The ICS‐‘BPH’ Study: uroflowmetry, lower urinary tract symptoms and bladder outlet obstruction
Open Access
- 1 November 1998
- journal article
- research article
- Published by Wiley in British Journal of Urology
- Vol. 82 (5), 619-623
- https://doi.org/10.1046/j.1464-410x.1998.00813.x
Abstract
Objective To explore the relationship between uroflow variables and lower urinary tract symptoms (LUTS); to define performance statistics (sensitivity, specificity, positive and negative predictive values) for maximum urinary flow rate (Qmax ) with respect to bladder outlet obstruction (BOO) at various threshold values; and to investigate the diagnostic value of low‐volume voids. Patients and methods The study comprised 1271 men aged between 45 and 88 years recruited from 12 centres in Europe, Australia, Canada, Taiwan and Japan over a 2‐year period. Symptom questionnaires, voiding diaries, uroflowmetry and pressure‐flow data were recorded. The relationship between uroflow variables and symptoms, Qmax and BOO, and the diagnostic performance of low volume voids were analysed. Results The relationship between symptoms and uroflow variables was poor. The mean difference between home‐recorded and clinic‐recorded voided volumes was −48 mL. Qmax was significantly lower in those with BOO (9.7 mL/s for void 1) than in those with no obstruction (12.6 mL/s; Pmax was negatively correlated with obstruction grade (Spearman’s correlation coefficient −0.3, Pmax (Spearman’s partial correlation coefficient −0.29, Pmax of 10 mL/s had a specificity of 70%, a positive predictive value (PPV) of 70% and a sensitivity of 47% for BOO. The specificity using a threshold Qmax of 15 mL/s was 38%, the PPV 67% and the sensitivity 82%. Those voiding 150 mL the likelihood of BOO was 56%. The addition of a specific threshold of 10 mL/s to these higher volume voiders improved the PPV for BOO to 69%. Conclusion While uroflowmetry cannot replace pressure‐flow studies in the diagnosis of BOO, it can provide a valuable improvement over symptoms alone in the diagnosis of the cause of lower urinary tract dysfunction in men presenting with LUTS. This study provides performance statistics for Qmax with respect to BOO; such statistics may be used to define more accurately the presence or absence of BOO in men presenting with LUTS, so avoiding the need for formal pressure‐flow studies in everyday clinical practice, while improving the likelihood of a successful outcome from prostatectomy. This study also shows that low‐volume uroflowmetry can provide useful diagnostic information and that, as such, the data from such voids should not be discarded.Keywords
This publication has 15 references indexed in Scilit:
- Correlation between uroflowmetry, prostate volume, postvoid residue, and lower urinary tract symptoms as measured by the international prostate symptom scoreUrology, 1996
- The ICS–‘BPH’ Study: the psychometric validity and reliability of the ICSmale questionnairePublished by Wiley ,1996
- The International Prostate Symptom Score in a community‐based sample of men between 55 and 74 years of age: prevalence and correlation of symptoms with age, prostate volume, flow rate and residual urine volumeBritish Journal of Urology, 1995
- Bladder-outlet obstruction ? assessment of symptomsWorld Journal of Urology, 1995
- Relationship of Symptoms of Prostatism to Commonly Used Physiological and Anatomical Measures of the Severity of Benign Prostatic HyperplasiaJournal of Urology, 1993
- The American Urological Association Symptom Index for Benign Prostatic HyperplasiaJournal of Urology, 1992
- The standardisation of terminology of lower urinary tract functionWorld Journal of Urology, 1989
- STATISTICAL METHODS FOR ASSESSING AGREEMENT BETWEEN TWO METHODS OF CLINICAL MEASUREMENTThe Lancet, 1986
- Value of postvoid residual urine determination in evaluation of prostatismUrology, 1982
- Prostatism and Prostatectomy: The Value of Urine Flow Rate Measurement in the Preoperative Assessment for OperationJournal of Urology, 1976