title: Different urodynamic patterns in female bladder outlet obstruction: Can urodynamics alone reach the diagnosis?
abstract: OBJECTIVE
  To define the different urodynamic patterns in female bladder outlet obstruction (BOO) and to assess whether urodynamics alone can be relied on for the diagnosis.
  
  
  METHODS
  This prospective study included 60 clinically obstructed women and 27 with stress urinary incontinence as a control group. All patients had pressure-flow studies and were divided into four groups. Group A (control group, 27 patients) and group B (22) had a maximum urinary flow rate (Q max) of >15 mL/s and a detrusor pressure at Q max (P det Q max) of <30 or >30 cm H2O, respectively. Group C (20 patients) and group D (18) had a Q max of <15 mL/s and a P det Q max of >30 or <30 cm H2O, respectively.
  
  
  RESULTS
  The mean Q max for groups A, B, C, and D were 21.8, 21.9, 10.8 and 9.9 mL/s, respectively, while the mean P det Q max was 20.8, 40.4, 48.7, and 18.7 cm H2O, respectively. The residual urine volume was <100 mL in groups A and B but >100 mL in groups C and D. When compared with group A, groups B-D had a significant difference in vesical pressure, groups B and C had a significant difference in P det Q max, while Q max, the maximum voided volume and residual urine volume were significantly different in groups C and D. Group A was obviously unobstructed, group B might have early obstruction, group C had compensated obstruction, while group D can be considered to have late de-compensated obstruction.
  
  
  CONCLUSIONS
  BOO in females has three different urodynamic patterns, i.e. early, compensated and late obstruction. However, urodynamics should be combined with the clinical presentation and residual urine volume for an accurate diagnosis.
authors.affiliation: Section of Female Urology and 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 Female Urology and 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 Female Urology and Voiding Dysfunction, Urology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
authors.forename: Gaber A
authors.initials: GA
authors.lastname: Ali
keywords: Bladder; Diagnosis; Females; MVV, maximum voided volume; Obstruction; PFS, pressure-flow study; PVR, postvoid residual urine volume; PdetQmax, detrusor pressure at Qmax; Pves, vesical pressure; Qmax, maximum urinary flow rate; ROC, receiver operating characteristic; SUI, stress urinary incontinence; Urodynamics