膀胱出口梗阻指数在评估良性前列腺增生症膀胱出口梗阻中的应用

目的 探讨膀胱出口梗阻指数(BOON)在评估前列腺增生患者膀胱出口梗阻(BOO)中的意义.方法 对临床有下尿路症状,怀疑存在因前列腺增生症(BPH)导致膀胱出口梗阻的76例患者,测定前列腺体积(经直肠),最大自由尿流率(Qmax)和平均排尿量,通过公式计算BOON=前列腺体积(cm3)-3×Qmax(ml/s)-0.2×平均排尿量(ml).同时对患者进行压力.流率测定,计算AG值和Schafer梗阻级别,与BOON对照,分析利用BOON评估膀胱出口梗阻的准确性.结果 将本组患者年龄、前列腺体积、最大尿流率、残余尿量及BOON值,以AG作为因变量,同AG进行多元线性回归分析.整体回归方程中R=0.542(P=0.000),其中BOON值同AG值相关性最强(P=0.000).18例BOON值>-10,此时利用BOON判断BOO的敏感性为31%,特异性为100%,取BOON>-20时,敏感性为42.4%,特异性为88.2%;取BOON>-30时,敏感性为66.1%,特异性为82.4%;而取BOON>-40时,敏感性为77.9%,其特异性为64.7%.取BOON值-30作为分界点,在不明显降低特异性的同时,能够更敏感的判断BOO,BOON数值越大,利用BOON判断膀胱出口梗阻的特异性越高.结论 通过测定前列腺体积,最大自由尿流率(Qmax)和平均排尿量计算膀胱出口梗阻指数,取BOON>-30为分界点,是预测前列腺增生症是否存在膀胱出口梗阻的一种简易、无创方法,具有较好的特异性和敏感性.     

The prediction of bladder outlet obstruction with prostate volume, maximum flow rate, residual urine and the international prostate symptom score in patients with lower urinary tract symptoms

We determined whether prostate volume (PV), maximum flow rate (Qmax), residual urine (RU) and the International Prostate Symptom Score (I-PSS) predicted bladder outlet obstruction in patients having lower urinary tract symptoms (LUTSs). The study consisted of 114 patients aged 50 years or older with LUTSs who had scores of 8 or more on the I-PSS and 2 or more for the quality of life index. All patients received transrectal ultrasonography for estimation of PV and pressure-flow study (PFS). When PFS showed an obstruction grade of 2 or more in Sch?fer's p/Q diagram, the result was defined as bladder outlet obstruction. When we examined which criteria indicated that 90% of patients had bladder outlet obstruction (positive predictive value: 90%), we found that PV of 35 ml or more, Qmax of 8 ml/sec or less, RU of 110 ml or more, and I-PSS of 30 or more did so. Fifty-nine percent of patients met at least one of these criteria. The results suggested that 59% of patients with LUTSs had bladder outlet obstruction with a 90% positive predictive value based on the value of PV, Qmax, RU or I-PSS.     

Factors causing differences in voiding parameters between conventional and ambulatory urodynamics

Voiding parameter values measured with ambulatory urodynamic monitoring (AM) are generally found to be different from those measured with conventional cystometry (CMG). The reason for this is unclear, but might be related to differences in the voided volume. To verify this hypothesis, we compared voidings from female patients at an initial bladder volume that was close to the modal volume (that is, the volume most often voided by the patient as derived from frequency/volume charts) with voidings at maximum cystometric capacity during a routine video urodynamic examination. A first group of 35 patients voided at the modal volume before they did at capacity. The order was reversed in a second group of 12 patients. The dependence of the voiding parameters on the voided volume and the order of the measurements were examined. It was found that the maximum flow rate depended significantly on the voided volume, but the associated detrusor pressure did not. Urethral resistance and bladder contraction strength were not volume dependent either. It was concluded that the differences between AM and CMG cannot be explained from possible differences in the voided volume. Received: 23 August 1999 / Accepted: 16 December 1999     

Correlation of bladder base elevation with pelvic floor hypertonicity in women with lower urinary tract symptoms

