Nirmal, T J (2010) Visual uroflowmetry: A viable screening tool for lower urinary tract symptoms? Masters thesis, Christian Medical College, Vellore.
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Abstract
INTRODUCTION: While a pressure flow voiding study is the definitive measure of bladder outlet obstruction, uroflowmetry is a simple, noninvasive test which provides valuable information. Flow rate measurement represents a reproducible way to quantify the strength of the urinary stream and, when used in combination with symptom scores for a small subset of patients (20%), has a high probability of correctly characterizing whether there is BOO. Chancellor and colleagues found that flow rate recording cannot distinguish between BOO and impaired detrusor contractility as the cause for a low peak flow (Qmax). Qmax appears to predict surgical outcome in some studies. Although considerable uncertainty exists, patients with a Qmax greater than 15 ml/s appear to have somewhat poorer treatment outcomes after prostatectomy than patients with a Qmax of less than 15 ml/s. Uroflowmetry and measurement of post void residue (PVR) are recommended as diagnostic tests in the initial assessment of men with LUTS and should be performed prior to prostatectomy (AUA 2003, EAU 2004 guidelines for BPH). However, Lloyd and Kirk have shown that as few as 28% of surgeons performing resection always carry out uroflowmetry with 46% using it only occasionally or never. This may be attributed to the inconclusive evidence supporting its use. Measurement of urinary flow rate requires sophisticated equipment and in a developing country like India, a major deterrent to setting up a uroflowmetry clinic is the prohibitive cost involved. Hence there is a need to develop a simpler tool which would not only objectively quantify urinary flow but also be cost-effective enough to be made accessible to all practising urologists. AIMS: The aim of this study was to compare patients’ visual assessment of urinary flow with uroflowmetry. OBJECTIVES: To compare the patients’ visual assessment of urinary flow guided by the modified Brian Peeling diagram consisting of a multiple choice representation of various flow trajectories with • Age, • Peak flow (Qmax), • International Prostate Symptom Score (IPSS), and • Post void residue (PVR). MATERIALS AND METHODS: This prospective study was conducted in the uroflow clinic of the Urology department. The study design and methodology was approved by the Ethics Committee and the Institutional Review Board. All patients were explained the nature of the study and an informed consent in the patient’s own language was obtained. Adult males, 18 years of age and older with lower urinary tract symptoms (LUTS) attending the uroflow clinic at the department of Urology were recruited. Patients were asked to fill the IPSS questionnaire and answer a multiple choice pictorial representation of flow trajectory. This was done immediately before performing the uroflowmetry. The flow protocol was unchanged from our standard practice. Uroflowmetry was carried out in a lockable toilet with auto start to remove dependence on the operator. Patients were asked not to strain or waggle their stream. The Dantec Urodyn 1000 rotating disk model was used after calibration. The index test was interpreted independently of the reference standard and without knowledge of the results. The uroflowmetry traces (reference standard) were assessed by an experienced observer to determine the ‘’true” Qmax taking into account “wag” and “straining” artefacts. Those unable to produce a flow volume of > 150ml were excluded. Immediately following the uroflowmetry, post void residue (PVR) was measured using transabdominal ultrasonography. RESULTS: A total of 100 patients were studied. The mean age of patients was 53 years. The median age was 56 years with a standard deviation of 13.78. Majority of the patients were over 50 years of age. There was an inverse correlation between age and Peak flow (Qmax) measured by the uroflowmeter. This was found to be significant (p < 0.01). However, eventhough there was an inverse correlation between Visual flow analogues marked by the patients and age, it was not significant (p = 0.05). Of the 100 patients in this study, 69 gave history of poor flow. Majority (82.5%) in this group marked visual flow analogues of 3 or less. Majority (70%) of the remaining 29 patients who did not have poor flow historically marked visual analogues of 4 or more. This difference was found to statistically significant (p < 0.01). Of the 100 patients studied, 64 had perceived a decrease in flow within the past 10 years and 80% in this group marked visual analogues of 3 or less. However those who didn’t perceive any change in flow within the past 10 years marked visual analogues of 4 or more. This difference was statistically significant (p <0.01). There was a significant correlation between between visual flow analogues and Qmax (p < 0.01). This correlation was found to be stronger in those who gave history of poor flow (p < 0.01) compared to those with a negative history (p < 0.05). The correlation between visual analogue scores and Qmax was significant in those who had received high school education or higher. CONCLUSIONS: In conclusion, self assessment of urinary flow using Visual Uroflowmetry showed significant correlation with peak flow, total IPSS and voiding symptoms in the IPSS like weak stream and incomplete emptying. Significant correlation was also seen between patients’ assessment of flow and QOL as marked in the IPSS. The correlation between visual analogues and Qmax improved with level of education. Hence Visual uroflowmetry may be used as a rapid and inexpensive tool for screening patients with LUTS.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Visual uroflowmetry ; viable screening tool ; lower urinary tract symptoms. |
| Subjects: | MEDICAL > Urology |
| Depositing User: | Kambaraman B |
| Date Deposited: | 12 Oct 2017 01:18 |
| Last Modified: | 12 Oct 2017 01:18 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/3468 |
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