title: Factors determining the amount of residual urine in men with bladder outlet obstruction: Could it be a predictor for bladder contractility?
abstract: OBJECTIVE
  To determine from urodynamic data what causes an increased postvoid residual urine volume (PVR) in men with bladder outlet obstruction (BOO), urethral resistance or bladder failure, and to determine how to predict bladder contractility from the PVR.
  
  
  METHODS
  We analysed retrospectively the pressure-flow studies (PFS) of 90 men with BOO. Nine patients could not void and the remaining 81 were divided into three groups, i.e. A (30 men, PVR < 100 mL), B (30 men, PVR 100-450 mL) and C (21 men, PVR > 450 mL). The division was made according to a receiver operating characteristic curve, showing that using a threshold PVR of 450 mL had the best sensitivity and specificity for detecting the start of bladder failure.
  
  
  RESULTS
  The filling phase showed an increase in bladder capacity with the increase in PVR and a significantly lower incidence of detrusor overactivity in group C. The voiding phase showed a significant decrease in voided volume and maximum urinary flow rate (Q max) as the PVR increased, while the urethral resistance factor (URF) increased from group A to B to C. The detrusor pressure at Q max (PdetQ max) and opening pressure were significantly higher in group B, which had the highest bladder contractility index (BCI) and longest duration of contraction. Group C had the lowest BCI and the lowest PdetQ max.
  
  
  CONCLUSIONS
  In men with BOO, PVR results from increasing outlet resistance at the start and up to a PVR of 450 mL, where the bladder reaches its maximum compensation. At volumes of >450 mL, both the outlet resistance and bladder failure are working together, leading to detrusor decompensation.
authors.affiliation: Section of Voiding Dysfunction, Urology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
authors.forename: Mostafa M
authors.initials: MM
authors.lastname: Elmissiry
authors.affiliation: Section of Voiding Dysfunction, Urology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
authors.forename: Amr G
authors.initials: AG
authors.lastname: Ali
authors.affiliation: Section of Voiding Dysfunction, Urology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Abulfotooh
authors.affiliation: Section of Voiding Dysfunction, Urology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
authors.forename: Ahmed A
authors.initials: AA
authors.lastname: Moussa
authors.affiliation: Section of Voiding Dysfunction, Urology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
authors.forename: Gaber A
authors.initials: GA
authors.lastname: Ali
keywords: AUR, acute urinary retention; BCI, bladder contractility index; Contractility; Obstruction; PFS, pressure-flow study; PVR, postvoid residual urine volume; PdetQmax, detrusor pressure at Qmax; Qmax, maximum urinary flow rate; ROC, receiver operating characteristic (curve); Residual urine; URF, urethral resistance factor; Urodynamics