.9 (1.3) mL/s, than on CUS, at 8.9 (0.8) mL/s. On the Abrams‐Griffiths nomogram the most significant changes were six men (10%) from equivocal to obstructed, seven (11%) from equivocal to unobstructed and two (3%) from obstructed to unobstructed on CUS and on AUM, respectively. Thus, in 24% of patients there was a potentially clinically significant change resulting from the information generated by AUM. DI was identified on CUS in 26 (41%) men and on AUM in 25 (40%); 35 men (56%) had evidence of DI on either AUM or CUS. Conclusion The significant disagreement between the findings on CUS and AUM suggests that the conditions under which pressure‐flow investigations are carried out significantly affect findings in borderline cases. The reclassification of patients by AUM into obstructed and unobstructed groups occurs in 24% and may be clinically relevant. AUM appears to be complementary to CUS in the assessment of men who are borderline for obstruction on conventional testing, but the clinical implications of this have yet to be determined.