Di Grazia Eugenio, Bartolotta Salvatore, Nicolosi Federico, Nicolosi Dario
Divisione di Urologia, Ospedale Tomaselli, Catania, Italy.
Arch Ital Urol Androl. 2002 Sep;74(3):134-7.
Pressure flow technique on males is considered a standard diagnostic procedure to investigate the voiding process, while on female this is still under investigation. Many studies have been conducted in order to establish a female bladder outlet obstruction nomograms using a 7 Fr catheter, but recently a report showed that 7 Fr catheter may adversely affect the voiding process on women. We studied the effect of 4 Fr urethral catheter in women undergoing pressure flow evaluation in order to assess any detrimental effect in the voiding process.
We evaluated a database of 85 patients referred for lower urinary tract symptoms. First, all patients had free uroflowmetry and then underwent pressure flow studies utilizing two catheters: a 12 Fr for filling and a 4 Fr mono J for measuring detrusor pressure. After filling we removed the 12 Fr catheter and pressure flow was performed leaving the 4 Fr only in the urethra. As positive correlation of flow rate with voided volume is well established, we selected only 33 patients who had similar prevoided volumes varying by less than 30% and free and intubated flow parameters were compared according to volume categories in order to strengthen the statistic analysis.
In each group all the free and pressure flow parameters were not statistically different. Only in the group who voided within 250 and 500 ml we found the pressure flow voiding time to be almost longer than the free flow equivalent, but not statistically different (31.1 +/- 15 versus 56.7 +/- 49.3; p = 0.05). Furthermore we did not find any difference in free and intubated morphology of curves.
A 4 Fr transurethral catheter does not affect adversely the voiding process in women undergoing pressure flow studies for lower urinary tract symptoms. This finding has very important clinical implications for interpreting female voiding patterns and may be considered the best tool to define bladder outlet obstruction on women.
压力流技术在男性中被认为是研究排尿过程的标准诊断方法，而在女性中仍在研究中。为了建立使用7F导管的女性膀胱出口梗阻列线图，已经进行了许多研究，但最近一份报告显示，7F导管可能会对女性的排尿过程产生不利影响。我们研究了4F尿道导管对接受压力流评估的女性的影响，以评估其在排尿过程中是否有任何有害影响。
我们评估了一个因下尿路症状前来就诊的85例患者的数据库。首先，所有患者均进行了自由尿流率测定，然后使用两根导管进行压力流研究：一根12F的用于充盈，一根4F的单J型导管用于测量逼尿肌压力。充盈后，我们移除12F导管，仅将4F导管留在尿道中进行压力流测定。由于流速与排尿量之间的正相关性已得到充分证实，我们仅选择了33例排尿前体积相似且差异小于30%的患者，并根据体积类别比较自由和插管后的流量参数，以加强统计分析。
在每组中，所有自由和压力流参数均无统计学差异。仅在排尿量在250至500毫升之间的组中，我们发现压力流排尿时间几乎比自由流排尿时间长，但无统计学差异（31.1±15对56.7±49.3；p = 0.05）。此外，我们未发现自由和插管后曲线形态有任何差异。
对于因下尿路症状接受压力流研究的女性，4F经尿道导管不会对排尿过程产生不利影响。这一发现对于解释女性排尿模式具有非常重要的临床意义，并且可能被认为是定义女性膀胱出口梗阻的最佳工具。
