Voiding chain cystourethography: assessing a historical test's role in selection for urethrolysis.
OBJECTIVE
To analyze the benefit of voiding chain cystourethrography (VCC) [placing a radiographic opaque chain into the urethra and bladder and asking the patient to void under fluoroscopy] in the urodynamic evaluation of female bladder outlet obstruction (BOO).


METHODS
Females with post anti-incontinence operation voiding dysfunction who underwent urodynamic evaluation augmented with VCC and later had urethrolysis were identified. Six diagnostic criteria for obstruction were applied to each patient: (1) VCC ( obstructed: chain was angulated and could not be voiding out) (2) Video urodynamic study (VUDS) (detrusor contraction combined with radiographic obstruction) (3) maximum flow (Qmax) ≤ 15 cc/sec, detrusor pressure (pDet)@ Qmax ≥ 20 cm H20 (4) Qmax ≤ 11 cc/sec, pDet@ Qmax ≥ 25 cm H20 (5) Qmax ≤ 12 cc/sec, pDet@ Qmax ≥ 25 cm H20 (6) Blaivas-Groutz (B-G) nomogram. Urethrolysis results were reviewed. Agreement in assessment of BOO criteria was assessed by estimating the proportion of pair-wise agreements along with an exact binomial 95% confidence interval (CI) and by estimating kappa along with a 95 % CI.


RESULTS
Twenty-one patients were identified. Twenty of the 22 urethrolyses (91%) were clinically successful. Diagnosis of BOO was most common for VCC (86 %) and then B-G Nomogram (67 %). Agreement with the VCC was relatively poor for each of the five other methods (14% -62%) with the video urodynamic study (VUDS) being the best. Three patients with successful urethrolysis were diagnosed only by the VCC. All of kappa values regarding agreement with the VCC were low; the highest value of 0.15 was observed for VUDS.


CONCLUSIONS
VCC may augment selection criteria for urethrolysis.
Department of Urology, Mayo Clinic, Jacksonville, Florida, USA.
Steven P
SP
Petrou
Karen
K
Ryan
Dorothea
D
Metz-Kudashick
Michael G
MG
Heckman
David D
DD
Thiel
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D057918:Fiducial Markers; D006801:Humans; D008875:Middle Aged; D011859:Radiography; D012016:Reference Values; D015203:Reproducibility of Results; D014521:Urethra / Q000000981:diagnostic imaging* / Q000601:surgery; D001743:Urinary Bladder / Q000000981:diagnostic imaging*; D001748:Urinary Bladder Neck Obstruction / Q000175:diagnosis* / Q000000981:diagnostic imaging; D014549:Urinary Incontinence / Q000601:surgery; D014563:Urodynamics / Q000502:physiology*