Presentation Authors: Rapisarda Sebastiano*, Giorgio Ivan Russo, Catania, Italy, Riccardo Lombardo, Cosimo De Nunzio, Rome, Italy, Carmen Scandura, Beatrice Carbonaro, Catania, Italy, Angela Sica, Carlo Vicentini, Rome, Italy, Sebastiano Cimino, Andrea Tubaro, Giuseppe Morgia, Catania, Italy
Introduction: Detrusor underactivity (DU) is a common clinical problem in patient being referred with lower urinary tract symptoms (LUTS). DU is defined as a contraction of reduced strenght and/or duration, resulting in prolonged bladder emptying and/or failure to achieve complete bladder emptying within a normal time span (ICS in 2003). However, many tools have been proposed with the aim of characterizing DU, but specific recommendations have been made on this regarding. The aim of our study is to evaluate the diagnostic performance of differents DU definition in a large cohort of patients undergoing urodynamic study.
Methods: We prospectively collected data of patients receiving urodynamic examination from February 2010 to September2018 according to EAU guidelines. Urodynamic exam has been performed on the basis of ICS recommendations. DU has been considered as the presence of a defined as detrusorial pressure (pDet)/Qmax < 30 cmH20 and it has been considered as the reference variable. We also calculated different variables including: bladder contractility index (BCI), watt factor (WF) and bladder voiding efficiency (BVE). The following cut-offs have been considered as suggestive for DU according to previious literature data: BCI < 100, BVE < 100, WF80 < 10
Results: In total, 792 patients have been included, 65.1% male and 34.9% female. The median age was 63.0 yrs (interquartile range: 47.0-71.0). 232 pts (29.29%) had a Pdet/Qmax < 30 cmH20, 590 (74.49%) had a BVE < 100, 370 (46.72%) had a BCI < 100 while 540 (68.2%) had a WF80 < 10. The agreements using the kappa Cohenâ€™s coefficients between PdetQmax and the other parameters were as following: with BCI was 77.53% (p < 0.01), with BVE was 36.87% (p=0.98) and with WF80 was 48.66% (p < 0.01). At the univariate logistic regression analysis, BCI < 100 (odds ratio [OR]: 26.96; p < 0.01), BVE < 100 (OR: 1.44; p=0.03) and WF80 < 10 (OR: 5.35; p < 0.01) were associated with PdetQmax < 30 cmH20. Finally, the decision curve analysis showed clinical benefit of BCI in predicting DU, with slightly increase in net benefit of BCI+WF80 over BCI
Conclusions: We found that BCI and WF80 exhibited agreement with PdetQmax for assessing DU and that combining both variables add clinical benefit in predicting DU. We suggest in improving definition of DU by investigating the clinical benefits of other variables for assessing DU.