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MP63-15: Concordance Of Urodynamic Definitions Of Female Bladder Outlet Obstruction

Sunday, May 14
3:30 PM - 5:30 PM
Location: BCEC: Room 153

Presentation Authors: Eskinder Solomon*, Habiba Yasmin, Megan Duffy, Sachin Malde, Jeremy Ockrim, Tamsin Greenwell, London, United Kingdom

Introduction: Unlike the diagnosis of bladder outlet obstruction (BOO) in men, BOO in women has neither a standard definition nor well-accepted defining diagnostic criteria. The aim of this study is to assess the level of agreement between seven diagnostic criteria for female BOO based on voiding pressure and/or flowrates with radiographic evidence of BOO.

Methods: We reviewed the video-urodynamics and clinical data of 535 women. We categorised the women as obstructed or unobstructed based on Farrar (1), Massey and Abrams (2), Chassagne (3), Lemack (4), Defreitas (5), Blavais and Groutz (6), Solomon-Greenwell (7) definitions of BOO. We also assessed if there was radiographical evidence of BOO in the presence of a sustained voiding pressure as per Nitti (8). We then assessed the level of agreement between urodynamics and radiographic data using Cohen&[prime]s kappa coefficient.

Results: Radiographic evidence of BOO was observed in 124 (23.2%) of patients. Of these patients; 104, 105, 94, 71, 82, 121 and 106 women were classified as obstructed according to (1) to (7) definitions of BOO respectively. Out of the 411 patients without radiographic evidence of BOO; 115, 35, 43, 8, 42, 156 and 18 patients were classified as obstructed according to (1) to (7) definitions of BOO respectively. The Blaivis-Groutz nomogram (6) is the most sensitive but least specific. Conversely, Lemack et al&[prime]s (4) definition of BOO is the least sensitive but the most specific. The highest Cohen&[prime]s Kappa coefficient of 0.81 (p<0.01), thus best level of agreement, was between the Solomon-Greenwell nomogram (7) and radiographic evidence of BOO (8).

Conclusions: The various urodynamic definitions of female BOO have wide ranging sensitivity and specificity when compared to radiographic evidence of obstruction. The Solomon-Greenwell nomogram cut off of Pdet.Qmax >2.2Qmax+5 demonstrated an excellent level of agreement with radiographic evidence of BOO.

Source Of Funding: None

Eskinder Solomon

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