New method for minimally invasive urodynamic assessment in men with lower urinary tract symptoms.
OBJECTIVE
Urodynamic studies are considered the reference standard to diagnose bladder outlet obstruction. However, the procedure is invasive, expensive, and time-consuming. The purpose of this study was to evaluate a new minimally invasive urodynamic assessment model and compare the results with those of conventional urodynamic evaluation.


METHODS
The study included 50 male patients who presented with lower urinary tract symptoms. Their mean age was 62 years (range 34 to 82). After undergoing a conventional urodynamic study, they underwent the minimally invasive evaluation. The urethral device is a conical apparatus that adapts to the urethral meatus and fossa navicularis. The isometric bladder pressure and interrupted flow were recorded. The results of the conventional assessment were classified according to the Abrams-Griffiths number and a logistic regression fit was applied to the minimally invasive method.


RESULTS
Only two variables demonstrated the predictive capacity: the isometric pressure and interrupted flow. In addition to selecting the relevant variables, logistic regression analysis is a more adequate model that provides a binary result of obstructed and unobstructed, used to predict the normal and equivocal categories of the Abrams-Griffiths classification, and taken as the reference standard. The sensitivity and specificity of the new method was 67% and 79%, respectively.


CONCLUSIONS
The urethral device proved to be simple and easy to use. The minimally invasive method was able to detect most patients with bladder outlet obstruction; thus, the conventional urodynamic assessment could be avoided. We consider this method to have a place as a first-line noninvasive examination.
D'Ancona
Carlos Arturo Levi
CA
Division of Urology, Faculdade de Ciências Médicas da Universidade Estadual de Campinas, Unicamp, Campinas, São Paulo, Brazil. cdancona@uol.com.br
Bassani
José Wilson Magalhães
JW
Querne
Fernando Augusto de Oliveira
FA
Carvalho
José
J
Oliveira
Ricardo Reges M
RR
Netto
Nelson Rodrigues
NR
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002408:Catheters, Indwelling; D004867:Equipment Design; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012680:Sensitivity and Specificity; D001745:Urinary Bladder Diseases / Q000175:diagnosis / Q000503:physiopathology*; D001748:Urinary Bladder Neck Obstruction / Q000175:diagnosis* / Q000503:physiopathology*; D014563:Urodynamics; D014572:Urology / Q000295:instrumentation