NEUROUROLOGY & FEMALE UROLOGY

Comparison of Diagnostic Criteria for Female Bladder Outlet Obstruction
Akikwala TV, Fleischman N, Nitti VW
Department of Urology, New York University School of Medicine, New York, New York, USA
J Urol. 2006; 176: 2093-7

• Purpose: There is no universally accepted definition of bladder outlet obstruction in women. We compared 5 contemporary urodynamic definitions and determined how well they correlated with each other and with clinical suspicion of bladder outlet obstruction.
• Materials and Methods: A total of 154 women who underwent videourodynamics were prospectively evaluated. Clinical obstruction was suspected when history, physical examination, symptoms and basic testing before urodynamics raised the suspicion. Women were classified as having obstruction based on 5 contemporary definitions, including 3 pressure flow cutoff point criteria, videourodynamic criteria and the Blaivas-Groutz nomogram. The McNemar Test was used to compare each definition to the others and to suspicion of clinical obstruction.
• Results: Of the women 91 were evaluable, including 26 (29%) with obstruction by videourodynamic criteria, 28 (31%) with obstruction by 1998 cut point criteria, 18 (20%) with obstruction by 2000 cut point criteria, 13 (14%) with obstruction by 2004 cut point criteria and 38 (42%) with obstruction by the Blaivas-Groutz nomogram. Videourodynamic and 1998 cut point criteria were not significantly different from each other (78.9% concordance) and each agreed with the clinically obstructed category in the comparison. Compared to the other criteria, the Blaivas-Groutz nomogram overestimated obstruction, while 2004 cut point criteria tended to underestimate it.
• Conclusions: Each urodynamic definition of female bladder outlet obstruction has merit. Videourodynamic criteria and 1998 cut point criteria have the highest concordance. The Blaivas-Groutz nomogram overestimates obstruction compared to the other criteria. Therefore, it should not be used as the sole or standard definition of obstruction in women.
  
  
• Editorial Comment
  The authors prospectively reviewed a cohort of women who had clinical suspicion of bladder outlet obstruction. The patients underwent a full evaluation including fluoroscopic urodynamic studies. The data obtained was applied to five definitions for female bladder outlet obstruction. The application results were then compared to each other and then to the clinical situation at hand.
  This is an excellent study was well planned and very illustrative of the difficulty in diagnosing bladder outlet obstruction in women in an absolute manner. The authors point out the challenge in diagnosing bladder outlet obstruction in females who have a current neurologic diagnosis or who do not generate a detrusor contraction during their urodynamic study. In addition, the results and discussion highlight the importance of combining clinical suspicion, physical examination, urodynamic evaluation as well as radiographic imaging during the diagnostic process. In our practice, though we incorporate multiple variables similar to this article in the evaluation of female bladder outlet obstruction, we do rely to a pronounced degree on the radiographic imaging during the patient’s micturitional cycle. This is definitely a reference article for the urologic surgeon, especially those involved in tertiary evaluations in female urology.

Dr. Steven P. Petrou
Associate Professor of Urology
Chief of Surgery, St. Luke’s Hospital
Associate Dean, Mayo School of Graduate Medical Education
Jacksonville, Florida, USA