AIMS: To determine whether the bladder base elevation as revealed by cystogram under fluoroscopy is associated with pelvic floor hypertonicity or bladder outlet obstruction (BOO) in women. METHODS: Sixty-two women who were referred to our videourodynamic laboratory for assessment of lower urinary tract symptoms (LUTS) were included in this retrospective analysis. Thirty-one of these women with bladder base elevation-revealed by cystogram under fluoroscopy during videourodynamic study-served as the experimental group, and another group of 31 women without bladder base elevation served as control. None of the patients had neuropathy, previous pelvic surgery or chronic urinary retention. The clinical symptoms, urodynamic diagnosis, and parameters were compared between the two groups. RESULTS: The mean voiding pressure (Pdet.Qmax) and postvoid residual (PVR) were significantly greater, and maximum flow rate (Qmax) and voided volume were significantly lower in the bladder base elevation group. When a Pdet.Qmax of >or=35 cmH2O combined with a Qmax of 相似文献   

Home uroflowmetry: improved accuracy in outflow assessment

To study home uroflowmetry and to compare this method to free or "traditional" uroflowmetry in the evaluation of the patient with symptomatic benign prostatic hyperplasia (BPH), and the relationship between the values of home uroflowmetry parameters and bladder outlet obstruction (BOO). Twenty-five patients (mean age, 67 years) with symptomatic BPH were examined with home uroflowmetry, free uroflowmetry, and pressure-flow measurement. The patients were assessed using the International Prostate Symptom score; digital rectal examination; routine blood chemistry, including serum prostate-specific antigen level; urinanalysis; transrectal ultrasonography; and post-void residual urine. The 24 hr were divided into "active time" (AT) and "sleep time" (ST). AT home uroflowmetry parameters were compared to ST ones. The home uroflowmetry parameters were compared to respective ones of the free uroflowmetry as well and those obtained by pressure-flow measurement. The patients were asked about their opinion of home uroflowmetry. Home uroflowmetry was found to be a simpler and more acceptable method than free uroflowmetry. The mean Qmax of AT was significantly greater than the mean Qmax of ST, but the mean voided volume and mean voiding time of ST were significantly larger than those of AT. There was a close relationship between the mean Qmax at home and the Qmax in hospital, but the voided volume and voiding time measured in hospital were significantly larger than those at home. Home uroflowmetry provided an estimation of BOO for 46% of the patients as low if the home mean Qmax was >14 ml/sec, and as high if the home mean Qmax was <10 ml/sec. Home uroflowmetry was well accepted by the patients and gave more information than free uroflowmetry. In 46% of the cases, an estimation of BOO was obtained with home uroflowmetry.     

Low reproducibility of maximum urinary flow rate determined by portable flowmetry.

To evaluate the reproducibility in maximum urinary flow rate (Qmax) in men with lower urinary tract symptoms (LUTSs) and to determine the number of flows needed to obtain a specified reliability in mean Qmax, 212 patients with LUTSs (mean age, 62 years) referred to the University Hospital Nijmegen, with various degrees of obstruction on pressure-flow studies, used a portable home-based uroflowmeter with 12 disposable beakers. Voided volume and maximum flow rate were recorded continuously during micturition. Flows with voided volumes of at least 100 ml and without possible artifacts were included. All analyses were repeated while excluding flows with voided volumes <150 ml. A coefficient of variation (CV) was calculated for each patient. The CV represents the standard deviation relative to the mean. All individual CVs were subsequently pooled into a population mean CV. This parameter was used to estimate the number of flows required to obtain a mean Qmax with specified reliability for an individual patient. All analyses were repeated, while successively excluding the first, the first two, and the first three flows, to assess a possible learning curve. A total of 1,854 flows was available for analyses, yielding an average of nine flows per patient. Mean Qmax was 13.2 ml/sec; the mean CV was 24%. To allow, for instance, a 10% deviation from the true mean Qmax (e.g., 15 ml/s +/- 1.5 ml/s), approximately 25 flows are necessary. The actual number of flows needed is in fact even higher due to the presence of small and artifactual flows. Using a 150 ml volume cutoff point, somewhat fewer flows are required, but the total number of flows needed (that is, valid, small, and artifactual flows) increases. There was no evidence of a learning curve. The boundaries of a confidence interval around a single Qmax measurement that is likely to contain the true mean Qmax, lie approximately 50% below or above that single Qmax measurement. To reduce this proportion down to 10%, approximately 25 flows are needed. Thus, to obtain reliable mean Qmax values, considerably more flows are required than are normally performed in urologic practice.     

