Bci and booi versus wfmax and ura

Konstantinos Vaios Mytilekas, Jesus Salinas Casado

Abstract


Objectives: The purpose of this retrospective study was to evaluate and compare the recommended BOOI and BCI with the urodynamic parameter URA and Watts graph, respectively. Is URA more sensitive and/or specific than BOOI in the diagnosis of BOO? Does the Watts factor graph give us more information on detrusor contractility than BCI?

Methods: Based on the hypothesis, that the specificity of two ideal urodynamic parameters which are used to independently calculate detrusor function and anatomic outlet resistance is increased when there is no correlation between them, we compared each other to the following urodynamic parameters: Bladder Outlet Obstruction Index(BOOI), Bladder Contractility Index (BCI), Urethral Resistance Factor (URA), Watts factor maximum (WFmax). Linear Passive Urethral Resistance Relation (LPURR), uroflow maximum flow (Qmax) and uroflow Post Void Residual (PVR) were also included in the analysis among 32 males with urodynamic diagnosis of benign prostatic obstruction (BPO) and recommendation for surgical treatment.

Results: Using the combination of urodynamic parameters PdetQmax≥45 cmH2O and Qmax<12 ml/sec as the gold standard of obstruction, the total sensitivity of BOOI≥40 and URA≥29 in the diagnosis of BPO was 87,5 % and 96,9%, respectively. Strong positive linear correlation, statistical significant was found between: URA-LPURR (P<0.0001, Pearson r =0.77), BOOI-LPURR (P<0.0001, Pearson r =0.75), BOOI-BCI (P<0.0001, Pearson r =0.85). Moderate negative linear correlation, statistical significant was found between: URA-Qmax (P<0.0001, Pearson r = -0.60). Moderate positive linear correlation, statistical significant was found between: URA-PVR (P<0.0001, Pearson r = 0.63). Weak positive linear correlation, not statistical significant was found between: WFmax-Qmax (P=0.0214, Pearson r=0.4053), BOOI-PVR (P<0.0336, Pearson r = 0.3766). Weak negative linear correlation, not statistical significant was found between: WFmax-PVR (P<0.03, Pearson r = -0.3754). No correlation was found between: BCI-Qmax, BCI-PVR, BOOI-Qmax, WFmax-URA.

Conclusions: Based on our results, the strong positive linear correlation, statistically significant between BOOI and BCI, automatically reduces the specificity in both of them. On the contrary, we recommended the combination of URA and WFmax due to the absence of any correlation between them, an observation which theoretically increases the specificity in both of them in the differential diagnosis between obstruction and detrusor underactivity, respectively.

Σκοπός-Υπόθεση: Η ειδικότητα δύο ουροδυναμικών παραμέτρων οι οποίες χρησιμοποιούνται για να αξιολογήσουν ανεξάρτητα την λειτουργία του εξωστήρα και τις παθητικές αντιστάσεις στην ροή των ούρων, αυξάνεται θεωρητικά όταν δεν υπάρχει συσχέτιση μεταξύ τους.

Ασθενείς και Μέθοδος: Αναδρομικά σε 32 ασθενείς με διάγνωση καλοήθους προστατικής απόφραξης (Benign Prostatic Obstruction, BPO) και σύσταση για χειρουργική αντιμετώπιση αυτής συσχετίστηκαν μεταξύ τους οι ουροδυναμικές παράμετροι της μελέτης πίεσης ροής BOOI (Bladder Outlet Obstruction Index)-LPURR (Linear Passive Urethral Resistance Relation), URA (Urethral Resistance Factor) -LPURR, BOOI-Qmax, BOOI-PVR, URA-Qmax, URA-PVR, BCI (Bladder Contractility Index) -Qmax, BCI-PVR, URA-Qmax, URA-PVR, BOOI-BCI και URA-WFmax (Watts Factor maximum). Η στατιστική ανάλυση έγινε με την χρήση του λογισμικού graphpadprism 5 logistics (Linear regression analysis και Pearson’s correlation analysis.)

Αποτελέσματα: Ισχυρή θετική γραμμική συσχέτιση, στατιστικά σημαντική παρατηρήθηκε μεταξύ: URA-LPURR (P<0.0001, Pearsonr =0.77), BOOI-LPURR (P<0.0001, Pearsonr =0.75), BOOI-BCI (P<0.0001, Pearsonr =0.85). Μέτρια αρνητική γραμμική συσχέτιση, στατιστικά σημαντική βρέθηκε μεταξύ: URA-Qmax (P<0.0001, Pearsonr = -0.60). Μέτρια θετική γραμμική συσχέτιση, στατιστικά σημαντική βρέθηκε μεταξύ: URA-PVR (P<0.0001, Pearsonr = 0.63). Ασθενής θετική γραμμική συσχέτιση, μη στατιστικά σημαντική βρέθηκε μεταξύ: WFmax-Qmax (P=0.0214, Pearsonr=0.4053), BOOI-PVR (P<0.0336, Pearsonr = 0.3766). Ασθενής αρνητική γραμμική συσχέτιση, μη στατιστικά σημαντική βρέθηκε μεταξύ: WFmax-PVR (P<0.03, Pearsonr = -0.3754). Απουσία συσχέτισης βρέθηκε μεταξύ :BCI-Qmax, BCI-PVR, BOOI-Qmax, WFmax-URA.

Συμπέρασμα: Στο μικρό αυτό δείγμα ασθενών, η παρουσία θετικής γραμμικής συσχέτισης μεταξύ των παραμέτρων BOOIκαι BCI ενώ η απουσία οποιασδήποτε συσχέτισης μεταξύ των παραμέτρων URA και WFmax φαίνεται να ενισχύει την άποψη ότι ο συνδυασμός των URA και WFmax είναι πιοειδικός από τον συνδυασμό των BOOI και BCI στην διαφορική διάγνωση υποσυστολίας και απόφραξης κατά την διάρκεια της μελέτης πίεσης ροής.


Keywords


Δείκτες υποκυστικής απόφραξης και υποσυστολίας;Bladder Outlet; Obstruction Index; (BOOI); Bladder; Contractility Index (BCI)

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References


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DOI: http://dx.doi.org/10.19264/hj.v26i4.49