Department of Urology & Obstetrics and Gynecology, Yale University School of Medicine, New Haven, Connecticut, USA.
Department of Obstetrics and Gynecology, Loyola University Chicago, Chicago, Illinois, USA.
Neurourol Urodyn. 2024 Nov;43(8):2084-2092. doi: 10.1002/nau.25584. Epub 2024 Sep 12.
Uroflowmetry is often used to assess lower urinary tract symptoms (LUTS). Criteria for characterization of flow patterns are not well established, and subjective interpretation is the most common approach for flow curve classification. We assessed the reliability of uroflowmetry curve interpretation in adult women.
Uroflowmetry studies were obtained in 296 women who participated in an observational cohort study. Four investigators with expertise in female LUTS and urodynamics reviewed and categorized each tracing for interrater reliability. A random subset of 50 tracings was re-reviewed by each investigator for intrarater reliability. The uroflowmetry tracings were rated using categories of continuous, continuous fluctuating, interrupted, and prolonged. Other parameters included flow rate, voided volume, time to maximum flow, and voiding time. Agreement between raters is summarized with kappa (k) statistics and percentage where at least three raters agreed.
The mean age of participants was 44.8 ± 18.3 years. Participant age categories were 18-24 years: 20%; 25-34 years: 17%; 35-64 years: 42%; 65+ years: 18%. Nine percent described their race as Asian, 31% Black, 62% White, and 89% were of non-Hispanic ethnicity. The interrater reliability was highest for the continuous flow category (k = 0.65), 0.47 for prolonged, 0.41 for continuous fluctuating, and 0.39 for interrupted flow curves. Agreement among at least three raters occurred in 74.3% of uroflow curves (69% for continuous, 33% for continuous fluctuating, 23% for interrupted, and 25% for prolonged). For intrarater reliability, the mean k was 0.72 with a range of 0.57-0.85.
Currently accepted uroflowmetry pattern categories have fair to moderate interrater reliability, which is lower for flow curves that do not meet "continuous" criteria. Given the subjective nature of interpreting uroflowmetry data, more consistent and clear parameters may enhance reliability for use in research and as a screening tool for LUTS and voiding dysfunction.
Parent trial: Validation of Bladder Health Instrument for Evaluation in Women (VIEW); ClinicalTrials.gov ID: NCT04016298.
尿流率测定常用于评估下尿路症状（LUTS）。目前尚未明确用于描述尿流模式的标准，而主观解读是最常用的尿流曲线分类方法。本研究旨在评估成人女性尿流率曲线解读的可靠性。
本研究纳入 296 名参加观察性队列研究的女性患者的尿流率测定研究资料。4 位具有女性下尿路症状和尿动力学专业知识的研究人员对所有尿流率曲线进行解读，并对其进行分类，以评估观察者间的可靠性。每位观察者还随机复查了 50 份尿流率曲线以评估观察者内的可靠性。尿流率曲线的分类标准为：连续型、连续波动型、间断型和延长型。其他参数包括尿流率、尿量、最大尿流时间和排尿时间。观察者间的一致性采用 Kappa（κ）统计量和至少 3 位观察者一致的百分比进行总结。
参与者的平均年龄为 44.8±18.3 岁。参与者的年龄分组为：18-24 岁占 20%；25-34 岁占 17%；35-64 岁占 42%；65 岁及以上占 18%。9%的参与者自述为亚洲人，31%为黑人，62%为白人，89%为非西班牙裔。连续型尿流曲线的观察者间可靠性最高（κ=0.65），延长型为 0.47，连续波动型为 0.41，间断型为 0.39。至少有 3 位观察者一致的尿流率曲线占 74.3%（连续型占 69%，连续波动型占 33%，间断型占 23%，延长型占 25%）。观察者内可靠性的平均κ值为 0.72，范围为 0.57-0.85。
目前接受的尿流率曲线分类标准具有中等至良好的观察者间可靠性，不符合“连续”标准的尿流曲线的可靠性较低。鉴于尿流率数据的主观解读性质，更一致和明确的参数可能会提高其在研究中的可靠性，并作为 LUTS 和排尿功能障碍的筛查工具。
母试验：女性膀胱健康评估工具的验证（VIEW）；临床试验注册编号：NCT04016298。