Disposable peak urinary flowmeter estimates lower urinary tract obstruction.

Peak urinary flow rate represents the highest flow rate achieved during a single urination and, as such, represents the patient's best effort at micturition. Peak flow rate, correlated with patient age and volume voided, effectively estimates lower urinary tract obstruction. The 63 normal and 368 abnormal male subjects urinated in privacy into a plastic sterile disposable device (the peakometer), which measured peak flow rate and volume voided. These data plus age, ultimate diagnosis and interval since last urination comprised our data base. Percentage distribution of diagnosis in this population was prostatic obstruction 47.3 per cent, stricture 19.3 per cent, normal 14.6 per cent, prostatitis 8.4 per cent, neurogenic bladder 2 per cent and miscellaneous 8.4 per cent. The average peak flow rate for normal male subjects reaches 27.6 ml. per second, which differs significantly from that for patients with prostatic obstruction--9.4 ml. per second, stricture--10.5 ml. per second, prostatitis--16.3 ml. per second and neurogenic bladder--13.9 ml. per second. The peak flow rate decreased progressively as the age of the subjects increased. We measured average decreases of 10 ml. per second peak flow for every 30 years after age 10. Peak flow rate increases as volume voided increases. Requirements of our measuring device combined with urodynamic responses caused us to select 100 ml. voided as the minimum acceptable volume. With volumes more than this any given individual may deviate plus or minus 10 per cent from the true mean peak flow depending upon volume voided. For practical purposes peak flow, age and volume must be considered to categorize voiding by peak flow rate. With these variables 2 graphs that compare peak flow, age and volume may be used to estimate voiding function for a given male patient. Comparison of peak flow rates, volume voided and voiding interval before and after surgical correction of obstruction documented significant increase in volume voided or in interval between voiding. Peak urinary flow rate measurement by this device predicted normality or abnormality with 90 to 95 per cent accuracy. Therefore, this represents a valid screening test but it does not in itself provide the diagnosis of abnormal urination.     

The effect of urethral instrumentation on uroflowmetry

OBJECTIVE: To evaluate in a prospective study the effect of urethral instrumentation (flexible cystoscopy) on uroflowmetry, and in particular the peak urinary flow rate (Qmax). PATIENTS AND METHODS: Thirty-two consecutive patients (median age 61.8 years, range 24-80) undergoing flexible cystoscopy were included in the analysis. Patients with active urethral stricture disease or urinary infection were excluded. The indications for cystoscopy included haematuria (44%), voiding symptoms (66%), history of bladder cancer (19%), and history of perineal trauma (3%). Patients underwent uroflowmetry immediately before instrumentation. The postvoid residual volume (PVR) was measured by bladder catheterization. After cystoscopy the bladder was completely emptied and then filled with the same volume of sterile normal saline (bladder volume = voided volume + PVR), and the patient underwent a second uroflowmetry. RESULTS: Patients with voiding symptoms (21, 66%) had a median (range) American Urological Association symptom score of 17 (4-34), a Bother score of 16 (1-23), and Quality of Life score of 3 (1-6). The mean Qmax was 16.9 (4.5-36.9) and 13.3 (4.5-39.4) mL/s before and after cystoscopy, respectively (P = 0.029). The mean percentage difference in Qmax was + 27 (- 23 to 139)% higher before than after cystoscopy. After cystoscopy, up to 25% (eight) and 21% (seven) patients had a lower Qmax, from > 15 to < 15 mL/s and from > 12 to < 12 mL/s, respectively. There were no significant differences in the bladder volume and PVR (P = 0.914 and 0.984, respectively). CONCLUSIONS: Urethral instrumentation by flexible cystoscopy significantly alters Qmax. A 'false' mean change in Qmax (favouring improvement) of +27% would result if uroflowmetry data after instrumentation were used at baseline. Therefore, study protocols for benign prostatic obstruction should exclude uroflowmetry data obtained after urethral instrumentation; failure to exclude such data will lead to disproportionately greater improvements in Qmax that are independent of the therapy delivered.     

