Are conventional pressure-flow measurements dependent upon filled volume?
OBJECTIVE
To determine, in a prospective study, whether detrusor pressure (p(det.Qmax)) and maximum urinary flow rate (Q(max)) measurements obtained after filling to maximum cystometric capacity (MCC) differ from those obtained with filling restricted to average voided volume (V(void)), as standard protocols for pressure flow studies (PFS) mandate bladder filling until the subject has a strong desire to void, which aids standardization but further divorces the test from real-life experience.


METHODS
After calculating the appropriate sample size, 84 patients attending for PFS with an adequately completed 3-day frequency-volume chart were recruited. Each underwent two consecutive PFS with filling to MCC and average V(void) in a random order, and measurements of p(det.Qmax) and Q(max) were compared. For men, the agreement for a diagnosis of obstruction between the tests was also assessed.


RESULTS
Complete data were obtained from 76 (90%) of the patients, with a mean (range) age of 64 (20-94) years. The mean (sd) difference between MCC and average V(void) was 134 (113) mL (P < 0.01). There were no significant differences between estimates of Q(max), at - 0.1 (3) mL/s (P = 0.75), and of p(det.Qmax), at - 1 (13) cmH(2)O (P = 0.91), obtained within each patient. For men there was 91% agreement (32 of 35) in the classification of obstruction.


CONCLUSIONS
Restriction of filling to the average V(void) during PFS allows a closer approximation to normal voiding and results in no clinically relevant change to the value of standard pressure-flow measurements or alters individual classification of obstruction.
Sahadevan
Kanagasabai
K
Department of Urology, Freeman Hospital, Newcastle upon Tyne, UK.
Leonard
Ann S
AS
Pickard
Robert S
RS
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011312:Pressure; D011446:Prospective Studies; D001748:Urinary Bladder Neck Obstruction / Q000175:diagnosis* / Q000503:physiopathology; D016055:Urinary Retention / Q000175:diagnosis* / Q000503:physiopathology; D014554:Urination / Q000502:physiology*