title: Non-invasive evaluation of bladder outlet obstruction in men suspected of benign prostatic hyperplasia: usefulness of the d index.
abstract: OBJECTIVE
  To compare a new index of voiding dysfunction (D) based purely on free uroflow vs. Abrams-Griffiths (A-G) number obtained from intubated flow, for classification of bladder outlet obstruction in men.
  
  
  METHODS
  Urodynamic tracings of 60 non-neurological patients (30 before transurethral resection of the prostate and of 30 men suspected of benign prostatic hyperplasia included in a medical therapy trial) were retrospectively analyzed. The Valentini-Besson-Nelson model was used to evaluate the value of the D index. A-G was obtained from intubated flows. Obstruction was defined as D > 32.5 cm H2O (translation of A-G criterion).
  
  
  RESULTS
  D showed 82.05% sensitivity with 66.66% specificity; the positive predictive value was 82.05% and the negative predictive value 66.66% for the whole population, 83.3 vs. 80.9% sensitivity with 58.3 vs. 77.7% specificity for pre- transurethral resection of the prostate vs. medical therapy group.
  
  
  CONCLUSIONS
  D index which can be obtained from a free uroflow appears as a valuable alternative to invasive urodynamic investigations when the diagnosis of bladder outlet obstruction needs to be more solidly established before a treatment decision or in men suspected of benign prostatic hyperplasia who elect for watchful waiting.
authors.affiliation: ER6-Université Pierre et marie Curie, Paris, France ; Physical Medicine and Rehabilitation, Hôpital Rothschild, Paris, France.
authors.forename: Françoise A
authors.initials: FA
authors.lastname: Valentini
authors.affiliation: ER6-Université Pierre et marie Curie, Paris, France.
authors.forename: Pierre P
authors.initials: PP
authors.lastname: Nelson
authors.affiliation: Department of Urology, UT Southwestern Medical Center, Dallas, Tex., USA.
authors.forename: Philippe E
authors.initials: PE
authors.lastname: Zimmern
keywords: Benign prostatic hyperplasia; Bladder outlet obstruction; Free uroflow; Non invasive testing; Voiding dysfunction index