Systemic augmentation of nitric oxide: is there an immediate effect on the urinary flow rate in healthy men?

INTRODUCTION: Nitric oxide (NO) is an important neurotransmitter in the lower urinary tract. Data from experimental studies in animals and humans suggest that NO donors like isosorbide dinitrate could be used to lower the infravesical resistance. Despite the potentially significant clinical benefit of such an effect, it has hardly been studied in vivo in men. We investigated the immediate effect of isosorbide dinitrate on the urinary flow rate and the functional bladder capacity in healthy young men. PATIENTS AND METHODS: A free urinary flow was measured in 20 healthy male volunteers on two consecutive micturitions. 15-25 min prior to the second micturition, 10 mg of the NO donor isosorbide dinitrate was administered sublingually. RESULTS: We found no significant difference between baseline measurement and the micturition after NO administration with regard to the totally voided volume, the maximal or the average flow rate as well as the flow rate corrected for the voided volume. CONCLUSION: Systemic augmentation of NO does not produce a relevant immediate effect on the urinary flow rate or the functional bladder capacity in healthy men.     

Transurethral incision versus transurethral resection of the prostate in small prostatic adenoma: Long-term follow-up

ObjectivesTo evaluate the efficacy of transurethral incision of the prostate (TUIP) compared to transurethral resection of the prostate (TURP) in patients with small benign prostate adenoma, based on long-term follow-up.Patients and methodsWe prospectively randomized 86 men with bladder outlet obstruction symptoms caused by a prostate less than 30 g to undergo TUIP or TURP. The following preoperative parameters were evaluated: prostate weight, international prostate symptom score (IPSS), voided volume, maximum flow rate (Qmax) and post-void residual volume (PVR). Postoperatively the patients were followed up for 48 months and the following data were collected: morbidity, operative time, catheterization period, hospital stay, Qmax, IPSS, voided volume, PVR and reoperation rate.ResultsA total of 80 of the 86 patients completed the study: 40 patients in each group. The mean age of patients in group I (TURP) and group II (TUIP) was 63.6 and 66.2 years, respectively. Preoperative parameters in both groups showed no statistically significant differences with regard to uroflow parameters and prostate weight. At 48 months follow-up the mean voided volume increased from 161 ml to 356 ml in group I and from 161 ml to 341 ml in group II, Q-max increased from 8.4 to 18.4 in group I and 8.4 to 16.6 in group II, the IPSS decreased from 19 to 5.8 in group I and from 19 to 6.3 in group II and PVR decreased from 107 ml to 20 ml in Group I and from 109 ml to 21 ml in Group II (all differences statistically significant). Comparing groups I and II there were statistically significant differences with regard to mean operative time (60.0 versus 20.6 min), duration of catheterization (3.2 versus 2.2 days), hospital stay (3.7 versus 2.6 days), and the incidence of postoperative retrograde ejaculation (52.5% versus 22.5%) and erectile dysfunction (20% versus 7.5%).ConclusionTUIP and TURP for small prostatic adenoma of less than 30 g are equally effective in providing symptomatic improvement. TUIP is more advantageous with to side-effects, operative time, hospital stay and the duration of catheterization.     

Transurethral incision of the prostate and bladder neck for the treatment of outflow obstruction caused by a small benign prostate]

