Department of Female, Functional and Restorative Urology, University College London Hospitals NHS Foundation Trust, London, UK.
Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
Neurourol Urodyn. 2020 Jun;39(5):1371-1377. doi: 10.1002/nau.24347. Epub 2020 Apr 6.
Bladder outflow in women (bladder outlet obstruction [BOO]) has no well-accepted defining diagnostic criteria. Various nomograms exist based on flow rates, pressure-flow data, and fluoroscopy. We have prospectively evaluated the Solomon-Greenwell bladder outflow obstruction nomogram (SG BOO nomogram) as a measurement of BOO resolution following targeted surgical intervention.
The routine posttreatment urodynamics of 21 unselected women with an original urodynamic diagnosis of BOO on fluoroscopy and the SG BOO nomogram (BOO boundary defined as Qmax > 2.2 Pdet.Qmax + 5) were reviewed. All women had symptomatic BOO secondary to anterior pelvic organ prolapse (aPOP), urethrovaginal fistula (UVF), previous stress urinary incontinence (SUI) surgery, urethral stricture (US), or urethral diverticulum (U Div). Following treatment, all presenting symptoms resolved and simple urodynamics were performed as part of routine follow-up.
The urodynamic findings preoperatively and postoperatively showed statistically significant changes posttreatment in mean flow rate which increased from 9.38 to 14.71 mL/s, mean Pdet.Qmax which decreased from 38 to 18.38 cmH O, and mean SG BOO nomogram probability (PBOO) which reduced from PBOO = 0.68 to 0.08. Mean SG BOO nomogram PBOO was significantly reduced posttreatment in all individual categories except UVF where a nonsignificant reduction from PBOO = 0.55 to 0.05 occurred.
All urodynamic parameters significantly improve in women who become asymptomatic following surgical treatment of BOO. This improvement is best demonstrated by the change in probability of BOO according to the Solomon-Greenwell nomogram. These findings underline the validity of the Solomon-Greenwell female BOO nomogram for diagnosing and monitoring BOO in women.
女性膀胱出口梗阻（BOO）尚无公认的明确诊断标准。现已有基于流速、压力-流数据和荧光检查的各种列线图。我们前瞻性地评估了 Solomon-Greenwell 膀胱出口梗阻列线图（SG BOO 列线图）作为靶向手术干预后 BOO 缓解的衡量标准。
回顾了 21 例经荧光检查诊断为 BOO 的未选择女性的常规治疗后尿动力学检查结果和 SG BOO 列线图（BOO 边界定义为 Qmax>2.2Pdet.Qmax+5）。所有女性均因前盆腔器官脱垂（aPOP）、尿道阴道瘘（UVF）、既往压力性尿失禁（SUI）手术、尿道狭窄（US）或尿道憩室（U Div）而出现有症状的 BOO。治疗后，所有患者的症状均得到缓解，并作为常规随访的一部分进行了简单的尿动力学检查。
术前和术后尿动力学检查结果显示，治疗后平均流量显著增加（从 9.38 增加到 14.71ml/s），平均 Pdet.Qmax 降低（从 38 降低到 18.38cmH2O），平均 SG BOO 列线图概率（PBOO）降低（从 PBOO=0.68 降低到 0.08）。除了 UVF 从 PBOO=0.55 降低到 0.05 之外，所有个体类别在治疗后平均 SG BOO 列线图 PBOO 均显著降低。
所有女性的尿动力学参数在 BOO 经手术治疗后无症状时均显著改善。这一改善在根据 Solomon-Greenwell 列线图评估 BOO 概率的变化时表现得最为明显。这些发现强调了 Solomon-Greenwell 女性 BOO 列线图用于诊断和监测女性 BOO 的有效性。
