الفهرس 
Lower urinary tract symptoms (LUTS)
Evaluation of Voiding FunctionOnly 14 pages are availabe for public view
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Abstract
Urodynamic study (UDS) is the current established standard test to distinguish between detrusor underactivity (DU) and bladder outlet obstruction (BOO). Concerns of patient discomfort and potential complications of catheterization deter its use, whereas uroflowmetry can be more easily performed in clinical practice. We inspected the variables in uroflowmetry used to discriminate between DU and BOO.
This is a one- armed clinical trial (Prospective interventional) study, done to replace the urodynamic study with a safer, non- invasive method to discriminate between DU and BOO. Forty patients were included in this study, which was carried out in Ain Shams University Hospitals, during the period starting from December 2016 till February 2018.
All of the forty patients in this study, underwent both urodynamic and uroflowmetry studies. Patients were divided into 2 groups based on UDS outcomes; DU (n=20) and BOO (n=20). from uroflowmetry, 5 variables including maximal flow rate (Qmax), average flow rate (Qave), voiding volume (VV), post void residual urine (PVR), and value of Qmax minus Qave (DeltaQ) were obtained. Multivariable analysis including receiver operating characteristic (ROC) curve analysis was performed to identify the important diagnostic predictors. The primary outcome revealed that uroflowmetry results were significantly different between DU and BOO groups. DeltaQ was smaller in DU group than BOO group (5.2 mL/s vs. 2.9 mL/s, p<0.001). Delta Q had excellent diagnostic value with an area under the ROC curve of 0.932 (p- value <0.0001). A cut- off value >3.9 ml/ s was found to be discriminatory between the two groups with a sensitivity of 95 % and specificity of 90 %.
In conclusion, DeltaQ value can to be a potential useful screening and diagnostic tool in differentiating between DU and BOO in men with obstructive lower urinary tract symptom.
We recommend that our findings should be tried on larger number of LUTS patients, with the aim of identifying if there are other conditions that may affect the deltaQ value. Furthermore, larger studies would enable the inclusion of not only DU and BOO patients but also those with mixed urodynamic problems. This ultimately aims to strengthen the diagnostic and discriminatory ability of the deltaQ value when assessing patients with obstructive LUTS.
Also we recommend a reverse study should be done. this study to start with uroflowmetry and analyses data particularly delta Q value and divide patient to DU and BOO and then do UDS study to confirm the diagnosis.