Transurethral incision of the prostate and bladder neck (TIPBn) was compared with transurethral resection of the prostate (TURP) followed by bladder neck incision in the treatment of 22 patients with outflow obstruction caused by a small prostate adenoma (below 15 gm). Eleven patients underwent TIPBn and another 11 TURP. An evaluation of the urodynamic findings and subjective symptoms was undertaken before the operation and 3 months afterwards. Urodynamic findings were evaluated, based upon uroflowmetry, i.e., in terms of maximum flow rate, average flow rate, voiding time, initiation time and residual rate. All patients in the TIPBn group revealed an improvement in every urodynamic parameter (MFR: from 6.1 to 10.8 ml/sec, AFR: from 3.1 to 5.8 ml/sec, Voiding time: from 95.5 to 24.2 sec/100 ml, Initiation time: 34.3 to 10.2 sec, Residual rate: 31.6 to 17.8%, in mean value). Ten out of the 11 in the TIPBn group subjectively considered the result to be good. The improvements in the urodynamic parameters in the TIPBn group were statistically comparable to those in the TURP. The improvements in voiding time and initiation time, however, tended to be much better in the TIPBn group. We conclude that TIPBn can be the operation of choice in the treatment of outflow obstruction caused by a small prostate.     

1024例儿童尿流率调查

目的 寻求长沙地区儿童尿流率正常值及其列线图。方法 对1024名正常儿童进行1048次尿流率检测。将所得资料按性别、年龄、体表面积、排尿量分组后进行统计学分析，并绘制出各组相应的列线图以阐明尿量、体表面积、平均尿流率、最大尿流率4者的相互关系。结果 正常儿童尿流率曲线为典型的钟形曲线。〈7岁男性儿童的最大尿流率随年龄增加而增加，年龄每增加1岁最大尿流率增加1．7ml／s，〉7岁者其最大尿流率同成年人相仿。〈9岁女性儿童的最大尿流率随年龄增加而增加，年龄每增加1岁最大尿流率增加1．2ml／s，〉9岁其最大尿流率同成年人相近。儿童最大尿流率、平均尿流率及排尿量均随体表面积增加而增加，同时，最大尿流率、平均尿流率也均随排尿量的增加而增加。结论 〈9岁的女童和〈7岁的男童最大尿流率的正常值有明显的年龄依从性。     

经尿道手术治疗小体积前列腺增生所致膀胱出口梗阻

目的探讨经尿道前列腺电切(transurethral resection of prostate,TURP)+经尿道膀胱颈切开术(transurethralincision of bladder neck,TUIBN)治疗小体积前列腺增生所致膀胱出口梗阻的疗效。方法 2002年3月～2007年1月,采用TURP+TUIBN治疗小体积前列腺增生所致膀胱出口梗阻31例,其中有完整随访资料的25例,年龄46～71岁,平均56岁,病程8～77个月,平均32个月,前列腺重量15～30 g,平均24 g。比较术前、术后国际前列腺症状评分(IPSS)、最大尿流率(Qmax)、残余尿量(PVR)等指标,以评估疗效。结果手术时间25～47 min,平均38 min。经尿道切除前列腺组织重量6～17 g,平均9.8 g。术后病理报告25例均为良性前列腺增生(其中20例为纤维增生型),15例伴慢性前列腺炎。术后随访6～24个月,平均15个月。23例排尿通畅,1例尿道狭窄(行尿道扩张后排尿通畅),1例膀胱颈挛缩。术前、术后6个月IPSS评分分别为(26.60±3.07)分、(6.92±1.26)分,Qmax为(7.96±2.30)ml/s、(19.60±2.31)ml/s,PVR为(132.80±64.84)ml、(18.60±7.97)ml,差异均有显著性(P=0.000)。结论 TURP+TUIBN是治疗小体积前列腺增生所致膀胱出口梗阻的一种较为理想的术式。     

