Investig Clin Urol.  2017 Jul;58(4):247-254. 10.4111/icu.2017.58.4.247.

How do we diagnose detrusor underactivity? Comparison of diagnostic criteria based on an urodynamic measure

• Jeong SJ
• Lee JK
• Kim KM
• Kook H
• Cho SY
• Oh SJ

• KMID: 2410291
• DOI: http://doi.org/10.4111/icu.2017.58.4.247

Abstract

PURPOSE
To compare several contemporary urodynamic criteria for diagnosing detrusor underactivity (DU) and estimate how well they coincide with each other.
MATERIALS AND METHODS
From our prospective urodynamic database we identified nonneurogenic lower urinary tract symptoms (LUTS) patients older than 60 years between 2003 and 2014. Patients were reclassified based on four and three contemporary criteria for DU among men and women. Each criterion was compared with the others using the McNemar test.
RESULTS
Urodynamic data of 4,372 patients (3,357 men and 1,015 women) were analyzed. In men, the prevalence of DU was estimated to be 56%, 17%, 5%, and 10% based on bladder contractility index, Abrams-Griffith number, maximal detrusor pressure at maximal flow rate (PdetQmax) 30, and bladder voiding efficiency (BVE) criteria. In women, 14.9%, 9.6%, and 6.4% of patients were classified as having DU based on maximal flow rate/postvoid residual (Qmax/PVR), PdetQmax 30, and BVE criteria. For individual subjects, all 4 criteria for men were significantly different from each other, while PdetQmax 30 and BVE criteria for women did not differ significantly (p=0.065). Additionally, BVE criterion for men and PdetQmax 30 and BVE criteria for women could distinguish the differences of patient age, free Qmax and free PVR between patient with and without DU.
CONCLUSIONS
Each urodynamic criterion for men does not coincide with each other in the diagnosis of DU within individual subjects. On the other hand, PdetQmax 30 criteria and BVE criteria for women could be appropriately applied to clinical practice when diagnosing DU in women with LUTS.

Keyword

Detrusor underactivity; Diagnosis; Urodynamics

MeSH Terms

Diagnosis
Female
Hand
Humans
Lower Urinary Tract Symptoms
Male
Prevalence
Prospective Studies
Urinary Bladder
Urodynamics*

Figure

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  Fig. 1 Flow chart for patient selection process from urodynamic database registry.

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  Fig. 2 Prevalence of detrusor underactivity by age group and year of performing an urodynamic study. (A) In men, the prevalence of detrusor underactivity significantly increased with patient age in BCI criteria (p<0.001), PdetQmax 30 criteria (p=0.029), and BVE criteria (p=0.042). (B) In women, the prevalence of detrusor underactivity significantly increased with patient age in PdetQmax 30 criteria (p=0.004) and BVE criteria (p<0.001). (C) In men, the prevalence of detrusor underactivity was consistent across the years in most of the criteria except BCI criteria (p<0.001). (D) In women, the prevalence of detrusor underactivity was consistent across the years except in PdetQmax 30 criteria (p=0.005). *indicates the statistical significance. DU, detrusor underactivity; BCI, bladder contractility index; AG number, Abrams-Griffith number; Qmax, maximal flow rate; PdetQmax, detrusor pressure at Qmax; BVE, bladder voiding efficiency; PVR, postvoid residual.

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