The standardisation of terminology of lower urinary tract function: Report from the standardistation sub-committee of the International Continence Society.

The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society.

The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society.

This is the first report of the International Continence Society (ICS) on the development of comprehensive guidelines for Good Urodynamic Practice for the measurement, quality control, and documentation of urodynamic investigations in both clinical and research environments. This report focuses on the most common urodynamics examinations; uroflowmetry, pressure recording during filling cystometry, and combined pressure-flow studies. The basic aspects of good urodynamic practice are discussed and a strategy for urodynamic measurement, equipment set-up and configuration, signal testing, plausibility controls, pattern recognition, and artifact correction are proposed. The problems of data analysis are mentioned only when they are relevant in the judgment of data quality. In general, recommendations are made for one specific technique. This does not imply that this technique is the only one possible. Rather, it means that this technique is well-established, and gives good results when used with the suggested standards of good urodynamic practice.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/nau.10066

Good urodynamic practices: uroflowmetry, filling cystometry, and pressure-flow studies

https://www.europeanurology.com/article/S0302-2838(04)00356-2/pdf/eau-2004-guidelines-on-assessment-therapy-and-follow-up-of-men-with-lower-urinary-tract-symptoms-suggestive-of-benign-prostatic-obstruction-bph-guidelines

EAU 2004 guidelines on assessment, therapy and follow-up of men with lower urinary tract symptoms suggestive of benign prostatic obstruction (BPH guidelines).

textThe 1988 version of the collated reports on standardisation of terminology, which appeared in Neurourology and Urodynamics, vol. 7, pp. 403–427, contains material relevant to pressure flow studies in many different sections. This report is a revision and expansion of Sections 4.2 and 4.3 and parts of Sections 6.2 and 7 of the 1988 report. It contains a recommendation for a provisional standard method for defining obstruction on the basis of pressure-flow data. 

2. Evaluation of Micturition 
2.1. Pressure-Flow Studies
At present, the best method of analysing voiding function quantitatively is the pressure-flow study of micturition, with simultaneous recording of abdominal, intravesical and detrusor 
pressures and flow rate (Fig. A.1.6.1). 

Direct inspection of the raw pressure and flow data before, during and at the end of micturition is essential, because it allows artefacts and untrustworthy data to be recognised and eliminated. More detailed analyses of pressure-flow relationships, described below, are advisable to aid diagnosis and to quantify data for research studies. 

The flow pattern in a pressure-flow study should be representative of free flow studies in the same patient. It is important to eliminate artefacts and unrepresentative studies before applying more detailed analyses. 

Pressure-flow studies contain information about the behaviour of the urethra and the behaviour of the detrusor.

/pdf/standardization-of-terminology-of-lower-urinary-tract-3np262z5hk.pdf

Standardization of terminology of lower urinary tract function: pressure-flow studies of voiding, urethral resistance, and urethral obstruction

The urethral continence zone and its relation to stress incontinence.

A group of 26 patients was tested for isovolumetric pressure and optimal flow rate by means of the cuff-uroflow (CUF) technique. The same patients were also examined in the clinic, and a diagnosis was recorded. The two processes were performed independently in a statistically double-blind manner. Standard statistical comparisons were made, and it was shown that there exists substantial correlation between the results of clinical examination and the cuff-uroflow procedure. It was also shown that the CUF technique converged more rapidly to a correct diagnosis than standard clinical procedures. Surgical treatment and watchful waiting were examined and it was shown, as expected, that surgical treatment resulted in substantial improvement in most cases, but that watchful waiting generated no statistically significant change.

Noninvasive urodynamics : a study of male voiding dysfunction

Patients in a private practice, evaluated for prostatism due to benign prostatic hypertrophy were offered the options of medical treatment with the alpha blocker terazosin, surgical treatment, or continued observation. Nineteen men accepted terazosin treatment and are the subjects of the present series. They were treated over a mean period of 8 months, the longest treatment lasting over 22 months. Dosage was started at 1 mg/d and increased as tolerated to 2, 5, and 10 mg/d over the test period. Extensive testing including invasive urodynamics, multiple voiding diaries, and symptoms scores at each dosage level was carried out. We found that flow rates increased moderately from baseline in a dose dependent fashion. At the 10 mg/d dosage some patients achieved flow rates in the low normal range. Patients on treatment documented a decrease in the number of voidings per day, a decrease in nocturia, an increase in bladder capacity and the volume of each voiding. On the other hand, patients frequently did not appreciate changes in their voiding patterns, as reflected in their responses to the symptom questionnaires. We could not demonstrate significant changes in bladder pressures on cystometry either during filling or voiding. Our data suggested that terazosin may well have a direct effect on the fundus of the aging bladder to increase capacity, and, through the well-known relationship between voided volume and flow rate, increase urinary flow rate.

Effect of terazosin on urine storage and voiding in the aging male with prostatism

Urodynamic evaluations of 221 female patients and 21 normal female subjects were performed to study the effects of a small ureteral catheter in the urethra on various voiding parameters. We found that the catheter induced a significant diminution of flow rate, interruption of flow, and stretching and flattening of the flow curves with respect to time. The most marked changes occurred in normal subjects and in patients with stress incontinence. The diminution of flow rate induced by the catheter was not strongly related to disease and varied so greatly within each statistical grouping that it was not possible to separate clearly the effects according to disease. Since the effects of the catheter were most marked on the normal population, catheter-induced reduction of flow rate could not be used as an index of urinary outflow obstruction.

Donald M. Gleason

Papers

Standardization of terminology of lower urinary tract function: pressure-flow studies of voiding, urethral resistance, and urethral obstruction

The urethral continence zone and its relation to stress incontinence.

Noninvasive urodynamics : a study of male voiding dysfunction

Effect of terazosin on urine storage and voiding in the aging male with prostatism

The effect of a fine urethral pressure-measuring catheter on urinary flow in females