Urodynamic parameters for the diagnosis of bladder outlet obstruction in women

INTRODUCTION: Bladder outlet obstruction (BOO) is often overlooked in the diagnosis of women with lower urinary tract symptoms. Although the incidence of BOO is not high in the female population with lower urinary tract symptoms, a correct diagnosis for BOO is important. This study was designed to compare the urodynamic parameters in women with bladder outlet obstruction (BOO), stress urinary incontinence (SUI) and asymptomatic volunteers. MATERIALS AND METHODS: Videourodynamic study was performed in 76 patients who were clinically diagnosed as BOO, 265 with stress urinary incontinence (SUI). In addition, 30 asymptomatic female volunteers were recruited and served as controls. Voiding pressure (P(det.Qmax)), maximum flow rate (Qmax), and urodynamic parameters were compared among the BOO, SUI and control groups and the criteria values for BOO in women were estimated. RESULTS: BOO was identified in 30 women with bladder outlet stricture, 40 women with dysfunctional voiding, and 6 women with high-grade cystocele. The mean P(det.Qmax) was significantly higher and the mean Qmax was significantly lower in the obstructed groups. When a P(det.Qmax) > or =35 cm H(2)O was set as the criteria for BOO, the sensitivity was 96.1% and specificity was 89.0%, whereas a P(det.Qmax) of > or =30 cm H(2)O had a sensitivity of 100% but the specificity was only 65.5%. If the criteria of BOO was set as P(det.Qmax) > or =35 cm H(2)O combined with Qmax < or =15 ml/s, the sensitivity for BOO was 81.6% and specificity was 93.9%. CONCLUSIONS: Our results demonstrate a P(det.Qmax) of > or =30 cm H(2)O is a good index value for screening of female BOO. When a P(det.Qmax) of > or =35 cm H(2)O combined with a Qmax < or =15 ml/s was found, a high suspicion of BOO should be raised, for which a specificity of 93.9% and sensitivity of 81.6% for BOO was obtained.     

女性膀胱颈抬高程度与膀胱出口梗阻相关性尿动力学分析

目的 探讨女性膀胱颈抬高程度与膀胱出口梗阻相关性尿动力学特点及临床意义.方法 实验组64例,筛选条件为主诉有尿频、尿急、排尿困难.排尿时间延长、下腹部胀痛不适等下尿路症状(Lower urinary tract syndrome,LUTS).对照组34例,为无LUTS症状的正常女性.所有患者均无神经系统疾病史,无糖尿病...     

A flow rate cut-off value as a criterion for the accurate non-invasive measurement of bladder pressure using a condom-type catheter

We developed a condom-type catheter to non-invasively measure the bladder pressure during interruption of the flow rate. The aim of the present study was to establish a minimum flow rate value at which a reliable bladder pressure measurement can be made with this catheter. We reanalysed data from 43 patients who completed a pressure-flow study and a non-invasive test. The patients voided without straining. During the test, we simultaneously measured the bladder pressure (invasively) and the condom pressure (non-invasively). The pressure increase in the condom after interruption of the flow rate was analysed in 40 of the 43 patients. A plot of the difference between the bladder pressure and the maximum condom pressure as a function of the flow rate revealed that in 70% of the patients who voided with a maximum flow rate exceeding 5.4 ml/s, the condom pressure accurately reflected the bladder pressure (+/-14 cmH2O). We conclude that to accurately and non-invasively measure the bladder pressure with a condom-type catheter, the maximum flow rate should exceed 5.4 ml/s.     

Detrusor pressure uroflowmetry studies in women: effect of a 7Fr transurethral catheter

PURPOSE: We evaluated whether a 7Fr transurethral catheter affects urinary flow in women undergoing pressure flow studies for voiding symptoms. MATERIALS AND METHODS: We reviewed a urodynamic database of 600 consecutive women referred for the evaluation of voiding symptoms. Before urodynamics all patients voided privately using a standard toilet and free flow was recorded. Urodynamics were performed using a 7Fr double lumen transurethral catheter. At functional bladder capacity patients were asked to void in the sitting position and pressure flow studies were performed. All uroflowmetry tracings were inspected and analyzed manually. Only patients who voided similar volumes varying by less than 20% on the free and pressure flow studies were assessed. Free and pressure flow parameters were compared according to voided volume category, main urodynamic diagnosis, uroflowmetry pattern and pre-void bladder volume. RESULTS: A similar volume was voided on the free and pressure flow studies of 100 women. In each voided volume category and urodynamic diagnosis pressure flow parameters were significantly different from the equivalent free flow parameters in all but 4 cases. Specifically the maximum flow rate was significantly less and flow time was significantly longer on pressure versus free flow studies (each p <0.01). An intermittent flow pattern was more common on pressure than in free flow measurements (43% versus 9%). CONCLUSIONS: A 7Fr transurethral catheter may adversely affect uroflowmetry parameters in women undergoing pressure flow studies for lower urinary tract symptoms. This finding may have further clinical implications regarding the interpretation of these parameters as well as establishment of an accurate diagnosis.     

