Valdevenito Juan Pablo, Mercado-Campero Alejandro, Olea Mauricio, Moreno-Palacios Jorge, Averbeck Márcio A
Department of Urology, Hospital Clínico Universidad de Chile. Santiago, Chile.
Department of Urology, Hospital Especialidades Centro Médico Nacional Siglo XXI, IMSS. Mexico City, Mexico.
Int Neurourol J. 2024 Dec;28(4):312-319. doi: 10.5213/inj.2448328.164. Epub 2024 Dec 31.
To compare voiding parameters in women with and without increased postvoid residual (PVR) volume, to correlate these parameters with PVR volume and PVR percentage, and to describe their ability to predict an increased PVR volume.
Retrospective cross-sectional study of urodynamics data prospectively acquired from consecutive symptomatic women over a 5-year period. Patients with spinal cord disorders and with abdominal straining during voiding (abdominal pressure ≥10 cm H2O over baseline at maximum flow rate [Qmax]) were excluded. Increased PVR volume was defined as ≥50 mL. Patients with and without increased PVR volume were matched by age, presence of urodynamic stress urinary incontinence and premicturition bladder volume. Female bladder outlet obstruction (BOO) index (female-BOOI), urethral resistance (UR), projected isovolumetric pressure 1 (PIP1), and relative BOO indexes (female-BOOI/PIP1 and UR/PIP1 ratios) were calculated. Linear regression analysis was applied to correlate the voiding indexes with PVR volume and PVR percentage. The area under the curve (AUC) of the receiver operating characteristic (ROC) analysis was calculated to describe diagnostic accuracy of these indexes for increased PVR volume.
One-hundred ten women with mean age 65.9±13.7 (range, 20-87) years were included. All voiding parameters were significantly different between women with and without increased PVR volume, except for PIP1. Female-BOOI showed the best correlation with increased PVR volume (R2=0.2509, P<0.001) and PVR percentage (R2=0.3677, P<0.001). PIP1 showed no correlation. Relative BOOI indexes did not improve these correlations. ROC curve analyzes confirmed that female-BOOI and UR had good ability to predict increased PVR volume (AUC=0.841 and AUC=0.856, respectively).
PVR volume and PVR percentage correlated with BOO but not to detrusor contraction strength parameters in symptomatic women that void without abdominal straining. The results of this study contribute to the understanding of the pathophysiology of increased PVR volume in women.
比较有无残余尿量（PVR）增加的女性的排尿参数，将这些参数与PVR量和PVR百分比相关联，并描述它们预测PVR量增加的能力。
对5年内连续有症状女性前瞻性获取的尿动力学数据进行回顾性横断面研究。排除脊髓疾病患者和排尿时腹部用力（最大尿流率[Qmax]时腹压比基线高≥10 cm H2O）的患者。PVR量增加定义为≥50 mL。有和没有PVR量增加的患者按年龄、是否存在尿动力学压力性尿失禁和排尿前膀胱容量进行匹配。计算女性膀胱出口梗阻（BOO）指数（female-BOOI）、尿道阻力（UR）、预计等容压力1（PIP1）以及相对BOO指数（female-BOOI/PIP1和UR/PIP1比值）。应用线性回归分析将排尿指数与PVR量和PVR百分比相关联。计算受试者工作特征（ROC）分析的曲线下面积（AUC），以描述这些指数对PVR量增加的诊断准确性。
纳入110名平均年龄为65.9±13.7（范围20 - 87）岁的女性。除PIP1外，有和没有PVR量增加的女性之间所有排尿参数均有显著差异。Female-BOOI与PVR量增加（R2 = 0.2509，P < 0.001）和PVR百分比（R2 = 0.3677，P < 0.001）显示出最佳相关性。PIP1无相关性。相对BOO指数并未改善这些相关性。ROC曲线分析证实female-BOOI和UR具有良好的预测PVR量增加的能力（AUC分别为0.841和0.856）。
在无腹部用力排尿的有症状女性中，PVR量和PVR百分比与BOO相关，但与逼尿肌收缩强度参数无关。本研究结果有助于理解女性PVR量增加的病理生理学。