Number of daytime micturitions and volume voided per micturition in the evaluation of efficacy of drugs for overactive bladder: findings from randomized clinical trials

OBJECTIVE: To analyze the relationship between mean volume voided per micturition and number of daytime micturitions. METHODS: We reviewed data from randomized clinical trials on the medical treatment of overactive bladder published in the international literature between 1997 and 2004. Fourteen studies including data on these two parameters were identified. RESULTS: Six studies compared tolterodine with placebo, two tolterodine and oxybutynin with placebo, two tolterodine with oxybutynin, two solifenacin and tolterodine with placebo, one oxybutynin CR with oxybutynin IR, and one different doses of solifenacin. The correlation between the percent change in the mean voided volume and in the number of daytime micturitions was assessed using the Spearman rank correlation coefficient (r), with r=-0.67 for all the studies. For groups of patients treated with each drug, we found r=-0.09 for oxybutynin, r=-0.59 for tolterodine, r=-0.85 for solifenacin, and r=-0.34 for placebo. CONCLUSION: The results of this analysis suggest that in the evaluation of the efficacy of a drug for overactive bladder, the mean volume voided per micturition may be a useful measure of efficacy.     

Urinary flow rate recording: the impact of a single dose of a diuretic on clinic logistics and flow rate parameters

PURPOSE: We determine the impact of a single dose of a diuretic given to patients scheduled for flow rate recording on clinic waiting time and flow rate parameters, and whether such practice induces artifacts in recording independent of those inherent in repeat recordings. MATERIALS AND METHODS: A total of 99 volunteers with a mean age plus or minus standard deviation of 54 +/- 10.9 years with no known urological condition participated in an open label, crossover study. On 2 separate occasions they came to the clinic for a flow rate recording, and were randomized to receive 20 mg. furosemide upon arrival at the first or second visit. Clinic waiting time, pre-void bladder volume, voided volume, maximum flow rate and other parameters were captured in a database and analyzed. RESULTS: Independent of diuretic use an increase in voided volume and maximum flow rate (19.8 to 21.2 ml. per second) was noted from the first to second visit. Diuretic use independent of sequence induced an increase in voided volume and significant reduction in waiting time (155 versus 81 minutes, p <0.001) without affecting maximum flow rate (19.9 versus 21.1 ml. per second, p = 0.058). Diuretic use on the second visit enhanced the learning effect on maximum flow rate, while first visit use negated the learning effect on the second visit. Waiting time reduction was significant independent of sequence. The positive correlation between voided volume and maximum flow rate remained unchanged with or without the diuretic. CONCLUSIONS: Repeat flow rate recordings are associated with a measurable learning effect leading to an increase in maximum flow rate. The use of 20 mg. furosemide reduces waiting time without inducing additional artifacts or significant changes in flow rate parameters. This practice is recommended for busy offices or clinical research centers to enhance urine flow, patient satisfaction and ultimately compliance with care.     

Interstitial cystitis: Clinical manifestations and diagnostic criteria in over 200 cases

Over 200 patients were evaluated for the syndrome of interstitial cystitis. The average patient was found to void 16 times per day with an average volume of 106 ml, nocturia averaged 4–6 times (but 18% of patients voided < 2 times per night) and symptoms were present at least 1 year. Eight-five percent of the patients were female and 83% had pain. The median age was 44. Cystoscopic changes revealed no carcinoma or carcinoma in situ in 175 patients studied with an average capacity under anesthesia of 561 ml (measured in 175 patients). Only 8% of the patients had ulcers and 89% had glomerulations. Seventy-five patients had cystometrograms demonstrating an average maximum capacity of 220 ml and an increased sensory urgency in 95% of patients (< 100 ml volume stimulating urgency was considered abnormal). The 90% confidence limit for findings in this disease showed the average voids per day was at least 10, with an average voided volume of < 160 ml, nocturia at least 1–2 per night, duration of symptoms over 1 year, anesthetic bladder capacity of < 850 ml.